Inspection on 04/08/05 for Lancaster House

This inspection was carried out on 4th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lancaster House 11/04/07

Lancaster House 11/01/06

Lancaster House 11/10/04

Lancaster House 28/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Lancaster House 3, Lancaster Place Blackburn Lancashire BB2 6JT Lead Inspector Jane Craig Announced 04 August 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lancaster House Address 3, Lancaster Place Blackburn Lancashire BB2 6JT 01254 681243 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Marilyn Clarke Mrs Marilyn Clarke Care Home Only Personal Care (PC) 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) 5 of places Mental disorder, excluding learning disability or dementia - over 65 years of age (MD)(E) 1 Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 1 (One) named service users requiring personal care within the category of MD (E). Date of last inspection 11, 12, and 13th October 2004 Brief Description of the Service: Lancaster House forms part of the Almond Villas Group and is registered to provide 24hour accommodation and rehabilitative support for 6 adults with mental health needs. The home is registered to provide personal care for 5 adults aged between 18 and 65 and one person over the age of 65. Service users generally move to Lancaster House from Almond Villas. Whilst the emphasis is on longer term care and support, service users are still encouraged and supported to develop independent living skills. Lancaster House is a large terraced property situated in a residential area close to Blackburn town centre. The house has a small front garden and a rear yard with a patio area. Parking is on the road. A bus stop, local shops and other amenities are within easy walking distance. The ground floor comprises two lounges, a kitchen and separate laundry room. Six single bedrooms and a shared bathroom are on the first floor. The offices and staff facilities are on the third floor. A second bathroom for the use of service users has also been added to this floor. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which meant that the residents and staff were told beforehand when the inspector would be visiting. The inspection took place over a half day. At the time there were 6 residents accommodated in the home. The inspector met with all six residents and spoke at length to three. Wherever possible they were asked about their views and experiences of living at Lancaster House and some of their comments are quoted in this report. Comment cards had been sent out to residents and visitors prior to the inspection. 5 were returned, all with positive comments. During the course of the inspection discussions were held with the registered provider, four other members of the management team, a member of staff and the keyworker for Lancaster House. A partial tour of the premises took place and a number of documents and records were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: The process for assessing and admitting new residents was very thorough. Staff from the home had several meetings with the prospective resident and other people involved in their care. This ensured that staff fully understood the resident’s needs before they were offered a place. The prospective resident also visited Lancaster House and had overnight stays before they made a decision whether the home was right for them. Staff were very good at writing care plans. The plans made sure that the resident’s needs were identified and gave staff very clear directions as to how they should provide assistance. Staff had good opportunities for training. New staff went through a thorough induction programme, which helped them to understand the needs of the residents and to learn how to give the right support. Staff said that they were encouraged to attend any courses that would help them in their work with residents. Staff helped residents to find appropriate ways to spend their time. Residents said they always had lots to do either with voluntary work, college or going out. Residents and staff got on very well together which helped to create a good atmosphere in the home. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 and 5 There was an excellent admission procedure, which ensured that staff had a clear understanding of the resident’s needs and how they were to be met. Prospective residents had ample opportunities to visit the home, which helped them to make a decision about whether the placement was suitable for them. EVIDENCE: Residents were usually admitted to Lancaster House from Almond Villas. Staff had access to all care records from Almond Villas before a decision was made as to whether the resident’s needs could be met at Lancaster House and a move would be beneficial to the resident’s ongoing programme. Residents were fully involved in the decision to transfer. In cases where residents were admitted directly to Lancaster House there was an extensive pre-admission assessment process, which often took several months to complete. Residents from Almond Villas were usually familiar with the staff and residents at Lancaster House but only made a decision to move to the home after a series of visits and short stays. All files seen contained a statement of terms and conditions of residency, which included a signed agreement from the resident. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 The care planning process was very good. It enabled residents to be involved in setting their own goals and ensured that staff were provided with clear and detailed information to help residents to meet their needs. The risk assessment and management framework supported residents to take responsible risks and work towards independent living. EVIDENCE: On admission residents completed a care plan assessment with their keyworker. The assessment identified the resident’s perspective of their strengths, needs and goals and covered all aspects of their past and present situation. Initial care plans were drawn up from this information. Care plans contained very detailed directions as to how the resident’s needs were to be met and by whom. Where residents were unable to be involved, staff indicated how the information had been obtained and agreed. Plans were reviewed and updated as and when any changes occurred and all residents had a formal, multi-disciplinary review at least every six months. One resident described how his plan was discussed and agreed during a multi-disciplinary review. Not all plans were signed by the member of staff involved in drawing them up. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 10 There was a policy on risk taking and risk management. All files contained risk assessments and detailed risk management strategies specific to the resident. Staff talked about how risks were introduced on a gradual basis. Each step was assessed and discussed with the manager and other staff. Residents were fully involved. One resident talked about how staff were helping them to work towards making a long journey on their own. Residents said the few limitations or restrictions made for their own safety. They gave examples of restrictions on alcohol and avoiding certain areas at night. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 16 and 17 Residents were provided with very good opportunities to engage in a wide range of appropriate activities and were supported to use community facilities. The home’s policies and staff practices ensured residents’ rights were upheld. Residents were supported to choose, plan and cook meals to increase their independent living skills. EVIDENCE: Residents drew up a weekly programme with their keyworker. One resident said “we get a copy so we don’t forget what we are doing.” Each programme included a wide variety of therapeutic and leisure activities designed to help the resident to develop skills and move towards independent living. Residents were very positive about their programmes. Two residents talked about their part time jobs in a charity shop, one went to a day centre and another was taking a college course. Two residents were involved in other voluntary work. One resident talked about joining the task group at Almond Villas and how she had learnt to do new things. All residents were encouraged to use community facilities, either independently or with staff. One resident said “we go out together one evening a week and every month go out for an evening meal to Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 12 try different places”. Residents usually joined residents from Almond Villas once a week for a group leisure activity. Residents talked about day trips and a recent holiday. One resident belonged to the service user forum that had been established since the previous inspection. The aim of the group was to participate in some management decisions and take a role in the development of the service. Residents said that routines were flexible and what time they got up depended on what they were doing. One resident said “there is no getting up time but everyone has a job to do in the morning”. Domestic tasks were rostered and residents said this worked well. Residents said there was a 10.30 curfew but they can stay out if they let staff know. Staff spoke about residents respectfully. They were very aware of residents’ rights and said that part of their role was to ensure that they were upheld. Residents said that staff always respected their privacy. Residents said that they had just started a new way of working at mealtimes. One talked about having more input into making meals to help them when they moved to their own place. Staff said they assisted residents who were less able and made sure that everyone had a varied and healthy diet. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Residents’ personal and healthcare needs were clearly identified and met by staff, with support from the multi-disciplinary team. Staff handled and administered medication in accordance with robust policies and procedures. However, the lack of assessments for residents who self medicate may result in risks not being identified or appropriately managed. EVIDENCE: There were detailed plans for residents who required assistance with personal care and personal safety. Directions for staff were very clear and included details about language to use and how to provide assistance. There had been improvements in the way residents’ physical healthcare needs were recorded. All residents had a care plan with regard to health care checks or monitoring of ongoing physical health needs. Plans contained information about appointments and one resident said that staff always reminded her when she had to go to the hospital or the doctors. Residents’ mental health care needs were thoroughly monitored and they all had very detailed care plans. All residents had regular contact with other health and social care professionals. There was a full set of policies and procedures relating to medication. Storage, administration procedures and disposal of medicines were appropriate. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 14 Residents were encouraged to self administer where able. One resident said, “I do everything myself with staff watching me but I’ll be on my own soon.” There were care plans to support self medication but there were no initial risk assessments as to the resident’s ability and safety. There were a some gaps on medicine administration records (MAR) sheets and handwritten MAR sheets were not signed or witnessed. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents knew how to make a complaint and were confident that their concerns would be dealt with appropriately. Staff had a thorough understanding of adult protection issues ensuring that any allegations would be dealt with appropriately. EVIDENCE: Residents had a copy of the complaints procedure in their rooms. The procedure contained all the relevant information. Appropriate records were kept of any complaints, investigations and outcomes. There had been no complaints to the home or directly to the Commission in the last year. Residents said they knew who to go to if they had any concerns. One said, “I would go to a member of staff, they are all good.” Another said that he had raised a problem with his keyworker during a one to one session and he had been helpful about how to sort it out. Staff received training in the protection of vulnerable adults during their induction and were provided with updates. Appropriate guidelines and procedures for recognising and reporting abuse were available. Staff spoken with understood protection issues and were clear about their roles and responsibilities in reporting allegations. One member of staff talked about the whistle blowing policy. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 and 30 Residents were satisfied with the furnishings in their bedrooms, which reflected their individual tastes. The standard of cleanliness and hygiene was satisfactory. EVIDENCE: Residents were happy with their rooms. One said, “it’s alright living here, I have everything I need in my room.” Two other residents said their rooms were “fine.” The rooms seen were personalised to a high degree and reflected the resident’s individual taste. The home was clean and tidy at the time of the inspection. Residents’ responsibilities for domestic tasks were included in their activity programmes. Domestic style laundry facilities were provided in a separate utility room. Where able residents did their own laundry or were supervised by staff. Induction training for staff included hygiene and infection control and there were written guidelines for reference. Staff said they passed on basic hygiene and infection control guidance to residents as they worked with them. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34 and 35 Recruitment policies and practices provided safeguards for residents. Staff had access to a variety of training which increased their knowledge and understanding of the needs of the residents and assisted them to fulfil the responsibilities of their roles. EVIDENCE: There were robust recruitment policies. Residents involved in the service user forum assisted with interviews of new staff. The file of one new member of staff demonstrated that appropriate pre- employment checks were carried out. Staff files contained the required documents and information. All the residents said they got on very well with staff. One resident said “they’re all brill,” other comments included, “very good”, “caring” and “friendly.” There was an excellent induction and foundation training programme that exceeded the national training organisation specifications. The programmes comprised five topics and included a mix of guided reading, workshop attendance and 1:1 time with a mentor. There was an assessment of competency at the end of each topic. Experienced staff had been through the programmes as refresher training. One member of staff said the programmes were “a good package and worth doing.” Staff also had access to a variety of in-house and external courses relevant to the resident group. 38 of care staff were trained to NVQ level 2 or above. The management team discussed Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 18 that a high proportion of the current NVQ syllabus did not equip staff to work with the residents at Lancaster House. Specific mental health units are due to be introduced in the near future and the uptake is expected to be higher at that stage. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40 and 42 Policies and procedures were up to date and safeguarded the rights and best interests of the residents. Health and safety training, practices and written procedures safeguard the health, safety and welfare of the residents and staff. EVIDENCE: There was a full set of policies and procedures that were reviewed annually. Following a recommendation from the previous inspection, a policy on physical interventions had been developed. Staff had clear guidance on managing aggression and de-escalation techniques. The service user forum was to be involved in developing policies in the future. Staff training in safe working practice topics was up to date. The annual fire training should include some instruction on fire prevention. Regular fire drills were carried out with the full involvement of residents. There was a full set of health and safety policies, guidelines and risk assessments. Some potentially hazardous substances were accessible to residents. Risk assessments for these products must be reviewed whenever a new resident is admitted to the Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 20 home or if there are any changes in residents’ individual risk assessments that indicate the potential for misuse. Maintenance and servicing of electrical and gas systems and other equipment was up to date. Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x 3 x x x 3 Standard No 11 12 13 14 15 16 17 x 4 4 4 x 3 3 Standard No 31 32 33 34 35 36 Score x 2 x 3 4 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lancaster House Score 4 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x 3 x 2 x F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 20 42 Regulation 13(2) 13(4)(a) Requirement Risk assessments must be carried out with residents who wish to self medicate. Risk assessments must be carried out with regard to the storage of potentially hazardous items in parts of the home accessible to residents. The assessments must be updated as new residents enter the home. Timescale for action 31/08/05 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 6 20 Good Practice Recommendations Care plans should be signed by the member of staff involved in drawing them up. Handwritten MAR charts should be signed and witnessed. MAR charts should include reasons why medication has not been administered. 50 of care staff should be trained to NVQ level 2 by December 2005. 3. 32 Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lancaster House F57 F07 S5804 Lancaster House V230490 030805 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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