CARE HOME ADULTS 18-65
Lanrick Cottage 41 Wolseley Road Rugeley Staffordshire WS15 2QJ Lead Inspector
Jane Capron Unannounced Inspection 9th January 2006 09:45 Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 1 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 Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 2 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 Stationery 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. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lanrick Cottage Address 41 Wolseley Road Rugeley Staffordshire WS15 2QJ 01889 585262 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Services (UK) Ltd Mrs Maureen Holcombe Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: Lanrick Cottage is a three-bedded care home for residents with autism/severe learning disability who also have specialist communication needs. Care Services UK Ltd has owned it since November 2004 but there was no change to the staffing or the service provided. The home is situated on a main road leading into Rugeley. The home is set back from the road with parking for a number of cars at the front. The home has an attractive garden at the front and a secure garden at the rear providing opportunities for service users to use the garden. The home is in keeping with the surrounding area. It is well located to access the town centre resources and public transport. The home has its own transport. The accommodation is well maintained and attractively decorated. The home comprises of a lounge, dining room, conservatory, toilet and kitchen and one bedroom with ensuite downstairs and two bedrooms and bathroom upstairs. The home provides residents with the opportunity to undertake a range of independent living tasks such as helping in the house and undertaking shopping. The home has links with local colleges and also provides the residents with a range of leisure activities both in and out of the home. Residents go on holiday and out for day trips. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over a three-hour period. All the residents were present and were observed as part of the inspection. Two staff were on duty and discussions were held with them. The speech therapist was present and a discussion took place with her. A range of documentation relating to the care of the residents and to the running of the home was examined. Since the last inspection there has been no complaints made to the CSCI and no additional visits have been made. There has been no change in the management of the home. What the service does well:
The home was providing residents with a good level of service. Staff were fully aware of their role and the aims and purpose of the home. Staff were aware of the individual needs of the residents and were able to describe how each resident communicated their wishes and preferences. Staff had received the mandatory training as well as training in communication methods, autism and adult protection. The Care Manager provided additional training literature. The staffing level was able to meet the needs of the residents. The home was responding well to the individual communication needs of the residents. The residents and staff were supported through the involvement of a speech and language therapist. A range of methods had been developed including the use of signing and through the use of pictures. Specific tasks relating to developing skills in independent living had been produced in pictorial form. These included making drinks and crossing the road Residents were supported to undertake a range of independent living tasks and to participate in aspects of tasks associated with running the home. Residents assisted with keeping their bedrooms clean and tidy, meal preparation, laying and clearing the table, doing their laundry as well as developing menus and doing the weekly shop. Residents had a weekly schedule that reflected their individual needs and preferences. All residents were encouraged and supported to access the community although the level of involvement varied. One resident accessed college four days a week and all the residents assisted in delivering newspapers in the local community. One resident regularly went to a local pub and another went horse riding. The residents’ health care needs were being met and there was evidence of multi agency working taking place. The residents were supported by the District Nurse and specialist health care professionals.
Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 6 The relatives of residents reported as part of the home’s quality assurance survey that they were happy with the service and that the home effectively liaised with them and that they felt involved in their relatives’ care. 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. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 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 the following standard(s): 3 The home’s staff are fully aware of the individual needs of the residents and provide them with a service that meets their needs. EVIDENCE: The three residents have lived at the home since it opened and therefore there have been no admissions for a number of years. The home is able to meet the needs of the current residents and is designed to meet their specific needs. The home is fully aware of the specific individual needs of each resident. The home has links with health professionals and residents receive the necessary health care services both primary and specialist care. All the residents have specific communication needs and the home has the support of a speech therapist that visits monthly both to work with the residents and to provide advise and support to the staff. The home has well developed communication strategies using both singing and pictorial methods. All staff receive training in communication skills as part of their induction training. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 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 the following standard(s): 6,7,8,9 Whilst the staff on duty were fully aware of the individual needs of the residents the support plans did not fully demonstrate the needs and would not provide all the information necessary to meet the residents’ needs. The home had developed methods for consulting with residents and for encouraging and supporting them to make decisions and to have a role in participating in a range of tasks related to running the home. Whilst the home had developed a range of risk assessments and most had been reviewed there were areas that needed risk assessments in place to ensure that all the information was available to staff to provide residents with adequate support and to prevent any unnecessary restrictions. EVIDENCE: The home has put together individual support plans that cover a range of areas of need. However these need further development to fully identify all the individual needs of the residents and to identify the actions needed by staff to be able to fully meet each specific need. It would be beneficial for support plans to be based on person centred planning principles.
Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 10 The current support plans were being reviewed and the home completed an updated assessment for the external reviews held by the funding authorities. The home had developed plans to respond to issues relating to aggression and self-harm. The home operated a non-physical intervention policy. The residents were encouraged to make decisions over their lives. Their ability to make decisions varied but all residents were able to make their preferences known to some extent. Residents were observed choosing the time to get up and how to spend their time. They were provided with choice over food and drinks. They chose what to wear. The home had developed a range of communication techniques both to ascertain wishes and to aid in developing residents skills. Residents were encouraged and supported to participate in a ranger of domestic tasks. There were involved in making their beds and keeping their bedrooms clean and tidy. They assisted with laying and clearing the table, filling and emptying the dishwasher and some of the residents had some involvement in meal preparation. Residents were involved in meal planning and shopping. They used pictorial symbols to identify foods they liked and to put together a shopping list. Residents were involved in doing their own laundry. The home had developed a range of individual risk assessments. There were some gaps in the risks identified and assessed and although the home was aware of the risks and was taking the action these were not formally recorded in risk assessments. There was evidence that most risk assessments had been reviewed. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 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 the following standard(s): 11,13,16 The residents benefited from having the support to develop social, emotional, communication and independent living skills. The home supported residents to access the community providing them with a more varied and fulfilling lifestyle. The home provided flexible routines within a predictable environment, which both met the residents’ needs and provided them with choice and variety. EVIDENCE: The home worked with residents to develop their social, emotional, communication and independent living skills. Due to their specific conditions and needs the residents have little relationships with the other residents living individually in the home. Residents were supported and encouraged to show respect for others. They regularly went out into the community went into social situations. One resident went to the pub to play dominoes. All residents were supported to develop their communication skills and the home had the involvement of a speech therapist.
Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 12 The inspection included observation of the speech therapist working with residents and providing advice to staff. Staff used pictures both to aid decision making to assist residents to develop their skills. For example the process of making a drink and crossing to road had been put in a pictorial form. Residents were seen communicating using makaton. Staff received training in methods of communication as part of their induction process. The home was in the process of assessing each resident’s communication skills in order to update the individual communication plans. All residents were supported to undertake and develop a range of independent living tasks including shopping and doing household tasks. All the residents access the community to varying levels depending on their ability to manage these situations. One resident attended college four days a week. All residents had the opportunity to go out for trips and several went out shopping regularly. All residents accessed the community to attend for some primary health care services. Whilst the residents responded to predictable environment, flexibility within this was provided. Residents got up at a time they chose depending on each resident’s agreed schedule. They had their breakfast when they got up and had the opportunity to choose what to eat. Meals were taken within a time framework and residents where able to decide whether to eat with other residents or to eat alone. Residents chose when to go to bed. Residents chose what to wear. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 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 the following standard(s): 19,20 The health care needs of the residents were being met with evidence of multi agency working taking place. The medication procedures of the home were ensuring that medication was being administered correctly and was supporting the residents’ health care needs. EVIDENCE: The home met the health care needs of the residents. The health condition of the residents was clearly recorded and all medical appointments were recorded. The home supported residents to receive primary and hospital based health care services. Residents attended the dentist where possible, had medical and medication reviews. Residents had eye tests. Nail care was being attended to. The residents attended for specialist appointments when needed. The home had developed links with the epilepsy nurse who visited the home. The home had a medication procedure in place. Checks on the records showed that they were being completed correctly and that there were no unexplained gaps in the records. Medication prescribed, corresponded to that being administered. Medication was stored securely. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 14 All staff received training in medication and three staff were currently undertaking a comprehensive distance learning medication course. The home maintained records of medication received and that returned to the pharmacist. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 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 the following standard(s): These standards were not assessed on this inspection, the standards having being met on the last inspection. EVIDENCE: Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 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 the following standard(s): 24,28 The home’s accommodation was well maintained, decorated and furnished in a domestic manner providing residents with a homely place to live. The shared accommodation provided was suitable to meet the needs of the residents. EVIDENCE: The home was located set back from the road providing a front and rear garden with adequate parking facilities. The home was within walking distance of the centre of Rugeley. The home was well maintained and decorated and furnished in a domestic and homely manner. The home had been fully redecorated over the last year. The home provided suitable private and communal accommodation. All bedrooms were for single occupancy with one ensuite room on the ground floor and two bedrooms upstairs. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 17 The home’s communal rooms comprised of a lounge, dining room and conservatory. The home had a domestic style kitchen that was large enough to enable residents to assist with domestic and meal preparation tasks. The home’s laundry was located in the garage. There was suitable washing and drying facilities. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 The residents were benefiting from staff that were fully aware of their role and aware of the individual needs of the residents. Staff were receiving the training to provide a service able to meet the residents’ needs and should in the near future achieve the standard of having at least 50 qualified to at least NVQ 2. Training in person centred planning and risk assessing is recommended. EVIDENCE: The home’s staffing levels were able to meet the needs of the residents. There was a minimum of two staff on duty during the day. At times there were additional staff to provide extra support to assist residents to access the community. The staffing level allowed for flexibility in having staff on duty when all the residents were in the home and additional staff could be provided when needed. The home had one sleep in staff at nights. The staff on duty had both worked at the home for some time and were aware of their role and the aims of the home. They were fully aware of the individual needs of the residents. They were able to identify the communication methods used with residents and how independence was promoted and how residents were encouraged to make decisions. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 19 The home supported staff to undertake training relevant to their role. Of the seven staff employed three had obtained at least NVQ 2 and two were in the process of undertaking the qualification. Staff had in addition undertaken the necessary mandatory training as well as training in adult protection, medication, communication and autism. The residents may benefit from having staff trained in person centred planning and in risk assessing. New staff undertook induction training. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 20 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41,42,43 The home undertook reviews to assess its performance through a range of checks and through gaining the views of relatives thus providing residents with a home that was trying to develop its service. The residents were being supported and safeguarded by the home having the necessary p0lcies and procedures that were reviewed and updated. The home’s health and safety procedures were helping to protect and safeguard the residents. The residents were benefiting from a home that was effectively run with satisfactory management systems in place both internally and externally. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 21 EVIDENCE: The home had a quality assurance policy in place and undertook a range of quality assurance systems. These included a range of checks on the environment and on care practices. The home sought the views of relatives and the last responses showed that relatives were happy with the care provided to their relative and that the home maintained good contact with family members. The home had a development plan in place. The home had the necessary policies and procedures in place both for the support of residents and for the efficient and safe running of the home. These policies showed evidence of being reviewed. The home had a health and safety policy in place and procedures to support the policy. Servicing of equipment was being undertaken. The home had a current gas safety certificate and the electrical installation had been checked. Staff had received training in fire safety and the fire risk assessment had been reviewed recently. Fire checks had been completed. Staff had received training in moving and handling, food hygiene, first aid and health and safety. The home was being effectively run. The home was displaying the registration and insurance certificates. Quality systems were in place and external procedures were in place to monitor the home. The Registered Individual was visiting the home on a regular basis and was completing the necessary regulation 26 reports. The company was providing the necessary administration and financial support to the home. Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 22 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 Standard No Score 1 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 3 29 X 30 X STAFFING Standard No Score 31 3 32 2 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 4 2 X LIFESTYLES Standard No Score 11 3 12 X 13 4 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X X X 3 3 X 3 3 Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 23 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 YA6 YA9 Regulation 15 13(4) Requirement The ensure that support plans be developed to cover all needs of residents To further develop the individual risk assessments. Timescale for action 01/04/06 01/03/06 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. 3. 4. 5. Refer to Standard YA6 YA35 YA35 YA42 YA39 Good Practice Recommendations For support plans to be developed using the principles of person-centred planning. To consider training accredited through the learning disability assessment framework. To consider training in person centred planning and risk assessment. To provide infection control training to all staff To develop more formal systems for the review of quality Lanrick Cottage DS0000062392.V277109.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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