CARE HOME ADULTS 18-65
1, Lansdowne Road Bedford Beds MK40 2BY Lead Inspector
Katrina Derbyshire Announced 24 May 2005 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. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 1, Lansdowne Road Address Bedford Beds MK40 2BY 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) 01234 357339 Lansdowne Care Services Vacant care home 14 Category(ies) of LD - Learning Disability registration, with number PD - Physical Disability of places 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd March 2005 Brief Description of the Service: 1 Lansdowne Road is a large three-storey house in a residential area of Bedford. The registered provider is Lansdowne Care Services. The home is within walking distance of the town centre and all the amenities on offer, these include shops, pubs, places of worship, parks and clubs. Access to bus and rail services are also within walking distance of the home. Care and support can be offered to fourteen young adults with a learning disability. The aim is to provide service users with the support and enviornment to promote their independence. Accommodation is provided across three floors. Thirteen rooms offering individual accommodation is available within the main building, alongside a self contained one bedroom flat at the rear of the home. In addition the home provides a lounge, dining room, quiet room and games room. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out on 24th May 2005. The Acting Manager, Ms Liz Lynes was present throughout. During the inspection several areas of the home were visited and the inspector spent time with many of the residents in the lounge and their own individual rooms. The care of three residents was examined in depth by looking at their records and interviewing the residents and staff who look after them. What the service does well: What has improved since the last inspection?
Residents explained that the previous manager and two staff had left. The home has appointed an acting manager who will soon be applying to be registered, this means that she intends to stay at the home for a while. Several of the residents commented that “she is nice” and staff spoke of her commitment to improving the care at the home. The home is also working very hard to appoint new staff and they were waiting for one member to start work very soon. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 6 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. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 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 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 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) 1 & 2. The assessment of residents needs is comprehensive and of a good standard, this ensures the home can meet the needs of the residents. EVIDENCE: The statement of purpose at the home was clear and contained all the information needed, so that residents would know about the staff and all the services the home could offer. A copy of this document was available in the home. Staff confirmed that they were aware of its purpose and contents and residents were also aware of that it was available. Assessments within the care files of residents were very detailed and showed that the physical, social, emotional and spiritual needs of residents had been assessed. Reviews were held on the residents, minutes of these meetings are kept and the views of the resident formed a large part of the outcome of each review. Residents are given the opportunity to express what it is that makes them happy and the staff support them in achieving this. Several of the residents explained how they are involved in planning their care both inside the home and whilst on their day care placements. One resident said “ my music, l like my music it makes me happy”, and the keyworker had supported the resident in the purchase and maintenance of their individual music collection.
1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 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, 7 & 8. The care planning system in place is clear and consistent and provides staff with the information that they need to satisfactorily meet the resident’s needs. EVIDENCE: The home maintains care plans on each of the residents; each care plan is directly linked to the assessments undertaken so that there is a plan in place, for each assessed need. Care plans set out any rehabilitation plans or communication development for the resident, and were clear in any restrictions on choice or freedom in place following a detailed risk assessment. Residents were aware of the care plans and spoke of their involvement supported by staff in their development. The home uses both formal and informal methods for supporting the residents in making personal decisions about their lives. Home meetings are held so that residents are enabled to voice their opinions; records of these are maintained alongside the action taken by the home in response to the residents. Opportunities to make day-to-day decisions were also seen to take place, for example residents were given the choice on what time they wanted their tea, what they would like to do in the evening and if they wanted to spend time alone in their individual rooms or join other residents in the communal areas.
1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 10 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 & 17. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices. EVIDENCE: Residents participate in a variety of daily activities. One resident spoke of their work placement at a local charity shop and how enjoyable they had found this; several other residents spoke of their attendance at various day centres. Plans were kept within the individual care files of the resident to guide and direct staff on how to support the resident in their chosen educational and development plan. Both residents and staff also spoke of the local resources that were used by the home, examples included shops, pub and cinema. Residents had a good knowledge of the local community and staff ensure that residents are kept involved with local opportunities through sharing information from the local paper on entertainment and possible excursions. Two residents did speak of their concern that an annual holiday had not yet been planned; as they understood there was no staff to take them. The Acting
1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 11 Manager confirmed that no holiday had been planned, the need to keep residents up to date is needed and an explanation given as to why a holiday had not been arranged. Mealtimes at the home are divided into two sittings for the residents; each resident was seen to be given the choice by staff on what time they wished to eat their evening meal. The menu within the home showed a varied and balanced diet was offered with fruit and vegetables, and resident’s participated in choosing the menu options. Several of the residents said that they enjoyed the food at the home and that it was of a good standard. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 12 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. Personal support is offered in a way that promotes and protects resident’s privacy, dignity and independence. EVIDENCE: Staff were seen to encourage and support residents in a respectful and individual way in accordance with their wishes. The individual needs of the residents were detailed in their care plan and for example explained the times of rising or going to bed so that staff could ensure continuity of care. A system is in place to monitor and make sure that all residents receive any required healthcare. Documents showed that the home keeps records of all appointments attended and the outcome of these, in addition the records showed that the home always acted promptly in securing the services of a healthcare professional if needed. Residents had regular access to opticians, primary healthcare teams, dentists and routine screening. Staff always accompanied residents to outpatient appointments if needed, and reviews with their relevant Doctor. Staff confirmed that each keyworker had a responsibility to make sure all health checks for each resident were kept up to date. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 13 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. The home has a satisfactory complaints system in the home, with some evidence that residents feel their views are listened to and acted upon. EVIDENCE: Both residents and staff were aware of the complaints system in the home, staff described the rights of the residents and how they can complain about the care they receive. The complaints procedure was clear and explained to whom the residents could talk to including the Commission for Social Care Inspection. Complaints would be responded to in a prompt manner, the Acting Manager was able to explain how the home would respond and record all concerns and complaints received. Residents also confirmed that they knew they had the right to complain, and that they had the right to have their concerns and complaints listened to and acted upon. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 14 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) 24, 25 & 28. The environment is clean and recent decoration in some areas result in a warm and homely environment for the residents. EVIDENCE: The home was clean and tidy throughout and offers communal living space alongside individual rooms. Furnishings and fittings are domestic and the use of photographs and ornaments assist in the creation of a homely environment. Several of the resident’s bedrooms were seen, each contained personal items and was decorated and arranged to reflect the residents’ own choice. All the resident’s who spoke about his or her individual rooms were very positive, each resident said that they were able to have a music system or television in their room if they wished. Communal areas in the home provide a sitting area, dining area and games area. Residents were also seen to access the kitchen in the home and had unrestricted access throughout the home, including the rear garden area. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 15 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) 31 & 33. The staff have a good understanding of the residents support needs. This is evident from the positive relationships, which have been formed between the staff and residents. EVIDENCE: Staff members have a job description, which is issued prior to commencement of their employment. This document makes very clear the responsibilities of the staff member and to whom they report to. Through discussion with staff it was confirmed that they had a very good knowledge of the resident’s needs, and how they can help them to achieve their goals. Staff were very committed to their keyworker role, one resident said of their keyworker “ l don’t know what l would do without her she has become my friend as well”. Staff were seen to work together in a coordinated manner, and communication between them and the residents was very supportive. Several staff did comment that at times the home was not able to cover the rota due to staff shortages, this could then impact on the amount of support given to residents in pursing their chosen social activity. The home had actively been seeking to appoint new staff to remedy this situation and was awaiting the commencement of one new member of staff. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 16 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 & 42. The homes policies and procedures are comprehensive and easy to understand in their guidance, this means staff are clear on the homes protocols and continuity of care for residents is maintained. EVIDENCE: Records are maintained within the home in a secure area, and staff were aware of their responsibilities relating to the Data Protection Act 1998. The home had a range of policies and procedures and a sample of these were seen, all were up to date and reflected current best practice guidance. Health and safety training had been arranged and staff had attended courses in the following areas, fire, food hygiene and first aid. Annual checks required by health and safety legislation had been undertaken and the home maintained documentary evidence to support this. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 17 However following an inspection by the local Fire service a recommendation had been made to carry out some work on a bedroom door, this was noted not to have been completed and is a requirement following this inspection. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 18 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 3 x x 4 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x 3 x x Standard No 11 12 13 14 15 16 17 x 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score 3 x 4 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
1, Lansdowne Road Score 3 4 x x Standard No 37 38 39 40 41 42 43 Score x x x 3 x x 2 I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 19 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. Standard YA42 Regulation 12(1)(a), 13(4),23 (4). Requirement The fire works on the bedroom door must be carried out in accordance with the Fire Services instructions. Timescale for action 30/10/05. 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. Refer to Standard YA12 Good Practice Recommendations Residents should be told why an annual holiday has not been arranged, and offerred the reasons why, if there will not be one available. 1, Lansdowne Road I51 S14924 1 LANSDOWNE RD V215063 240505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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