Inspection on 16/02/06 for Laura House

This inspection was carried out on 16th February 2006.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Laura House 13/01/09

Laura House 03/10/06

Laura House 06/10/05

Laura House 02/02/05

Laura House 23/09/04

Laura House 18/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Laura House Belmont Terrace Totnes Devon TQ9 5QB Lead Inspector Wendy Baines Unannounced Inspection 16th February 2006 9:30 Laura House DS0000003739.V283436.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 Laura House DS0000003739.V283436.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. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Laura House Address Belmont Terrace Totnes Devon TQ9 5QB 01803 866541 01803 847771 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) Robert Owen Communities Mrs Therese Annette Timberlake Care Home 16 Category(ies) of Learning disability (16), Physical disability (16) registration, with number of places Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: Laura House is a care home registered to provide care for sixteen service users with a learning disability who may also have a physical disability. It is situated close to the centre of Totnes, which is reached via steep roads. The premises are a detached, modern, purpose- built building, divided into three separate flats or houses. Houses One and Two accommodate service users with higher levels of needs and/or a physical disability. These are on one floor, with a full passenger lift to access other areas. House Three is a semi-independent unit for four people with accommodation on two floors, and its own external entrance. Service users are accommodated in single rooms. Each house has its own lounge, dining room, kitchen and adapted bathing facilities. Fifteen people only now live in Laura House, as two bedrooms have been converted to one to provide more spacious accommodation for a wheelchair user. Outside there are two enclosed lower ground floor patio areas at the rear, accessed from Houses Two and Three. The premises are built on a sloping site and access to the grassed area below the patios is via a steep ramp. There is limited parking at the front of the building Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the 16th February between 9.30 and 2.30. The Registered Manager Mrs Theresa Timberlake was present throughout the day. A tour of the premises took place and the inspector was able to meet with and observe the care being given to several service users. A sample of records relating to service users, staff and the running of the home were sampled, and the inspector was able to meet with all staff on duty. One agency member of staff gave a very positive account of working in the home and said that information provided is clear and consistent, which ensures that she is aware of how to support service users and meet their needs each time she works in the home. The atmosphere of the home was warm and welcoming. What the service does well: Laura House provides a good level of care and support for service users. New and current service users are provided with adequate information to make an informed choice about where they live and what services they receive. The home has been organised into three separate units and service users within these units have a similar level of care. Staff numbers are sufficient and staff have the skills to meet service users assessed needs. The homes admissions process ensures that the home can meet the needs of prospective service users. There is a clear and consistent care planning process, which provides staff with sufficient details about service users needs and how care should be delivered. Staff have a good understanding about service users rights and much consideration is given to enabling all service users to make choices about their lifestyle and care. Service users have access to a range of leisure and educational activities outside the home and much consideration has been given within the home to creating a stimulating, interesting and homely environment. The home has a good relationship with the Healthcare services and Specialist Learning Disability Team. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 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. Laura House DS0000003739.V283436.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 Laura House DS0000003739.V283436.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): 1.2.3.4.5. Current and prospective service users are provided with sufficient information about the home to help them make an informed choice about where they live. The homes admission process ensures that prospective service users know that if they move to the home their needs will be met. EVIDENCE: The Home has a Statement of Purpose, which describes the facilities and services provided. This information should include room sizes and information about staff qualifications and training. Information about the home is also available in signs, symbols and video. Since the last inspection the home has been undertaking Pre-admission assessments for someone who may move to the home. Information has been gathered from a range of sources including the family and care manager. Visits have been arranged, and a care-plan and risk assessment completed for the home. As part of the transition plan the home have arranged training sessions for the staff to ensure that needs of the service can be met. A statement of terms and conditions is completed for all new and current service users. The Registered Manager said that this information was being reviewed. Laura House DS0000003739.V283436.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): 6.7.8.9.10. The home has a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Service users are encouraged and enabled to make choices and have control over their lives. EVIDENCE: Service user plans were available covering all areas of need and included guidelines for staff. The detail within these plans varied dependent on the level of need, and type of support required. In addition Person Centred Plans are completed with the service user and highlight personal goals, wishes and aspirations. This information is held by the service user and is completed in a range of formats dependent on the needs of each individual. One service user had been supported as part of Person centred plan to complete a video looking at her needs and wishes relating to a possible move within the home. Staff spoken to gave many examples of how service users are encouraged and supported to make choices. It was recognised that this is easier for service users who are able to communicate verbally and much consideration had been Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 10 given to creating opportunities for all service users living in the home to have control over their lives. One member of staff said that the home was looking to use objects that one service user enjoys to touch, and to add familiar pictures of family, friends and places to these objects to help her communicate her needs and wishes. Risk assessments had been completed for all activities inside and outside the home. Records and discussion confirmed that service users who are more independent are able to make choices about their daily routines and lifestyle, but are given advice and guidance from staff about how to keep safe. Records confirmed that care plans are reviewed at least annually or every sixmonths and external agency’s are kept informed and involved of any significant changes. The home has an office where main records are stored and each house now has locked cupboards to store care-plans, charts, and daily communication books. Laura House DS0000003739.V283436.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): 11.12.14.15.16. Service users are encouraged and supported to participate in community, social and leisure activities and to maintain contact with family and friends. Service users rights are respected and responsibilities recognised in their daily lives. EVIDENCE: Details about arrangements for activities and leisure are available for each service user. This information was available in a range of formats dependent on need. The Registered Manager explained that for some service users this information is provided in writing and is flexible dependent on the wishes of the individual. For others details of activities may need to be in picture/symbols format and clearly outlined on a weekly timetable. Examples of this information were seen throughout the day. Service users attend a range of leisure, work and educational opportunities, these include; college placements, day centres, work opportunities, including working at a farm on the outskirts of Totnes. Throughout the inspection service users were seen going out with staff, returning from activities and relaxing in the home. All service users have an annual holiday and the plans and destination are agreed as part of the individuals Person Centred Plan. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 12 Within the home much consideration has been given to creating a stimulating, interesting and homely environment. Some service users were spending time in their bedrooms with sensory equipment, soft lighting and relaxing music. Discussion and records confirmed that the home supports and encourages service users to maintain links with family and friends and any restrictions are agreed and documented. Throughout the day staff were observed knocking on service users bedrooms and responding sensitively and respectfully to there needs and requests. Laura House DS0000003739.V283436.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): 18.19.20. Personal support in the home is offered in a way that promotes and protects service users’ privacy, dignity and independence. Service users health care needs are regularly monitored and any changes are addressed with specialist input when necessary. EVIDENCE: Service users health care needs are assessed and medication is reviewed regularly. Some service users have profound physical, learning and communication difficulties and this level of need is reflected in the detail of information available to staff. Moving and handling plans and risk assessments were seen. There are designated key-workers to provide continuity of support. Staff spoken to demonstrated a good understanding of service users needs and their preferences about how they like support to be delivered. Staff spoken to said that they continue to explore ways of supporting service users to make choices about their care when they are not able to communicate verbally. A range of daily health charts are completed and handover meetings and daily diaries are used to monitor any changes. The district nursing service and specialist learning disability team visit the home regularly and offer advice and support regarding specific individuals and consistency issues. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 14 The inspector did not check all medication procedures on this occasion, however, since the last inspection arrangements have been made to ensure that all keys to medical cabinets are stored securely. Laura House DS0000003739.V283436.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): 22.23. The Registered Provider responds to complaints promptly using the homes Complaints procedures, and takes seriously any concerns made in relation to the home and service users. The homes policies and procedures protect service users from abuse, selfharm and injury. EVIDENCE: The home has a written complaints procedure. The Registered Manager said that since the last inspection the home has dealt with two complaints made by a relative of a service user. This information had been documented and was available for inspection. Records confirmed that the home had responded to the complaint using their procedures and had written to the complainant advising them of an internal investigation. At the time of the inspection the investigation was on going and the home had continued to keep the complainant and care manager informed of progress. Daily records, person centred plans, handover meetings and service user meetings are all used to ensure that service users can express their opinions and advise staff of any concerns. Records and risk assessments confirmed that the home recognises the importance of service users having access to the complaints procedure, 1:1 meetings with key-workers and advocacy input. There is an adult protection procedure and the locally issued Alerters guide for staff reference. Staff receive training in adult protection. Records and discussion confirmed that clear guidelines are available to staff to deal with and manage episodes of difficult behaviour and/or aggression. Risk assessments and individual records included lone working and missing persons’ procedures. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 16 The Registered Manager was very aware of the need to involve other agencies when dealing with difficult situations and all incidents were documented. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 17 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): The standard of the environment within this home is good providing service users with an attractive, homely and safe place to live. EVIDENCE: The premises are purpose built to cater for service users with arrange of needs, from those who are semi-independent to those with profound physical, learning and communication difficulties. The home has been arranged into three separate units/houses each with their own lounge/dining area, kitchen, bathrooms, toilets and patio. The unit for service users who live more independently also has a separate entrance. There are two patio areas, but outside space is limited. Service users also have the use of an activities room within the main part of the house. Several service user bedrooms were seen throughout the inspection and these contained many personal items and adaptations to meet individual needs. Much consideration has been given to making the environment stimulating, interesting and homely. Signs, symbols and photographs had been used to assist service users with communication difficulties and several individual bedrooms and bathrooms contained a range of sensory equipment. Suitable equipment is provided for service users with physical disabilities’, including adapted bathing facilities, overhead tracking hoists, mobile hoists, Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 18 slings and lifts. An OT assessment had been completed and information about the use of specialist equipment was documented within service user plans. Each unit/house has a daily cleaning plan, and the home was found to be clean and hygienic throughout. Wash hand basins, gloves, and other cleaning equipment were available to ensure the control of infection. The Registered Manager said that since the last inspection the home has had a full building survey, and any recommendations made will be addressed as part of the homes on-going maintenance plan. Arrangements had also been made for checks of all electrics and two of the service users bedrooms had been decorated. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 19 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): 31.32.33.35.36. Staff are sufficient in number, and have the skills and attitudes to ensure that service users needs are sufficiently met. EVIDENCE: Each of the three separate units/houses within the home has their own staff team. The number of staff is dependent on the level and type of support needed and staffing levels are kept under review. Records and discussion confirmed that the home had recently reviewed staffing levels due to the changing needs of a service user and to ensure the safety of all those living in the home. The staffing rota was available for inspection. There are two waking night staff and one on-call sleeper. All staff spoken to were very aware of service users needs and were able to give a clear and detailed account about how care and support should be delivered. Staff demonstrated a good understanding of issues relating to service users rights, choice and independence. Agency staff spoken to said that information is clear and accessible and that they are treated as part of the staff team. The home has a staff- training plan. The LDAF framework is used within the home and all staff are undertaking an NVQ qualification. All staff complete statutory health and safety training as well as specialised training which includes; Total Communication, POVA, Epilepsy and Autism awareness. The Registered Manager said that the home has good links with the Health services Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 20 and specialist Learning disability team who often come to the home to offer training events and general advice. Formal 1:1 staff supervision sessions take place every six weeks and this information is documented. Three members of the management team have completed supervision training. The Registered Manager demonstrated a good understanding of the need for supervision and said that staff working very closely with service users needed time to discuss their role and to raise any concerns. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 21 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): 37.38.40.41.42. Service users and staff benefit form an open, inclusive and positive style of management. The manager is supported well by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The Registered Manager Mrs Theresa Timberlake is a qualified nurse and has completed the Registered Managers award. Throughout the inspection the atmosphere in the home and between staff and management was open, positive and supportive. Since the last inspection there has been a reorganisation of the management structure within the home, and this now consists of the Registered Manager and two Generic Deputy Managers overseeing all three units. There are comprehensive systems for Health and Safety management, record keeping, policies and procedures. There are risk assessments of the environment and evidence that these are reviewed regularly. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 22 Staff receive mandatory training in fire safety, first aid and safe working practices. The registered manager had recently completed an Infection control audit and reviewed all policies and procedures. Several door wedges were found around the home holding fire doors open. The Registered Manager must ensure that the use of door wedges ceases and appropriate hold open devices are fitted if required. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 23 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 X 3 3 2 X Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 24 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 YA42YA42 Regulation 12/13 Requirement The Registered Provider must ensure that the use of door wedges ceases and advice should be taken from the fire officer regarding fire doors and hold open devices. Timescale for action 01/04/06 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. Refer to Standard YA1 Good Practice Recommendations The statement of purpose should include the room dimensions and information concerning staff currently employed including their qualifications. Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Laura House DS0000003739.V283436.R01.S.doc Version 5.1 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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