Inspection on 07/09/05 for Lavender Fields (1)

This inspection was carried out on 7th September 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

Lavender Fields (1) 17/05/07

Lavender Fields (1) 10/02/06

Lavender Fields (1) 31/03/05

Lavender Fields (1) 01/03/05

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

CARE HOME ADULTS 18-65 Lavender Fields 1 Lavender Fields Lucas Lane Hitchin SG5 2JB Lead Inspector Louise Bushell Unannounced 07.09.05 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. Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lavender Fields Address 1 Lavender Fields Lucas Lane Hitchin Hertfordshire SG5 2JB 01462 452460 01462 440186 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) Leonard Cheshire Elizabeth Turton Care Home with Nursing 10 Category(ies) of PD Physical Disability - 10 registration, with number of places TI Terminally ill - 10 Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home may only accommodate service users between the ages of 16 and 24. Date of last inspection 31.03.05 Brief Description of the Service: Number 1 Lavender Fields is a newly completed, purpose built care home with nursing, registered to provide care and accommodation for up to 10 young physically disabled people between the ages of 16 and 24 years. It is owned and operated by the Leonard Cheshire organisation. The young persons unit is part of a social care complex which sits in its own landscaped grounds close to the town centre of Hitchin, with its shops, transport and social amenities. The home is built on one level and comprises two wings with large bedrooms, each with full en-suite facilities and access to a patio area overlooking the grounds. There is a communal lounge, kitchen and dining room and a large study/activity room that includes an information technology suite. Lavender Fields is intended to provide a transitional service supporting, encouraging and equipping young people to gain the life skills and confidence they need to enable them, where appropriate, to move on to more independent living settings. Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Where information has remained the same following the last inspection, this has been carried forward to this report. This unannounced inspection was conducted on a weekday morning. The home was running smoothly, with a relaxed and positive atmosphere. This was a very positive inspection. Staff numbers were adequate. The purpose-built premises provide a very comfortable environment for service users, with a commendable level of equipment and facilities. Not all the service users were at home during the inspection, however all those who spoke with the inspector were most positive about their lives in the home, the attitudes and commitment of staff and the opportunities they had to develop their skills and confidence before they move on to more independent living. What the service does well: There are many areas throughout the inspection, in which the home does well. Care plans were seen to be very individualised and centred in the promotion of individual rights and choices. The home presents as a homely, clean, cheerful environment for the staff and the service users. Involvement in the running of the home, by the service users is empowered and encouraged. The gardens of the home are well maintained and promote service user independence whilst presenting as a relaxing space. Many positive comments were received from the service users at the home concerning the general standards of living, the food, the staff and the activities provided / support provided to encourage engagement. Minibus vehicles are available within the home for the service users and independence and enhancement of independent living skills are always encouraged. Following discussions with a number of service users and through the homes detailed policies and procedures, it was determined that the referrals and admission procedure to the home is person centred and that in working practice empowers and enables the choices and the rights of the service users. Lavender Fields I52_s58611 Lavender Fields v233603 070905 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. Lavender Fields I52_s58611 Lavender Fields v233603 070905 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 Lavender Fields I52_s58611 Lavender Fields v233603 070905 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, 3, 4 & 5 The Service Users Guide and Statement of Purpose are comprehensive and informative documents for service users to determine and make positives choices within the their lives about where to live. EVIDENCE: Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 9 The Statement of Purpose, Service User’s Guide and individual contracts fully meet the requirements of this set of standards. All documents can be made available in alternative formats including audiotape where this is necessary. The Service User’s Guide makes good use of symbols and line drawings to make it clear and accessible. A full assessment is always completed prior to admission. Copies of these were available for inspection. Each service user has a detailed individual service plan covering all aspects to meet the standard. The care plans in place are good working examples of service users choices and independent living skills being empowered and supported, with clear aspirations and individual goals identified. Service users’ files contain ample evidence of the involvement of specialist services for service users where required. Staff make use of Delta talker and Bliss, an internet-compatible communication system to support and encourage effective communication with the service users. Time was spent with a particular service user using a Delta Talker, feedback determined that he feels that staff respond and support him well. The service user discussed attending college at the end of September. Feed back from service users strongly indicated that staff related to them well and understood their individual needs and aspirations and this was reinforced by the inspector’s observations during the inspection. The home has made several referrals for advocacy services and has made contact with the Pohwer advocacy service. One service user discussed the input that they had received from a careers advisor external from the home. All service users are invited to come for a tea visit, an overnight stay and a longer short-term stay prior to any decision on admission. All admissions are subject to review after one week and again after three months. A contract is agreed with the service user at the review meeting convened three months after admission, which is attended by interested professionals and relatives as appropriate. This is written up and held on file in the home. Service users confirmed that the referrals and admissions procedure was effective and that the process was smooth and sensitive to individual needs. Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 10 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, 9 & 10 Individual needs and choices are reflected in the service user care plan ensuring changing need and goals are reviewed, met and developed. EVIDENCE: All service users have an individual care plan and an allocated key worker and nurse to support them. Individual daily notes and guidelines for the service users where observed. All service users are supported within the Care Management Framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the care plans of each individual are owned by the individual. The system appears to be effective as a working document and focuses on service users individual goals and aspirations. Care plans in place were fully reviewed and showed a clear system of meeting individual needs and aspirations. All risk assessment and guidelines were service users specific and depicted the needs of the service user clearly ensuring staff could provide the correct provision of care. Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 11 The documents held within the individual files determined that the choices and the desires of service users had been sought. Service users were able to provide confirmation that they were aware of their individual care plans and that their consent had been sought for a variety of processes within the home, this includes the administration of medication. Regular service user meetings are held. Service users said that these were well publicised and provided a worthwhile forum for discussion. Information is provided, wherever necessary in appropriate formats and by using accessible technology. Service users are encouraged to take part in routine cleaning and washing of their own clothes and rooms as part of their independence training programmes. The home and the Leonard Cheshire organisation seek the participation of service users in making decisions affecting them and facilitate the use of advocates where appropriate. Confidentiality training forms part of staff induction and the Leonard Cheshire organisation has policies on confidentiality and data protection which are made available to service users and their relatives/carers. All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 12 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) 11, 12, 13, 14, 16 & 17 Personal development opportunities are encouraged for all service users ensuring interactions within the local community and that individual rights and responsibilities are recognised and supported. An opportunity for engagement in activities within the home occurs. The home encourages inclusion into the local community thus enabling integration into community life. EVIDENCE: Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 13 Service users spoken with described numerous examples of activities they have engaged in, from going out socially to more practical excursions such as shopping that demonstrated considerable involvement and participation in the local community and use of local social amenities. They all expressed general satisfaction with their lifestyles. This is well documented in the individual service plans. Service users are supported to maintain contact with families and friends if that is their wish. The leisure activities listed above mean that all service users have the opportunity to make friends in the community regardless of any disability. Staff were seen to treat service users with respect and appeared to relate well to them. Interactions observed between service users and staff were extremely positive. Service users seemed to enjoy positive relationships with each other, leading to a pleasant and relaxed atmosphere. The appropriate boundaries between professional relationships and friendship were clearly understood and maintained. Service users freely discussed their plans for the future, explaining how staff helped them in their day-to-day lives to work towards achieving greater independence. Service users are involved in menu planning and preparation as appropriate. They all spoke highly of the food provided and said they had a fair level of choice. Staff try to promote healthy eating. Weight records and dietician referrals are recorded as appropriate within the service users’ care plan documentation. Following discussions with a number of service users it was determined that they are supported to complete food preparation within the home which further develops and supports the working ethos of the home in the promotion of independent living skills. Service users attend a variety of different day centres and colleges accessing courses suitable to their individual needs and aspirations. Discussions with the service users with support from staff determined that they have a variety of day activities to be involved within. A recommendation for service users to commence further food hygiene training is being made following service user feedback. The home has access to a mini bus and an allocated drivers. Staff support and encourage all service users to maintain and develop social, emotional, communication and independent living skills. The involvement and encouragement of the service users in a variety of tasks was observed throughout the inspection. The home is centrally located, and is within a short distance form shops and the local community amenities. The home values and seeks to reflect racial and cultural diversity of service users through celebration of, and awareness of different cultures, religions and festivities. Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 14 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 Service users physical and health needs are met, ensuring that their safety, wellbeing and health is promoted at all times. EVIDENCE: Service users spoke highly of the skill and attitudes of staff. All interaction between service users and staff seen during the inspection was mutually respectful and appropriate. Service users are fully involved in drawing up their Individual Service Plans and are able to make choices. Care planning documentation includes details of a range of specialist support services that are accessed on the basis of assessed need. Gender preference for personal care is noted in the care plan documentation. Lavender Fields I52_s58611 Lavender Fields v233603 070905 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 & 23 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. Robust policies, procedures and training are in place to ensure service users are protected and safe. EVIDENCE: The clear complaints procedure is included in both the Statement of Purpose and the Service User’s Guide. Every service user is also given a copy of the Leonard Cheshire “Have Your Say” leaflet. Comprehensive policies covering abuse and whistle blowing are in place. All staff receive training in issues around abuse and the recognition of abuse and the home has available copies of Hertfordshire County Council’s adult protection procedure. Lavender Fields I52_s58611 Lavender Fields v233603 070905 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) 24, 25, 26, 27, 28, 29 & 30 The home’s environment is very well maintained, thus promoting a homely, comfortable safe space for service users to live. All resources and equipment is provided within the home in abundance ensuring specialist and individual needs are promoted and changing needs met at all times. Shared space both compliments and supplements service users individual space ensuring that individual space is tailored to personal style and taste. EVIDENCE: Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 17 Number 1 Lavender Fields is a purpose-built, fully wheelchair-accessible home, pleasantly decorated to provide a non-institutional environment. Bedrooms are particularly spacious and have been nicely decorated, although some service users have decided to change the rather neutral colour schemes in their bedrooms to something more to their tastes. There is a need for the home to devise a redecoration plan for the home to ensure that repainting and repairs occur at a staggered level and that the current levels of comfort can be maintained. Service users have personalised their bedrooms with posters and ornaments. Some minor wear and tear to furniture and walls was evident but the manager stated that this would be attended to under the maintenance programme. In addition to the en-suite shower facilities provided in all bedrooms there are two assisted bathrooms and three toilets. Communal areas are well equipped and although all service users could not access the kitchen simultaneously, the adjacent sitting area provides ample practical space and was being used by service users during the inspection in preference to the lounge. The manager of the home discussed the plans to refit and make suitable alterations to the kitchen area in which service users were more able to access. The current space, does however provide height adjustable appliances and work surfaces. The separate information technology and physiotherapy rooms are excellent facilities that really enhance the scope of the service provided. All bedrooms are lockable and service users have their own keys. Rear facing bedrooms and communal areas have access onto an outside patio area which a safe and private outdoor space with some pleasant views and landscaped gardens. Following the last inspection, improvements have been made to the garden area. The home is purpose built for this service user group and includes all the appropriate facilities and equipment, including a separate physiotherapy treatment room. Corridors are very wide, allowing easy passage of wheelchairs. The home was clean, tidy and free from any unpleasant odours throughout the inspection. The laundry is modern and well equipped, with ample capacity to cope with the workload likely to be generated by ten service users. Following the last inspection new equipment has been purchased for the laundry area. Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None Not inspected on this occasion. EVIDENCE: Not inspected on this occasion. Lavender Fields I52_s58611 Lavender Fields v233603 070905 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) 37, 38, 41, 42 & 43 The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is running meeting its aims and objectives. Systems for effective health and safety management are in place, works are still required within the home to ensure the safety is maintained. EVIDENCE: The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach of the home creates an open, positive and inclusive atmosphere, staff and service users spoken to comment that they feel extremely supported and they feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The service users Lavender Fields I52_s58611 Lavender Fields v233603 070905 stage 4.doc Version 1.30 Page 20 appeared to benefit from this well structured and well run home. Service users spoken to during the inspection appeared to be extremely happy with the home and appeared to be relaxed in their environment. All staff and managers within the home are adequately and suitably trained in order to meet the complex changing needs of the service users. The staff team and the manager of the home are adequately trained and experienced to ensure that service users needs are being met. Periodic training occurs within the home to ensure staff development is maintained. The home has a vast range of policies and procedural guidelines in place. Staff are requested to read and sign risk assessments and polices. The home has a multitude of risk assessments in place. Many risk assessments in place are reviewed and remain as active working documents. There is a need for the home to ensure that risk assessments are dated and the First Aid Provision at Work risk assessment requires reviewing. All records required by regulation were available and maintained. All records are secure within the home and were up to date and held in accordance with the Data Protection act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. Lavender Fields I52_s58611 Lavender Fields v233603 070905 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lavender Fields Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 2 3 I52_s58611 Lavender Fields v233603 070905 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 24 42 Regulation 23 (2) (d) 13 (4) (c) Requirement A redecoration plan must be in place. The home must review and date the First Aid Provisions at Work risk assessment. Timescale for action 25th October 2005 25th October 2005 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 11 Good Practice Recommendations It is recommended that the home further support the facilitation of basic food hygeine training for the service users. 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