Inspection on 20/09/07 for Lee Court - Leonard Cheshire Disability

This inspection was carried out on 20th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lee Court - Leonard Cheshire... 21/07/06

Lee Court - Leonard Cheshire... 06/02/06

Lee Court - Leonard Cheshire... 28/06/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Lee Court Queen Street Wellington Telford Shropshire TF1 1EH Lead Inspector Deborah Sharman Key Unannounced Inspection 20th September 2007 09:00 Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 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 Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 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. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lee Court Address Queen Street Wellington Telford Shropshire TF1 1EH 01952 272020 01952 272050 caroline.redford@lc-uk.org 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) Leonard Cheshire Caroline Redford Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate up to 5 persons with a Learning Disability who can be either up to the age of 65, or over 65 years of age. 21st July 2006 Date of last inspection Brief Description of the Service: Lee Court is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and short-term care for a maximum of five adults with a learning disability at any one time. The home currently provides a service for 40 people. Referrals are made through the Joint Community Learning Disability Team based at Tan Bank, Wellington, Telford. The property is purpose built and comprises a lounge, kitchen/diner, 5 bedrooms a bathroom and level access shower room. The service provider is Leonard Cheshire Foundation and was registered with the CSCI in April 2005. The Responsible Individual is Mr Michael OLeary and the manager of the home is Ms Dorothy Neill. Lee Court is situated in Queen Street near the centre of Wellington, Telford and is in walking distance of local amenities and just a short journey away from Telford Shopping Centre. Leonard Cheshires mission statement is included in the homes Statement of Purpose and states To work with disabled people throughout the world, regardless of their colour, race or creed, by providing the environment necessary for each individuals physical, mental and spiritual wellbeing. Consultation with service users is largely informal with the organisation making efforts to implement a questionnaire to review quality following each visit. Current service user contributions towards the service range from £57.50 to £75.40. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this unannounced key inspection between 8.50 am and 5.00 pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Progress the home has made towards meeting previous CSCI requirements issued to ensure improvement was also assessed. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection the Commission for Social Care Inspection was provided with written information and data about the home in their annual return. Additionally prior to inspection, the Commission for Social Care Inspection sought the views of people who stay at Lee Court for temporary respite and those of their relatives. Written responses were received from 11 guests and 15 relatives. All this information was analysed prior to inspection and helped to formulate a plan for the inspection and has helped in determining a judgement about the quality of care the home provides. During the course of the inspection the Inspector used a variety of methods to make a judgement about how service users are cared for. The Registered Manager was available throughout the inspection day to answer questions and generally support the process. The Inspector interviewed two care staff and on arrival chatted briefly with all the guests staying at Lee Court about their experiences before they went off to their respective day centres. The Inspector has had the opportunity since inspection to speak on the telephone to a relative about their perception of the service. The Inspector assessed in detail the care provided to two people (a new guest and a long term guest) using care documentation. Neither of these people were resident at the time of inspection and so aspects of care e.g. the administration of medication were assessed for other guests who were resident on the day of inspection. The Inspector sampled a variety of other documents related to the management of the care home such as training, staff supervision, maintenance of the premises, accidents and complaints. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The principles of individualised person centred care needs to be more firmly established in practice. Feedback from relatives confirms this. Relatives consistently see the service as inflexible as it can be booked in week blocks Friday to Friday only. The Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 7 Manager is aware of their feelings but is restricted by how the service is funded and the need to assure maximum occupancy and value for money. Feedback about staff is mixed. Positive comments refer to a caring atmosphere, doing an excellent job, most staff are kind and helpful and clients are looked after well. Areas for improvement according to those providing CSCI with feedback are staff listening skills, attitude and training. Inspection of records shows that there is no lack of training so either the quality of training requires review or some staff need to reflect upon how they are applying theory to practice. The suitability and choice of activities is also an area highlighted in feedback to CSCI as an needing improvement. Activity scheduling follows a similar pattern each week and is resource lead rather than needs lead. Inspection of documentation, discussion with staff and discussion with the Provider since inspection has confirmed the need to improve activities and the Provider is reviewing systems to support this. 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. The summary of this inspection report can be made available in other formats on request. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 8 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 Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is good. New guests can be assured that sufficient steps are taken by the Manager to ensure that she and staff are aware of guests needs and are confident that those needs can be met at Lee Court before a place is offered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New guests are able to visit Lee Court before they stay there. Sufficient information is available to the Manager to help her to decide whether it is appropriate to offer a respite place at Lee Court. Staff are satisfied that when a new guest is booked in that they receive sufficient information both written and verbal to help them to confidently meet guests needs from the beginning of their stay. The homes conditions of registration were reviewed on site. The home’s Statement of Purpose does not accurately reflect the conditions of registration and this requires review to ensure that the Manager is clear in respect of the age range of guest that the home is able to accommodate. Care plans and risk assessments are in place and they tally with pre admission assessments undertaken by both the Local Authority and Lee Court’s Manager. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 10 Contracts were assessed. One has been issued to a long-term guest but not to a new guest. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. Steps have been taken to improve care planning. Anomalies between care planning and practice however must be clarified and addressed to enable a shared understanding of need, wishes and preference and to facilitate greater choice for guests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans have been improved to ensure they reflect issues identified at the assessment stage. Some anomalies remain between care planning and care practice. For example staff understand a guest to need prompting and encouragement with personal care. The care plan states he needs help with shaving every other day. A recent end of stay evaluation form completed by the guest says ‘it was good but I can shave myself’ and feedback from the relative evidences concern that ‘he has been to day services without a shave for several days’. Care records show that the provision of showers is monitored but records do not evidence support with shaving and therefore this Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 12 could not be evidenced. Similarly feedback indicates the none provision of a drink for a guest who retired to bed after the others. Care plans guide evening routines but preferences re nighttime drinks are not included or monitored. ‘These anomalies need rectifying. This can be achieved at care reviews involving all interested parties. The guest case tracked who has been attending Lee Court for many years has not had a review. The Manager is aware of this and as a first step has canvassed relatives about how often they would like a review to be held. Feedback from relatives shows that there is capacity to improve the provision of support that is expected as responses ranged from ‘always’ to ‘usually’ and ‘sometimes’. Risk assessments have been carried out for risks that are individual to the service user as well as more generalised hazard assessments. The hazards had been identified in initial assessments and control measures are in place that adequately guides staff without overtly limiting the guest. Discussion with staff members showed good understanding of choices available to guests. Staff said that guests choose meals, activities, bed times, rising times, when and whether to shower etc. Records evidence how guests rise and retire to and from bed at a range of different times. Residents go weekly shopping for food and choose items in the supermarket. Guests are less satisfied with activity choices available to them and this is discussed more fully under ‘Lifestyle’. Staff showed less understanding of factors that might limit the choices available to guests. . Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is adequate. Guests go out particularly at weekends during their stay. However a consistent theme in the feedback is that there is little choice available to them or that staff make the choices. Inspection has confirmed the validity of guests’ feedback. Activities are group activities based upon the principle of compromise to suit inflexible staffing arrangements and are not planned around individual interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Group trips take place at weekends and guests go to a variety of places. There was no evidence that the guest case tracked is supported to engage in his assessed interests either within or outside Lee Court. Activity schedules follow a predictable pattern each week, are group orientated based upon group agreement and compromise and guests are encouraged to join in for the greater good. Staff said they rarely take guests out without a colleague being with them and activity records generally show ‘all guests took part’. The Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 14 ‘need’ for staff to accompany each other on trips reduces choices available to guests. Records show that where one guest was sick, a planned visit to the pub was cancelled for everyone, which is disappointing as there are only 5 people accommodated at any one time. However a guest’s evaluation form for a recent stay said that it had been ‘better as they went to more places’. Guests comments include: ‘Group decisions are made about what we do at weekends. Sometimes we are not taken to the social club on Thursdays’ ‘We can do what we want at weekends if there are enough staff and everyone agrees’ ‘Staff make the decisions what we are doing at weekends’ and sometimes staff barge into my room without knocking. Relative comments include: ‘More activities are needed to suit all the residents but they look after him at all times’ ‘They do not always take service users to their social clubs in the evenings’. ‘Need extra staff to make it easier to take groups out and also to cater for those wanting to stay behind’. ‘Does not encourage those users who are able to, to make cups of tea etc. Does not always take to social activities – will usually take out for a meal to a pub – could do cinema, football matches’ One relative commented positively that what Lee Court does well is to ‘enable our daughter to continue her regular activities’. Discussion with guests showed they like the meals and, that alternative meals are provided when there is something on the menu that they don’t like. Food stocks are plentiful and it was positive to see a good supply of fresh meat, fresh vegetables and fruit. One guest told me that she always has a jacket potato as this is her favourite and she had it for tea on the day of inspection. Staff were able to describe action they take to meet individual dietary needs for a diabetic guest and other guests who need food to be cut up or mashed for a variety of reasons. One guest expressed concern that he was repeatedly not provided with a cup of tea at bedtime because he chose to go to bed at different times from other guests. This could not be ratified either way at inspection. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 15 Guests can lock bedrooms from the inside but are not currently offered keys to their rooms so they can be secured in their absence. The Manager is aware of this, had highlighted the issue in her annual return and is keen to address the matter for the benefit of guests. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. Guests can be assured that changes in their health will be noticed, monitored and that medical advice will be sought and will be acted upon. There are some anomalies in the provision of personal care and medication systems, which need to be addressed to safeguard and meet all guests’ needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All guests presented as well groomed with individual style. Staff are aware of issues of privacy and dignity and described how they respect this for a guest who is known to prefer help from male carers and in the absence of any at Lee Court reluctantly accepts help from female staff. Case tracking showed some anomalies in the provision of some personal care. This is discussed under Individual Needs and Choices and could be resolved by holding regular care reviews that include all parties. Daily records are good and note details of guests well being, mood changes and changes in health which were appropriately monitored and responded to Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 17 with treatment obtained. The Manager intends to write to all relatives to assure them that if this coincides with the wishes of the guest that Lee Court is happy to continue to accommodate guests who may develop none serious health conditions and intend to ballot families about whether they would wish to be contacted in this event or not. The management of medication in an establishment that offers solely respite presents different challenges to those in establishments where residents live permanently: Medication protocols need to be reviewed. Further medical direction for the administration of medication prescribed as ‘as required’ is needed. Protocols are needed too for the management of homely remedies and the use of prescribed products with use by dates. The home is not currently satisfying itself that homely remedies or products with limited shelf life are safe to administer. Products are accepted into the home and it is not known whether the product is within its use by date. In the case of eye drops for example, this risks staff introducing infection into the guest’s eye by using a product which may have passed its safe date after opening. The home currently does not have relationships with guests GP’s and does not have the support of a local community pharmacist. Medications are being accepted on trust from families. Whilst copies of prescriptions are held to demonstrate that the medication has been prescribed, the home does not have assurance from the prescriber that they are in receipt of the full range of current prescribed medications. The Manager needs to consider confirming prescriptions directly with the GP practice prior to each admission and should give consideration to how the home would dispose of and replace spoiled medication. Developing relationships with guests GPs and a local community pharmacist are central to this. Medication records are completed well and assessment of medication stocks also demonstrate that medications are being administered with integrity. Staff who have received training are administering medications in twos to minimise then risk of error whilst administering. This is good practice. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. Feedback from guests and their relatives is diverse. Relatives all know how to complain but have not always been satisfied with the response. A recent complaint has been responded to fully and appropriately but it will take time to restore stakeholder confidence. Guests gave a full range of responses in answer to whether they know how to complain and the effectiveness of the pictorial complaint information on display is therefore questionable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All relatives in feedback to CSCI said they know how to complain but there were concerns expressed about the management of complaints. This was followed up after inspection with a relative who indicated that her reservations about complaint management are not directed at the current management of the home. Records indicate that a complaint received by the new manager was investigated, was partly upheld and was resolved to the satisfaction of all. The complaint stated that an inadequate amount of packed lunch had been provided to a guest. The Manager indicated that she would welcome comments from families and guests so that they can make any improvements necessary. Pictorial information about how to make a complaint is on the wall for guests. However guests fed back a full range of replies in respect of whether they know how to complain with some stating ‘always’ and three respondents stating they ‘never’ know how to complain. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 19 Complaints records are now held confidentially but should be stored following analysis on the individual’s file to whom they relate. Financial records have been improved and show that good systems are in place to protect guests’ financial interests. An inventory is completed upon admission that helps to account for and to protect guests’ possessions. Staff have received training in adult protection awareness and discussion with staff showed that they are fully aware of the principles and their role in the event of their being a concern about someone’s welfare. There have not been any allegations or safeguarding adults investigations. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. Guests are provided with a clean, safe and modern environment for their comfort and enjoyment during their stay. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the environment showed it to be finished and furnished to a high specification. Observation showed it to be clean, odour free, tidy and free from evident hazards. For example knives and chemicals were locked away, a fire door that had been sticking on a new carpet has received attention and is now closing freely, protective equipment is available for staff and radiators are guarded to protect guests from the risk of burns. Water outlets with known excessive water temperatures such as the laundry are kept locked and this was observed. On going improvements are made to the premises. For example a cupboard has been constructed to enable clean laundry to be removed from the laundry Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 21 facilities to reduce the risk of cross contamination. Carpets were scheduled for cleaning also. The Manager is aware of the need to repaint the ceiling in the shower room and long term damage to door frames by a wheelchair should be addressed especially as the guest no longer uses the service. The premises are all on the ground floor but windows are not restricted and risk assessments to demonstrate there is limited risk to guests have not been carried out. The Inspector explained that the risk that needs consideration is not so much the risk of falling from a window on ground floor premises but the risk from intruders in premises where windows are unsecured. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good overall. With one exception guests are satisfied that staff always treat them well. The perceptions of relatives about the performance of staff is more mixed. Staff are now well supervised and receive regular training. The challenge for staff is to work flexibly and to improve how they listen to and act upon what guests say to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training undertaken by one guest’s key worker was assessed and she had undertaken a full range of expected training. Only moving and handling training was out of date and refresher training needed. The Manager has a good training programme in place and computerised records assist the identification of training undertaken and needed for individual staff members. The Manager and staff confirmed that they have undertaken medication and infection control training with a distance learning training provider but that months later it has been difficult to secure certificates as evidence, although Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 23 some were seen. The Manager is intending to support staff to redo the training that has not been certificated. Twelve out of thirteen staff have achieved their NVQ 2 and plans are in place for the thirteenth staff member to commence this training too. This is an achievement and staff should be congratulated. Staff turnover is low and agency use is very limited. There is a key worker system in place but the Manager intends to review this. Rotas are clearly maintained and show that two staff are on duty at all times which given the needs of the guests at the time of inspection seemed sufficient. However, following feedback about restricted activities the Manager should review whether staff are being used as flexibly as they could be. This goes hand in hand with the need to support staff to understand and implement person centred care to avoid feedback, which for example states that staff make decisions about activities and what is watched on the television. The provision of supervision was assessed for two staff members. Improvement has been prioritised and both staff members have received appropriate levels of supervision at regular frequencies. Supervision records are excellent and demonstrate that the function and purpose of supervision is being carried out. Staff confirmed feeling well trained and well supported. No new staff have been recruited since the last key inspection so performance was not assessed on this occasion. Many comments in feedback to CSCI were positive about the staff approach. However it is important that staff reflect upon feedback received from those who are less content with the service that staff provide. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good overall. The new manager has demonstrated the ability to implement change positively and demonstrates having the ability to bring about further improvement. Although there are some omissions in service maintenance documentation most were in place and CSCI is confident that the required action will be taken. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a good response under the new manager to previous requirements issued to bring about improvement, many of which have now been deleted. The quality of the records management is now good and apart from the need to individualise complaints and accidents records, they are now organised, indexed, detailed and readily accessible. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 25 Staff meetings are held monthly including on the day of inspection and minutes are excellent evidencing guidance, consultation and a guest focus. Staff spoke highly of the newly registered manager describing the home as being managed ‘very well’ and the manager as ‘approachable and calm’. They added that she ‘follows through, is organizing training, gives praise and informs us when things need improving.’ They also indicated that resources are made more readily available now. A sample of evaluation forms completed by guests at the end of their stay in 2007 were viewed and showed a high degree of satisfaction. Comments included: ‘Enjoyed stay as usual’ ‘Enjoyed meals, enjoyed gateway disco. Would have liked to have gone to pub for a drink’. Concerned other clients go into bedroom without knocking or even go to borrow things without permission’ . ‘It was better this time. Everyone was friendly. The staff listened to me. The food was better. It was not dry. I had a good time’ . ‘I enjoyed my first stay in 2007 and had enough to do. I thought the food was good’. Please can we have a proper pudding on a Sunday’. ‘Very satisfied with the care given’ ‘Very happy in Lee Court’. My stays are always enjoyable due to the staff and surroundings’ The Manager prioritised improving the COSHH assessments upon her arrival and they are completed to the best standard that the Inspector has seen. Cold and hot food temperatures are being taken to limit the risk of food borne illness to guests. Recommendations for improvement following a fire inspection in October 2006 have been met and are confirmed as met by the fire officer who carried out a follow up inspection in January 2007. However one bedroom fire door was wedged open during this inspection and this would not provide satisfactory protection in the event of a fire. Action must be taken that meets with the Fire Officers approval if it is the wish of the guest to prop the door open. Some service maintenance documentation was available and some was missing. The gas cooker had not been serviced upon the advice the Inspector was told of the gas engineer and a gas landlords certificate had not been issued. Bath temperatures are taken before guests get in and steps have been taken to assure the quality of the water supply. However regular reports by Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 26 the Manager to the water contractor in relation to concerns about the temperature of 4 regulated water outlets had not been satisfactorily responded to. This was followed up on the day of inspection with assurances of a speedy resolution to protect guests from the risk of scalding from taps where water at 49.9 degrees was in excess of the recommended safe range. Accident records show few accidents over a 12-month period and most of those recorded are in respect of slips and trips for a number of different guests. It was suggested that these are filed on individuals’ files to accord with good records management practice but also so that trends can be analysed and appropriate action taken to respond to risk from the analysis of emerging trends. There is a range of environmental risk assessments in place that have all been recently reviewed by the Registered Manager. A quality assurance tool was last completed in 2006 and was ineffective in identifying where the home needed to improve and develop. The new Manager is currently working through the quality assurance tool for 2007 with a view to self-assessing the performance of the home and to take action where necessary based upon a combination of her findings and guest feedback. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 27 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 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 2 X X 3 X Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 28 Yes 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 YA6 Regulation 15(1)(2) Requirement Individual support plans must contain information to ensure staff are fully aware of how care is to be delivered for each individual (Previous timescale of 12.9.05 and 31.3.06 not met) This will ensure that care needs are known and are met. Not fully met at this inspection September 2007.Timescale given reflects fact that this is a respite service. Timescale for action 31/12/07 2 YA6 15(2) Guests individual support plans must be kept under review, where practicable in consultation with the guest and or a representative of his, revising the plan where necessary and notifying the guest of any such revision. This will avoid anomalies in care and ensure there is a shared understanding of care that is expected to be provided. New Requirement arising from this inspection September 2007. 31/03/08 Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 29 Timescales given reflect fact that this is a respite service. 3 YA20 13(2) Medication protocols must be reviewed to particularly address: The safe management of homely remedies Receipt of drugs into the home to ensure that the home satisfies itself it has available all prescribed and current medications Spoiled medications The safe administration of medications and medical creams / drops / ointments which may have a use by date. These steps will promote the health and welfare of guests by ensuring that they safely receive all medications as prescribed. Risks arising from this will be minimised. New requirement arising from this inspection September 2007. 31/10/07 4 YA42 13(4) Steps must be taken to minimise the risk of scalds to guests from water temperatures that exceed the agreed safe range. New requirement arising from this inspection September 2007. 26/09/07 5 YA42 23 The practice of propping open fire doors must cease to ensure that in the event of fire guests and staff are protected as far as possible from the spread of fire and smoke. The advice of the fire service must be sought and implemented to ensure that where guests wish to prop open doors that this can be done safely. 20/09/07 Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 30 New requirement arising from this inspection September 2007. 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 YA13 Good Practice Recommendations Staff time with, and support for, guests outside the home should be flexibly provided, including evenings and weekends. This should be a recognised part of staff duties. New recommendation arising from this inspection September 2007. 2 YA14 Steps should be taken to consult guests and their representatives about the programme of activities arranged by the home. Guests should be supported to pursue their own interests and hobbies with group activities being arranged for people who share the same interests. This will be better supported by using available staff hours flexibly. New recommendation arising from this inspection September 2007. 3 YA22 Steps should be proactively taken to ensure that all guests are informed how to make a complaint should they need to. New recommendation arising from this inspection September 2007. 4 YA32 The provision of training for staff in person centred care should be considered. New recommendation arising from this inspection September 2007. 5 YA42 A Gas Landlords certificate should be obtained to evidence the maintenance of all gas appliances within the premises. New recommendation arising from this inspection September 2007. 6 YA42 Steps should be taken to assess the level of risk from ground floor windows based upon the vulnerabilities of guests and other factors. New recommendation arising from this inspection September 2007. Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Lee Court DS0000064235.V344816.R01.S.doc Version 5.2 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!