CARE HOME ADULTS 18-65
Lee Court Queen Street Wellington Telford Shropshire TF1 1EH Lead Inspector
Rebecca Harrison Unannounced Inspection 6th February 2006 12:20 Lee Court DS0000064235.V282622.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 Lee Court DS0000064235.V282622.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. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lee Court Address Queen Street Wellington Telford Shropshire TF1 1EH 01952 272020 01952 272050 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 Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 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. 28th June 2005 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. Lee Court DS0000064235.V282622.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 commenced at 12.20 p.m, was carried out by two inspectors over two hours. The inspection included discussions with the administration officer and a support worker, examination of a number of records and a brief tour of the home. At the time of the inspection the manager was on sick leave however discussions did take place with the manager on the following day after the inspection. The staff on duty co-operated fully throughout the inspection. The purpose of this unannounced inspection was to review the progress made by the home since the announced inspection undertaken on the 28th June 2005 where nine requirements and one recommendation were made. No complaints have been received by the home or the Commission for Social Care Inspection since the service was last inspected. There have been no referrals made under adult protection procedures. What the service does well:
Lee Court provides a homely and comfortable environment to people receiving short-term care. People accessing Lee Court are supported by a committed staff team. A member of staff on duty reported that both the manager and her deputy are ‘open and approachable’. Service users are able to continue attending their usual evening clubs and social events that they attend when they are at home. Contact sheets seen on a number of files evidence that the home encourage family contact and service users may call their relatives as required. The menus seen during the inspection appeared well balanced and offered choice. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Individual support plans must be developed as a matter of priority for all of the individuals accessing this service to ensure that staff are provided with the relevant information for care delivery. The changing needs of service users must be recorded to ensure appropriate monitoring and staff awareness. Risk assessments for supporting individuals to take risks as part of an independent lifestyle need to be developed and risk assessments for safe working practices need further development in order to safeguard service users. It was reported that the organisation conducts annual appraisals with their employees and that it is nearing twelve months since the home was registered under the new provider. Therefore this requirement has been brought forward and will be reviewed at the next inspection of the service. Evaluation forms have been sent out to all service users however the home has only received four responses since November 2005. Comments included: ‘Our daughter is very happy to come because staff are very kind and help her’. ‘My son enjoys his stay and looks forward to the next’. ‘Enjoyed his stay, staff are very happy and friendly’. ‘I did not like Lee Court this time as in the Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 7 second week I did not go out or do anything and I wanted a lie in but somebody banged on my door and woke me up’. The manager reported that families are welcome to visit the service and that three families visited the home in November. Further avenues need to be explored in order to measure success in achieving the aims, objectives and statement of purpose for the home therefore an annual development plan should be developed to assist in measuring success and inform future planning. Record keeping systems are still in need of significant improvement in order to fully safeguard people using this service. 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. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 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.V282622.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 5 Appropriate procedures are in place to enable successful short-term admission to the home. EVIDENCE: The intended outcomes for key Standard 2 was assessed and met at the previous inspection. A requirement was made at the previous inspection for the service user guide to be developed in a format appropriate to the needs of the people accessing the service. The administrator reported that he has approached the Joint Community Learning Disability Team and sourced a relevant computer programme to assist with the development of producing a guide in an appropriate format. This will therefore be reviewed at the next inspection. A requirement was previously made for a written contract to be developed between the home and each service user. The Administrator was able to evidence that the home has developed a draft contract, which has very recently been approved by the organisation. A copy of the draft contract was shared with the inspector and appeared satisfactory. It was reported that a copy of the final document would be in place shortly for all service users. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 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 the following standard(s): 6 and 9 The staff have an understanding of the service users’ support needs, however record keeping systems must be significantly improved to ensure the staff have the relevant information for care delivery and risk management; which are regularly reviewed and updated. EVIDENCE: The intended outcomes for key Standards 7 was assessed and met at the previous inspection. Key Standards 6 and 9 were previously assessed and not met. Three requirements were previously made in relation to care planning and that the support plans contain information to ensure staff are fully aware of how care is to be delivered for each individual; that the changing needs of service users be recorded to ensure appropriate monitoring and that these be reviewed and updated every six months. Inspectors selected a number of care plans in relation to the five people currently residing at the home and the three people scheduled to receive a service the forthcoming week. It is positive to report that one of the files reviewed was detailed and much improved. The personal support plan was
Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 11 dated 02.02.06 and had been compiled by the manager with the information provided by the parents of the service users and the staff team. A risk assessment had not been developed for road safety or for the use of the minibus tail lift that the person accesses. A behaviour support plan was not available on file as referred to in the personal support plan. Other care documentation seen on other service users files was of the same standard as found in the previous inspection and had yet to be transferred onto the preferred care planning format. Discussions held with the manager on the following day indicate that individual support plans for all people accessing the service would be in place within the next four weeks. Information provided by the parent of another service user identified that the person had no sense of danger, cannot go out alone, can be very challenging and required a bedrail due to medical reasons. A risk assessment for the management of behaviours was seen on file-dated 07.04.05 and there was evidence that the person had been formally reviewed by the Joint Community Learning Disability Team on 02.06.05. The risk assessment for the management of behaviours identified that the person requires a minimum of two staff at all times. It was reported that the person very rarely accesses the community whilst at the home through choice, therefore due to current staffing levels this may impact on the social activities of other people receiving a service at that given time. Following discussions held with the manager the following day it was reported that the person no longer requires this level of support however the risk assessment had not been updated to reflect the current situation. A risk assessment for the use of bedrails had not been developed. Another plan identified that a person requires guidance when walking but there was no further information documented. Another personal profile record completed by a parent stated that the person ‘has difficulty with crowds and noisy places and can become withdrawn and anxious’ however no action had been identified by the home for the level of support the individual requires and how to appropriately support him in the community. A requirement was made at the last inspection in relation to risk management. Risk assessments were not available for supporting individuals to take risks as part of an independent lifestyle for example no assessment had been undertaken for someone to access the community independently or to attend social activities or take part in in-house activities, cookery, shopping etc. An extremely brief risk assessment was found to support an individual with the management of her epilepsy and this did not take into account implications this may have for staff and service users when using the homes vehicle. The only risk assessments seen on the files reviewed were general safe working assessments for the kitchen, lounge, shower, bedrooms and moving and handling. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15,16 and 17 Service users may maintain contact with their family and are supported to attend their usual social activities throughout their stay and have a community presence. Service users are offered a varied and balanced diet. EVIDENCE: It is the homes expectation that people accessing the home continue to attend day service provision provided by the local authority and for the home to provide the transport to enable this process. All five people residing at the home at the time of the inspection were in day services. Lee Court is unable to provide permanent full time placements therefore it is not appropriate for staff to provide employment opportunities for service users or to deal with the management of service user benefits. People accessing the service are able to continue attending their usual evening clubs and social events that they attend when they are at home. Activities were documented on most of the care files reviewed. The minibus logbook also
Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 13 evidenced that people had been a to a garden centre, evening clubs, local towns and pubs. A new vehicle has been purchased since the last inspection. Although the home provides short-term care, service users are able to request friends they wish to be with during their stay and there was evidence to suggest that people are encouraged to maintain their friendships. Contact sheets seen on a number of files evidence that the home encourage family contact and service users may call their relatives as required. It was reported that people have very few visitors of an evening due to the nature of the service offering short-term care. Routines were documented on ‘personal support’ sheets completed by service users relatives. As previously stated the individual support plan completed for one individual on 02.02.06 by the manager was much more detailed and included morning and evening routines. Bedroom doors are lockable in order to provide privacy to service users and preferred forms of address were clearly documented on the care files reviewed. It was reported that none of the current service users choose to smoke. The menus seen during the inspection appeared well balanced and offered choice. The individual support plan dated 02.02.06 provided staff with relevant information on how the person, with very limited communication skills, makes her preferences known in relation to choice of food. However some information provided by the parents on 05.12.05 had not been transferred to the new individual support plan to include the persons dislikes of food or that the person requires her food to be cut up. Fresh fruit is readily available and a new freezer has been purchased since the last inspection. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 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 the following standard(s): 18 and 19 Care planning and record keeping systems need to be improved to ensure staff are familiar with service users preferred personal support and healthcare needs. EVIDENCE: The intended outcome for key Standards 20 was assessed and met at the previous inspection, however a recommendation has been made as a result of this inspection. As previously stated guidance relating to individual personal support needs were seen on file completed by parents of service users. Preferred routines were found documented on the new individual support plan on one file dated 02.02.06 which provides staff with more detailed information to ensure consistency of care for the person concerned. It was reported that key-workers are now responsible for ensuring new individual support plans are in place for the people they key-work. Other care documentation seen on other service users files was of the same standard as found in the previous inspection and had yet to be transferred onto the preferred care planning format. A risk assessment for the use of bedrails had not been developed for one person and another plan identified that the person requires guidance when walking but there no further information was found documented.
Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 15 The relevant contact details of health professionals was found documented on all service user files reviewed. Due to the nature of the home staff do not usually support individuals with health appointments unless required to do so. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 16 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): x EVIDENCE: The intended outcomes for key Standards 22 and 23 were assessed and met at the previous inspection of the service and were not reviewed on this occasion. It was recommended at the previous inspection that all service users/parents be provided with a copy of the homes complaint procedure. The Administrator reported that this has been met. No complaints have been referred to the registered manager or to the Commission of Social Care Inspection since the service was last inspected. There have been no referrals made under adult protection procedures. Lee Court DS0000064235.V282622.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): x EVIDENCE: The intended outcomes for Standards 24,25,27 and 30 were assessed and met at the previous inspection of the service and were not reviewed on this occasion. The home was found very clean and tidy. Since the last inspection a number of improvements have been made in order to provide a more comfortable environment for people to stay. These include a new lounge suite and the redecoration of a number of rooms. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 Annual appraisals for all employees have been scheduled. EVIDENCE: The intended outcomes for Standards 32,33,34 and 35 were assessed and met at the previous inspection of the service and were not reviewed on this occasion. Standard 36 was previously assessed and not met. A requirement was previously made for staff to receive an annual appraisal with their line manager to review performance against job description and agree career development plan. There was evidence that staff appraisals have been scheduled to take place over the next two months and this was confirmed by a staff member on duty and through discussions held with the manager the following day after the inspection. It was reported that the organisation conduct annual appraisals with their employees and that it is nearing twelve months since the home was registered under the new provider. Therefore this requirement has been brought forward and will be reviewed at the next inspection of the service. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41 and 42 Record keeping systems must be improved to ensure service users receive consistent care in a preferred manner. Quality assurance and monitoring requires further development to inform future planning. Risk assessments for safe working practices must be improved to safeguard service users. EVIDENCE: The intended outcomes for Standards 37,42 and 43 were assessed and met at the previous inspection of the service and were not reviewed on this occasion. Standards 39 and 41 were previously assessed and not met. A requirement was previously made that the home develop and implement an effective quality assurance and monitoring system based on seeking the views of service users, relatives and stakeholders to measure success in achieving the aims, objectives and statement of purpose for the home.
Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 20 It was reported that evaluation forms had been sent out to all service users however the home has only received four responses since November 2005. The manager reported that families are welcome to visit the service and that three families visited the home in November. Discussions were held with the manager the following day of the inspection in relation to the difficulty the home has experienced in acquiring the views of the people and their families. Further avenues need to be explored in order to measure success in achieving the aims, objectives and statement of purpose for the home therefore an annual development plan should be developed to assist in measuring success and inform planning and review. A requirement was made at the previous inspection relating to the homes record keeping systems. As highlighted throughout this report records need to be improved to ensure staff have sufficient information for care delivery, which is recorded, reviewed and updated. As previously stated one individuals support plan has recently been developed and implemented and the information was much more detailed however this format for care planning needs to be in place for all people receiving a service. Although health and safety procedures were reviewed and met at the previous inspection, this visit identified that individual and generic risk assessments for safe working practices require further development as identified throughout this report to include an assessment of the tail lift, staffing ratios and the minibus. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 x 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 x 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 x x 1 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 x x x x 2 x 1 2 x Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 22 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 The changing needs of service users must be recorded to ensure appropriate monitoring and staff awareness. (Previous
timescale of 12.09.05 not met). Timescale for action 31/03/06 timescale of 12.09.05 not met). 2 YA6 15 (12)(b) 31/03/06 3 YA6 15 (12)(b) Individual support plans must be reviewed with the service user at least every six months and updated to reflect their changing needs. This must be amended in the homes Statement of Purpose.
(Previous timescale of 22.08.05 not met). 31/03/06 4 YA9 13 (4) (b Risk must be assessed prior to admission and service users enabled to take responsible risks within a risk-assessed framework, which is
DS0000064235.V282622.R01.S.doc 31/03/06 Lee Court Version 5.1 Page 23 regularly reviewed and updated for, all in house and community activities.
(Previous timescale of 15.08.05 not met). 5 YA18 12 (4)(a) 6 YA36 18 (2) The registered person must 31/03/06 ensure that service users’ preferences with regard to their care are identified and recorded. Staff must have an annual 31/03/06 appraisal with their line manager to review performance against job description and agree career development plan.
(Previous requirement carried forward). 7 YA39 8 YA41 24(1)(a)(b)(2)(3) The registered person must develop the homes quality assurance and monitoring systems further to inform future planning. 17 All records required by regulation for the protection of service users must available and regularly reviewed and updated. (Previous
timescale of 31.08.05 not met). 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA5 YA20 Good Practice Recommendations It is recommended that the contract between the provider and service user states what is and what is not included in the fees charged. It is recommended that service users current medication requirements be stated on the support plan in addition to records stored in the medicine cabinet. Lee Court DS0000064235.V282622.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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