Inspection on 17/05/05 for Leighton House

This inspection was carried out on 17th May 2005.

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 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

Leighton House 18/11/08

Leighton House 30/01/07

Leighton House 04/11/05

Leighton House 03/12/04

Leighton House 17/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Leighton House 44 Station Street Cinderford Gloucestershire GL14 2JT Lead Inspector Richard Leech Unannounced 17 May 2005 15:15 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. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Leighton House Address 44 Station Street Cinderford Gloucestershire GL14 2JT 01594 827358 01594 827358 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) Merryden care Denise Leighton Care Home 2 Category(ies) of LD - Learning Disability Both (2) registration, with number of places Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd December 2004 Brief Description of the Service: Leighton House was first registered in May 2004. The home provides care for two service users with learning disabilities. The property is a two-storey terraced house. It is located close to the centre of Cinderford. Residents are accommodated in single rooms on the first floor. Each bedroom has a hand basin. There is a shared bathroom and toilet on the first floor and a toilet on the ground floor. There is a lounge and a separate dining room, as well as a small garden at the rear with seating. The home provides transport for the service users and supports them to access activities in the local community.The provider is in day-to-day charge of the home and acts as manager. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began at 3.15 on a Tuesday afternoon and lasted for about three hours. Both service users were spoken with along with two members of staff. The manager was not available during the inspection. Most areas of the home were looked at and some care plans and other records were also checked. The inspection was followed up with a telephone call to the manager on May 23rd 2005 to clarify and talk through some of the issues and findings. What the service does well: What has improved since the last inspection? Care plans have improved, and place more of an emphasis on helping people to become more independent and to develop their skills. Risk assessments have also become more detailed, and are used to support people to take up different opportunities and to become more independent as safely as possible. New wooden flooring has been fitted downstairs and there is some new seating. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 6 New health and safety checks have been introduced to help make sure that the building is a safe place to live and work. 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. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.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 Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.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) 2 Admissions are handled well and steps are taken to ensure that the placement is appropriate and that service users’ needs can be met. EVIDENCE: There have been no new admissions this year. During the last inspection comprehensive in-house assessments for both service users were viewed. The manager described how these had been completed with staff in the former setting, professionals involved in the person’s care and service users’ families. The manager said that the service users were also involved in the assessment process. There was documentary evidence of the placing authority conducting reviews with the service users in September 2004. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 & 10 Care planning in the home is generally good and promotes the development of skills and independence. Service users are offered choices and control over their lives, though there may be potential for this to be extended in a measured and structured way. Risk assessments promote service users’ independence and the taking of appropriate risks in everyday life. Service users’ confidentiality is put at risk by lapses in storage and information handling. EVIDENCE: Care plans viewed covered appropriate areas and were being reviewed regularly. The emphasis on promoting independence has been developed further. For example, one person had a care plan describing a staged approach to using a local swimming baths more independently. The team should consider whether care plans sufficiently describe support and goals/aims in different areas of independent living such as cooking, budgeting and other domestic skills as relevant. Discussion with service users and the manager indicated that considerably more good work was taking place with this than Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 10 was care planned and recorded. For example, one person now makes their own breakfast and packed lunch with minimal supervision. As noted in the last inspection, one person had relatively few care plans. This was raised in the draft report. The manager felt that no additional care plans were needed at the moment, but stated that care plans were live documents under continual review. Care plans included reference to promoting people making informed choices. However, care plans for this area did not provide much information about how this was to be done. During the last inspection there was particular discussion about one person’s choices and decision-making. Following this visit, the manager described how she was aiming to strike an appropriate balance between promoting choice and autonomy whilst not overloading the person. She is chasing up a report from the CLDT’s psychologist which is of relevance and will continue to review whether advocacy services should be involved. Care plans and notes, as well as discussion with the manager, provided evidence that a service user had consented to a care plan about weight loss and that a health professional was involved. Service users are supported to be as independent as possible with their finances, holding their own money if appropriate. Risk assessments viewed covered appropriate areas and provided clear guidance for staff. There was evidence of regular review and of an emphasis on promoting independence. A cupboard in the dining room was unlocked and included financial and care planning information about some service users from another home. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 & 17 Activities are varied and suit individuals’ preferences and interests. Service users are supported to become a part of the local community and to have their social needs met. A balanced diet is provided and service users enjoy their meals. EVIDENCE: Both residents expressed satisfaction with how they spent their time. Their programmes are individual and reflect their interests and needs. There was evidence from notes and discussion that this includes support to access facilities and services in the local community, as well as to stay in close contact with family and friends. The manager described the progress service users have made in diversifying their activities and growing in confidence. It was agreed that in due course there may be scope for one person to look at more vocational activities and perhaps to develop an independent source of income. Menus appeared to be varied and balanced. Staff said that the manager wrote the menu in conjunction with the service users. Notes provided evidence that mealtimes could be flexible, depending on people’s activities. Staff said that fresh fruit and vegetables were always available/used. The service users expressed satisfaction with the food served in the home. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Service users’ personal and healthcare needs are appropriately met. However, shortfalls were identified in the storage and handling of medication in the home which could place service users at risk and leave staff in a vulnerable position. EVIDENCE: Service users had care plans about aspects of personal care where appropriate. One person has a weekly visual check of their body. The manager has said that this was because the person had a history of not revealing that they were in pain or discomfort and that they seemed to be prone to minor skin ailments and conditions. The check is conducted only by a male staff member. The service user’s consent is recorded on file. One person said that they would like to go clothes shopping. The manager described the issues around this as well as plans for this to take place. Records along with discussion with the manager provided evidence that service users are supported to access the healthcare that they require. Staff said that none of the service users’ are on any prescribed medication besides an inhaler. An inhaler was found in a kitchen cupboard with a number of over-the-counter supplements, Nurofen and some paracetamol. There was some unlabelled Bonjela in a drawer. These must be stored appropriately. A staff member’s medication was found in the former sleeping-in room. This room was unlocked. This medication must not be stored on the premises. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users are enabled to air their views and concerns. EVIDENCE: The home has procedures for minor complaints and a separate procedure for more serious complaints. Service users indicated that they feel able to say if they are unhappy with any aspect of their care. One service user described the monthly house meetings. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26 & 30 Some shortfalls in the environment compromise what is otherwise a homely, attractive and clean setting. In some cases these could put service users at risk. EVIDENCE: Leighton House is very homely and is attractively decorated and furnished. The home appeared to be generally clean and hygienic throughout. Some points were noted as requiring attention: • • • • • • The area of the washing machine where powder is inserted needed cleaning. Many of the kitchen cupboards needed cleaning since they had considerable amounts of food debris. A drawer on an item of furniture in the lounge was coming apart and needed to be secured. If the dining room is now to be used as sleeping-in room the sofa-bed must be folded away each day so as not to compromise communal space. Staff must be vigilant about hygiene issues in terms of the pets in the home. Dogs were observed climbing onto the surfaces in the kitchen. Some dog excrement was reported to have been found in the home that day. There were reports of this occurring in the past. This must be avoided as far as possible and staff must promptly clear it up if it does happen. D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 15 Leighton House It is recommended that the following also be actioned: • • • • • The downstairs toilet had some peeling paint on the wall which should be repainted. The same room had no soap. A hand-towel was provided. Ideally there should be a liquid soap dispenser and paper towels in this room. Some cakes had been opened and left in the packet. These should have been stored in an airtight container. The fridge was quite untidy, with foods touching each other. This should be tidied up since this could pose contamination risks. Consideration should be given as to whether the fridge is large enough. The former sleeping-in room was full of the manager’s personal belongings. These should not be stored in the care home. Service users indicated that they were happy with their bedrooms. They are pleasantly decorated, comfortable and personalised. Since the last inspection new flooring and furniture has been provided downstairs. The manager described plans for a new carpet on the stairs and for the bathroom to be redecorated. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 16 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 of the standards in this section were fully inspected on this occasion. EVIDENCE: Since the last inspection the manager has arranged for some training about meeting the needs of people with autistic spectrum conditions. She has also obtained relevant information and literature from local and national organisations. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 17 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) 42 Health and safety is generally well managed in the home but some identified shortfalls could place service users at risk. EVIDENCE: Some bleach was found in the upstairs bathroom. Even if service users have been assessed as being safe with household chemicals, it is advisable to lock away (or at least put away) stronger, more hazardous substances such as bleach. The manager said that bleach would normally be kept in a kitchen cupboard and that this has been assessed as a safe arrangement. As noted in the ‘Environment’ section some areas of concern were identified around hygiene, which in turn could impact upon health and safety. Given the issues identified in the report the manager should consider how to ensure that the home runs appropriately when she is not present, in particular during a prolonged absence. Fridge and freezer temperature records were satisfactory. Staff are also now conducting periodic checks of hot water temperatures at each outlet. Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 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 Leighton House Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 10 20 Regulation 17 (1) b 13 (2) & (4) Requirement Confidential information about service users must be securely stored. Medication, including over-thecounter remedies, must be appropriately stored and labelled. Staff members medication and over-the-counter remedies must not be stored on the premises. When they are legitimately brought in by a staff member they must be stored securely for the duration of their shift. Implement the requirements listed in the first set of bullet points of the Environment Section. Timescale for action 15/06/05 15/06/05 3. 24 & 30 12 (1) a. 13 (3) & (4). 23 (2) d 15/06/05 4. 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 6 Good Practice Recommendations Consider whether care plans sufficiently describe support D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 20 Leighton House 2. 7 provided and overall aims/objectives in areas of independent living such as cooking, budgeting and other domestic skills. Periodically review whether it would be appropriate to involve an advocate with service users. Consult with service users about this. Continue to chase up an outstanding report from the CLDT psychology service as discussed. Consult with them about the scope for re-involvement around issues of choice and motivation. Consider also whether a referral to Speech and Language therapy would be beneficial in terms of how the person communicates and expresses choices, and general empowerment within the context of their diagnosed condition. Implement the recommendations listed in the bullet points of the Environment Section. Consider how to ensure that the home runs appropriately in the managers absence, including ensuring that staff have the necessary skills, knowledge and experience. Even if service users have been assessed as being safe with household chemicals, it is advisable to lock or put away stronger, more hazardous substances such as bleach. 3. 4. 5. 24 & 30 37 42 Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 21 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Leighton House D51_D03__S60129_LeightonHse_V228315_170505_Stage4_U.doc Version 1.30 Page 22 - 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. 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