Inspection on 05/12/05 for Lemsford Road

This inspection was carried out on 5th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lemsford Road 28/12/06

Lemsford Road 12/07/05

Lemsford Road 13/01/05

Lemsford Road 17/08/04

Lemsford Road 03/12/03

Lemsford Road 17/06/03

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

CARE HOME ADULTS 18-65 Lemsford Road 66 & 66a Lemsford Road St. Albans Hertfordshire AL1 3PT Lead Inspector Mrs Jan Sheppard Unannounced Inspection 5th December 2005 10:00 Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 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 Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 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. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lemsford Road Address 66 & 66a Lemsford Road St. Albans Hertfordshire AL1 3PT 01727 850 436 01727 810 723 Lemsford.Roadnitedresponce.org.uk www.unitedresponse.org.uk United Response 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) Terri Matthias Care Home 11 Category(ies) of Learning disability (11), Physical disability (11) registration, with number of places Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: 66 Lemsford Road is a detached house divided into three separate living areas on three floors. 66a Lemsford road is a detached annex house standing in the large garden of the main building. In each of the four living areas there are single bedrooms, a lounge, a kitchen diner, a laundry and bathrooms. Lemsford Road is a busy road about one mile from central St. Albans but within easy reach of all amenities of the city. It has good access to major roads (M1 and M25) and has excellent public transport links. The home, which is owned by the Health Authority, is staffed and run by United Response. It offers care services for 11 adults with learning and physical disabilities. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The e mail address for this home is Lemsford.Road @unitedresponse.org.uk not as shown on the title page. This unannounced visit was the second inspection of this inspection year and took place over one day when the manager all the staff on duty and the residents who were at home on that day were all spoken with. The comments made in this report reflect the observations made by the inspector during that day and also take note of the written replies and information supplied to the Commission in the pre-inspection documentation. Not all of the standards were examined during this inspection as they were all covered during the previous visit on 12th July 2005 to which reference may be made. This home continues to provide a warm homely and stable environment for its residents. Since the last inspection there have been no new residents admitted to the home and the staff team also has remained the same. All the requirements made following the last inspection have been met or have works well in hand to meet them. Three requirements and two good practice recommendations are made following this inspection. What the service does well: What has improved since the last inspection? Since the last inspection the range of activities and outings for the residents had been expanded so as to better meet their individual interests and needs. Efforts to promote more unified working together by the whole staff team and to develop a better understanding by the staff of all the residents needs, not just for the residents on their unit, have been successful. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 6 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. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards have not been inspected on this occasion as no new residents have been admitted to the home since the last inspection. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. The home maintains detailed individual care plans, which reflect the personal needs and aspirations of each resident. EVIDENCE: The care plans examined were all found to be maintained to a high standard. A previous exercise to remodel the format in which these plans are compiled has now been completed resulting their uniformity and clarity, which made them very accessible for the inspector. They were seen to be kept up to date with clear concise details as to changing care needs and how should be met with amended risk assessments accompanying the changes in needs. The changes in care needs for one resident which now necessitate some peg feeding were seen to have been properly prepared for by the home with appropriate multidisciplinary discussion, this including the CSCI, and specialist training planned for all staff. Some of the residents in their discussions with the inspector demonstrated their ability and the expectation that they would makes decisions and plans concerning the activity of their lives.” I now walk into the town on my own”, and “I travel on the bus to see my father in X town”, were comments made to the inspector. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 10 The care plans recorded how these activities had been planned for and the training that had occurred before, following a new risk assessment, it was agreed to be safe for the resident to take make these journeys unaccompanied. The manager discussed with the inspector the new plans that are in hand to assist the residents, those who are able to do so, have more involvement with the planning and compiling of their own care plans and to make these plans more easily accessible to them. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14, and 17. Each resident has an individually planned activity and educational programme arranged to meet their needs and promote their skills and interests. The home provides a nutritious and varied menu chosen by the residents and supervised by a dietician, which offers fresh ingredients and home cooking on a daily basis. EVIDENCE: There have been no major changes to the arrangements concerning the provision of meals since the last inspection. The dietician continues to visit regularly to supervise the menu planning, each of the four units continues to prepare its own menu these planned to reflect the likes of their residents and to accommodate any of their requirements concerning reducing or increasing dietary needs. All the residents continue to have a weekly day care and activities programme these being tailor planned to meet individual needs interests and abilities. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 12 The manager discussed with the inspector the recent alterations that they have been forced to make to many of these programmes following the changes in the provision of services offered by the local colleges and the social services day centres. These changes, over which the home has now influenced or control, are not always proving to be to the benefit of the resident. Some much appreciated college classes have been cancelled and day care activities are now planned on a shorter sessional basis, some only last for one hour. These changes have had quite profound effects for the home, extra staffing and travel costs and for some residents who just do not have the energy to go out more than once a day and are consequently now receiving a less varied programme. To attempt to compensate for these changes the home has increased the programme of outings and visits as well as the number of communal activities using their garden and patio BBQ facilities. A recent pre Christmas visit to Southend to view the lights and to have a fish and chip supper was mentioned as having been particularly enjoyed by all the residents and in September a Football Tournament and Car Boot sale held in the garden to which other local homes and day centres were invited was particularly successful. The inspector was shown happy photographs of both these events Over the summer period all the residents who wished to do so and were physically fit enough to safely go away were able to take a holiday. Locations included Dorset, Bognor and Scotland. Several residents also spent some holiday time visiting their families. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21. Personal care and health care is offered to the residents in an individually planned manner so as best to meet their needs. The home has a robust medication storage and administration system but some errors in recording and practice omissions were found. Better evidence of the residents, (and relatives) wishes and plans for any terminal illness and after life arrangements should be recorded. EVIDENCE: Care was observed to be being delivered in a calm kindly and sympathetic manner by staff who knew the residents very well and could interpret their non verbal communication skilfully. The care pans evidenced that good working relationships exist between the homes local GPs and community Nursing teams and with various specialist Consultants at local hospitals. There have been no changes in the homes medication supply, storage and administration arrangements since the last inspection. Each of the four units holds and administers their medication separately. The records examined on two units were found to be accurately kept with good management surveillance. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 14 However one error in recording was found on the MAR sheet on the third unit, one medication storage cabinet was seen to have the keys left in the door and one liquid medication was found to be being stored at too high a temperature. Requirements are made. The manager discussed with the inspector ways in which the wishes of the residents and of their families concerning after life arrangements could be better evidenced on their care plans and where appropriate discussed with them also. A recommendation concerning this good practice issue is made. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has the required complaints policy and procedures a copy of which has been given to all the residents and where possible also to relatives and families. The home has policies and procedures concerning Adult Protection and Whistle Blowing, which follow the guidelines given in the Hertfordshire County Council Adult Protection Joint Agency procedures. EVIDENCE: There have been neither complaints nor any incidents concerning Adult Protection since the last inspection. The training plan records evidenced that refresher training for all staff concerning Adult Protection has been planned for early next year. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. This home has spacious and appropriately appointed accommodation to meet the needs of its residents for whom it provides a homely comfortable and safe environment. The homes planned routine maintenance programme is now being adhered to with in acceptable timeframes. EVIDENCE: Since the last inspection various works of repair redecoration and improvement have been carried out in the home which now has a very light and airy feel combined with a pleasant homely appearance. The residents bedrooms are particularly well personalised each one reflecting their individual tastes and interests. Several of the residents were keen to show off their rooms to the inspector. The manager evidenced that works to provide the new windows for the home were well in hand, because of the age of the building and the planning requirements these windows have hade to be individually made, and it was agreed with the Commission that the date for fitting these could be deferred until after the Christmas period so as not to disrupt the festive arrangements in the home. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 17 On the day of this unannounced inspection the home was found to be very clean and tidy. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 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): 35 and 36. The home has the appropriate recruitment policies and practices. It is fully staffed with experienced and well qualified carers who work well together as a team. A vacancy exists for an assistant manager following the post holders departure to commence nurse training. EVIDENCE: The care staff group is very stable and there have been no changes since the last inspection. It was not therefore possible to examine the recent recruitment practice records. The manager commented that she had been able to retain as a bank worker the services of a previous assistant manager of the home who is now undertaking a professional nurse training and that this greatly assisted with the continuity of care for the residents who all know him extremely well over many years. The home continues to promote staff training at all levels and the national training standards are exceeded. More than 60 of the care staff hold an NVQ at level 2 and many also have this at level 3. The manager and deputy have studied NVQ at level 4 and also hold the Assessors certificate. All the staff spoken with said that they were very well supported by the home managers and that their views were regularly sought concerning the running of the home in an inclusive and enabling manner. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 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): 37 and 42 The home is well run by a qualified, competent and experienced manager who leads a dedicated staff team who work very well together. Close consideration to the health, and welfare needs of the residents is given and this results in a warm caring environment where the residents seemed happy and relaxed. However constant attention must be given to the continual maintenance of a safe environment for these very vulnerable residents. EVIDENCE: All the staff spoken with said that they were happy working at the home and that they were well supported by the homes manager who consulted with them often and regularly sought their opinions as to the care of their particular residents. Generally there seemed to be a good level of awareness amongst the staff concerning the residents safety but on one unit a cupboard containing potentially dangerous cleaning materials was found to be unlocked and the medication cabinet although locked had the keys left in the door, both of these Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 20 being situations that could have resulted in risk to the residents. A requirement is made. To ensure safe hygiene practices paper towels should be provided in all the toilets. A number of the records were examined and generally these were found to be kept in good order. However it was noted that since the last inspection one of the monthly unannounced Regulation 26 visits made to the home by the provider could not be evidenced. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lemsford Road Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x DS0000019445.V269242.R01.S.doc Version 5.0 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2)(b) Requirement The works of repair and replacement to the rotten windows and door frames throughout the building must be carried out this to ensure that the safety of the home for its residents and staff is not compromised The revised dates for the fitting of these windows has been agreed with the CSCI To ensure the safety of the residents at all times cupboards where dangerous substances or medication are stored must be kept locked at all times It is a requirement that the records concerning the administration of medication are accurately kept and that a fridge is provided so that liquid medication can be stored at the correct temperature. Timescale for action 31/01/06 3 YA42 13 (4) (a) 31/12/05 2 YA20 13 (2) 31/01/06 Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 23 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 YA21 YA42 Good Practice Recommendations The resident’s wishes and plans for after death arrangements should be fully recorded on their care plans. To ensure infection control measures are fully maintained paper towels should be provided in all toilet areas. Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Lemsford Road DS0000019445.V269242.R01.S.doc Version 5.0 Page 25 - 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!