CARE HOME ADULTS 18-65
Lewis House Higher Merley Lane Corfe Mullen Nr Wimborne Dorset BH21 3EG Lead Inspector
Sophie Barton Unannounced Inspection 13 February 2006 9:30
th DS0000026836.V286546.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 DS0000026836.V286546.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. DS0000026836.V286546.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lewis House Address Higher Merley Lane Corfe Mullen Nr Wimborne Dorset BH21 3EG 01202 887255 01202 887255 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) Mrs Jillian Elborn Mr John Francis Elborn Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000026836.V286546.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th June 2005 Brief Description of the Service: Lewis House is a care home offering accommodation to a maximum of six adults who have a learning disability. The premises are located in a quiet semi rural setting in the village of Corfe Mullen. Local amenities are close by and include churches, a supermarket and a public library. Public transport operates close to the home, taking residents into Wimborne, Broadstone and Poole. The property is a well-maintained detached family style house, with a family atmosphere. The home is staffed 24 hours a day by a small staff team. Mr and Mrs Elborn own and work in the home. Mrs Elborns mother and a family friend also reside at Lewis House. Mr and Mrs Elborn and their family also run 2 other homes, Woodside and a self contained flat. Lewis house offers care and support to service users who are moving towards increasing their independence. Day care is provided and support given for many social activities outside of the home. DS0000026836.V286546.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 13th February 2006 from 9:30am to 1.00pm. There was no prior warning given of the inspection. The registered manager was not available, but one of the proprietors Simon Elborn was present throughout. As well as examining care files, policies and other records, two service users and two members of staff were seen and spoken with informally. The inspector was made very welcome by staff and service users and was assisted in all aspects of the inspection. This inspection focused on the requirements and recommendations made at the previous inspection. What the service does well: What has improved since the last inspection?
There has been improvement in the record keeping relating to service users medical appointments, administration of medicines, and staff recruitment information. Of particular importance is that staff working in the home have been appropriately checked. There has now been appropriate servicing of the fire equipment in the home. The manager has partly addressed a number of requirements. For instance training for staff has been booked, new care plan proformas introduced and fire training organised but as these have not been put into practice yet there continues to be requirements made (see below). DS0000026836.V286546.R01.S.doc Version 5.1 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. DS0000026836.V286546.R01.S.doc Version 5.1 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 DS0000026836.V286546.R01.S.doc Version 5.1 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): 2 is not applicable as there have been no new service users admitted for 2 yrs EVIDENCE: These standards were not assessed at this inspection. Standards 1, 3 and 4 were reviewed in June 2005 and assessed as being met in full. DS0000026836.V286546.R01.S.doc Version 5.1 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 Assessment and care planning systems remain poor, with service users not having an up to date care plan and no record of their personal goals or aspirations. Risk assessment systems also continue to be limited and fail to ensure staff know how to protect service users from harm. Improvement is still needed in relation to the home promoting service users independence with finances. In all other areas, independence is promoted by the home, with service users enabled to make their own decisions about their lives. EVIDENCE: An immediate requirement was made to the registered manager regarding the need to complete up to date care plans for the residents at Lewis House by August 2005 (see previous inspection report). This has not been complied with and five out of the six service users still have limited and out of date care plans. One of the Proprietors, Simon Elborn, confirmed to the inspector that new formats for care plans have been devised but that it has only been completed for one of the service users so far. The inspector was shown the new formats, and they are detailed and appropriate. Risk assessments for service users have also not been developed. There continue to be old and
DS0000026836.V286546.R01.S.doc Version 5.1 Page 10 limited assessments for some of the service users. The new care planning forms will cover identified risks and management of these but again are incomplete as yet. The minimum standards inform providers that service users should be enabled to manage their own finances and that any limitations and restrictions on the service users rights should be clearly recorded in their care plans. As yet this is not stated in their care plans, but the new formats will cover this. The service users benefits are also still paid into the home’s accounts. Although the Proprietors have arranged for service users to have their own bank accounts these have yet to be utilised. Following discussions with service users and staff it was evidenced however that service users are enabled to make decisions about their lives. One service user spoke about their choice of work placements/day activities and that this has been carried through. Another service user spoke about deciding when to have contact with friends. DS0000026836.V286546.R01.S.doc Version 5.1 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): 15, 16 and 17 The home promotes service users rights, individuality and wellbeing which encourages service users to be independent and maintain dignity and privacy. Service users enjoy mealtimes, having a choice of nutritious and healthy meals. Priority is given to encouraging friendships and staff are proactive in supporting service users in maintaining appropriate personal and family relationships. EVIDENCE: Please not that standards 12-14 were fully assessed at the previous inspection and were met in full. Following discussions with service users and staff and observing interactions and routines, the inspector assessed that the house rules and routines promote service users independence and choice. Service users help plan and prepare meals. They take part in household tasks of shopping and cleaning. Meals are flexible and depend on the needs and choices of service users. DS0000026836.V286546.R01.S.doc Version 5.1 Page 12 Service users are able to spend time by themselves and they have unrestricted access to all communal areas of the home. It is a family home with the service users being treated as family members and mixing and socialising as a family does. Staff were seen interacting closely with service users and asking their permission and opinions on things. One service user stated that the staff had helped them arrange a valentine meal with their partner. Two service users also confirmed that contact with family is encouraged and that family and friends are able to visit them at any time. DS0000026836.V286546.R01.S.doc Version 5.1 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 and 20 Health planning and needs assessments are limited, therefore staff do not have sufficient information to be confident that the needs of service users are met. The home provides a high level of flexible personal support to service users, but again limited working records limit the information staff have to ensure they are providing appropriate levels of guidance. However, the recording of health appointments has improved with service users having support with routine health screening. Medication administration recording has improved although written procedures and training for staff remains poor. EVIDENCE: The pharmacy inspector visited the Proprietors other home in August 2005, and a number of the requirements and recommendations made following this visit are applicable to Lewis House. The Proprietors accordingly put into action changes in relation to Lewis House administration of medication. The medication administration forms now include allergies, administration route and a description of the medication. An audit trail is now possible as when medication leaves the home it is recorded. Staff have yet to complete an accredited medication course and the home does not have a detailed medication procedure for staff to follow.
DS0000026836.V286546.R01.S.doc Version 5.1 Page 14 There are no detailed health plans or assessments for service users. There is evidence, following discussions with the proprietor however, that service users have been supported to see specialist health professionals (psychiatrist, psychologist). New forms are now used to track health appointments and to record the outcomes of appointments and tests. Service users have had up to date dental and eye examinations. In discussion with staff, service users and the proprietors it was evidenced that flexible personal support is provided to service users, and that service users are encouraged to be independent in choosing clothes, times for getting up and going to bed, having baths etc. Two service users have very limited verbal communication, but there were no records setting out their preferred routine, likes or dislikes in order to aid consistency and privacy. Without working records or an assessment the staff cannot be sure that they are providing the care that is wanted or needed. DS0000026836.V286546.R01.S.doc Version 5.1 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): Standard 22 and 23 were assessed at the last inspection in June 2005, and were met in full. EVIDENCE: DS0000026836.V286546.R01.S.doc Version 5.1 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): Standard 24, 28 and 30 were assessed at the last inspection in June 2005, and were met in full. EVIDENCE: DS0000026836.V286546.R01.S.doc Version 5.1 Page 17 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): 34 and 35 Staff recruitment practices have improved with service users now protected by the home following safe good practice. Steps have been taken to improve staff training and the skills of the staff team. However, at present the staff team lacks assessed skills and competence in meeting specialist needs of service users. EVIDENCE: An immediate requirement was made at the last inspection in relation to recruitment practices as staff were working in the home without appropriate checks. The proprietor has rectified this with staff files now showing appropriate references, CRB certificate and a POVAfirst check. There were also copies of identification and details of the member of staffs experience and qualifications. The proprietor has also sent off for CRB checks on all existing staff as well. The proprietor has organised an in house training package for staff that meets the induction and foundation training standards. New staff however have yet to start this. The two staff spoken with who were on duty had an appropriate qualification in care. A course has been booked for some staff on learning disabilities and associated needs. Staff continue to need training in autistic spectrum disorder, communication and challenging behaviour.
DS0000026836.V286546.R01.S.doc Version 5.1 Page 18 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, 38, 39, 41 and 42 The service users benefit from a home that is open, inclusive and has a positive atmosphere. The home is well run, however the registered manager is frequently absent from the home and has delegated his responsibilities. Service users therefore need clearer lines of accountability. Quality assurance systems are poor with service users and representatives views not being sought. The home has improved fire safety and record keeping within the home, with procedures now in place to safeguard the welfare of service users. EVIDENCE: The home is owned by Mr John Elborn, Mrs Jill Elborn and their son Mr Simon Elborn. Mr John Elborn is the registered manager. However over the last year John Elborn has semi retired and Simon Elborn has taken over the management of the home. This needs to be formalised with the Commission, as Simon Elborn is currently unregistered to carry out this role and is a breach in regulation. However it remains that the service users and staff spoken with
DS0000026836.V286546.R01.S.doc Version 5.1 Page 19 consider the home to be well managed and that Mr Elborn is a competent and accessible manager. The staff confirmed that John and Jill Elborn are also available if necessary. The staff stated that the home has an open and inclusive atmosphere. Simon Elborn has consistently worked closely with the Commission and the inspector has always been made welcome in the home. The service users were observed enjoying activities in the home and two service users spoken with stated that they felt comfortable and liked the home. Following an immediate requirement made in June 2005 for the need to have fire equipment serviced appropriately there has since been two services of the equipment by a qualified person. Simon Elborn is booked to do a ‘fire marshall’ course. Staff have received basic fire instruction but as yet this has not been taught by someone qualified to do so. Fire drills and evacuations have been carried out, water and food temperature checks taken appropriately, and gas and electrical servicing undertaken. The proprietor confirmed that staff have completed training in first aid and food hygiene. The proprietor has also organised the staff and service user files into better order. DS0000026836.V286546.R01.S.doc Version 5.1 Page 20 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 N/a 3 N/a 4 N/a 5 x 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 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x 1 3 1 x 3 1 x DS0000026836.V286546.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes 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. Standard Regulation Requirement Each service user must have an up to date care plan, detailing how the home is to meet their day to day needs. Assessments and Care Plans must be regularly reviewed. Previous timescale of 01/08/05 not met. The Registered Providers must support service users to have their own bank accounts, so that their money is paid into this account and not the homes account. A clear record must be made, and agreed with the service user and/or their representative, for when restrictions are placed on the service users rights, choice and freedom. Previous timescale of 01/08/05 not met. Risk assessments must be completed and made available to staff for when a risk is identified, detailing how the risks are to be minimised. Previous timescale of 01/08/05 not met. Timescale for action 1. YA6 14, 15 01/05/06 2. YA7 20 01/05/06 3. YA9 13 01/05/06 DS0000026836.V286546.R01.S.doc Version 5.1 Page 22 4 YA20 13 5 YA37 8 6. YA39 24 7. YA42 23 There must be an appropriate medication policy and procedures for the home for staff to follow. The Commission must be informed of the current management responsibilities for the home and receive an application form for the proposed registered manager. The Registered Providers must ensure that they review the quality of care provided by the home regularly. Previous timescale of 01/08/05 not met. Staff must receive regular fire training from a competent person. Previous timescale of 01/08/05 not met. 01/07/06 01/05/06 01/06/06 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations There should be a clear record made of the service users goals and aspirations and how the home is to help to meet these. Care Plans should be developed in a format suitable to the needs of service users. This recommendation is again carried forward from the inspection dated June 05. There should be a clear record kept, and made available to staff, of the service users personal care needs and their preferences to how they would like to be guided. This recommendation is again carried forward from the inspection dated June 05. There should be a detailed record of the service users health needs. Staff who administer medication should complete an accredited medication course.
DS0000026836.V286546.R01.S.doc Version 5.1 Page 23 1. YA6 2. YA18 3 4 YA19 YA20 5. YA35 6. YA39 The Registered Providers should ensure that all staff have at least an NVQ 2 qualification in care or are working towards one. The Registered Providers need to ensure staff have training in autism, challenging behaviour and communicating with service users who have a learning disability. This recommendation is again carried forward from the inspection dated June 05. The home should have an annual development plan, reflecting the aims and outcomes for service users. This recommendation is again carried forward from the inspection dated June 05. DS0000026836.V286546.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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