Inspection on 14/01/09 for Lewis House

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lewis House 23/01/10

Lewis House 21/07/08

Lewis House 21/01/08

Lewis House 28/08/07

Lewis House 07/03/07

Lewis House 21/06/06

Lewis House 13/02/06

Lewis House 08/06/05

Lewis House 22/02/05

Lewis House 25/08/04

Lewis House 18/03/04

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 19/06/2009.

CARE HOME ADULTS 18-65 Lewis House Higher Merley Lane Corfe Mullen Wimborne Dorset BH21 3EG Lead Inspector Jo Johnson Unannounced Inspection 14th January 2009 10:00 Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lewis House Address Higher Merley Lane Corfe Mullen Wimborne Dorset BH21 3EG 01202 887255 01202 888820 lewis.house@btconnect.com 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 Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st July 2008 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 home is located in a quiet semi-rural setting on the outskirts of Corfe Mullen. Local amenities are close by and include churches, a supermarket and a public library. A public transport route into nearby towns operates close to the home. The property is a detached family style house with a family atmosphere. The home is staffed 24 hours a day including a sleep-in duty at night. The home is owned by Mr and Mrs Elborn who also run two other care homes in the local area. The registered provider’s mother also lives at the home. She is not included within the registered numbers permitted at the home. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. This inspection visit was unannounced (we did not let the home know that we were coming) and took place on 14th January between 9.30 am and 1 pm by two inspectors. The lead inspector returned at 4.30pm to spend more time with the people who live at the home. The inspection involved; Observations of, talking and Makaton signing with the five people who live at the home and the staff on duty and the acting manager. Two people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. This inspection was carried out by two inspectors, but throughout the report the term we and ‘us’ is used, to show that the report is the view of the Commission for Social Care Inspection. What the service does well: People living at the home see it as their own and are very relaxed in all areas of the home. The environment is warm and welcoming and the home is clean and tidy. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 6 There is a low staff turnover and stable staff team. This means that people living at the home have a regular team of staff who have a good understanding of their needs. Most people go to day or community day services or work for part of the week. For the rest of the time they are supported to stay at home or do other things in the community. People are supported to maintain relationships with their families and other important people. The people living at the home have good positive relationships with staff. People living at the home get on well with each other. Staff have regular support and guidance meetings with their managers. What has improved since the last inspection? There has been good progress on meeting the ongoing requirements from previous inspections. This means that there have been improved outcomes for people living at the home. Care plans have been reviewed with individuals and are supported by symbols and pictures. There is now a new medication policy so staff know how to safely give people their medication. The way the people’s money is looked after has changed. Everyone now has their own bank account. The house and garden are now as safe as possible. There is now a staff rota that shows who is on duty. There are more staff on duty when people need more support or want to do different things away from the other people in the house. New staff are fully checked to make sure they are safe to work with people before they start work at the home. Staff are now trained so that they are able to safely work with people who live at the home. Health and safety at the home has improved. Equipment is now safety checked. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is, good People’s needs are assessed and some people are provided with accessible information so that they are clear about their rights and entitlements at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service User Guide is now supported by pictures, which makes it easier for people with learning disabilities to understand the services in the home. This has been updated to include the contact details of the commission. The guide should be made more accessible by using photographs the home and of key people, such as the providers and staff. This is so the information is more accessible to the two people who have different ways of communicating. There have been no new people admitted to the home for two years so the outcomes for any new person coming to live in the home could not be assessed. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 10 The assessments in people’s care records that have been reviewed recently. This means that staff have up to date information about people’s needs. However, as detailed in the ‘individual needs and choices’ section, there are some areas identified that have not been planned for. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate Care plans and risk assessments are not always detailed enough or completed for all areas identified in assessments to ensure that people’s specific needs are identified and met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people’s assessments and care records were seen. Since the last inspection, all of the assessments and care plans have been reviewed. The information was supported by pictures so it was easier to follow for some people. We went through one person’s care plans with them. They were more accessible but not all of the people at the home can see the font size or understand the pictures. When we used photos with one person they were able to understand and their communication increased. The font size should be increased and photographs should be used for those people who will find it easier to understand. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 12 There has been progress on developing care plans and involving people in the reviews. One person told us that “I have done my care book with xxx she’s my key worker”. There were some areas that had been identified in people’s assessments that had not been planned for or risk assessed. For example: One person’s assessment identified that they need support to manage personal relationships and friendships. The assessment also referred to risks relating to this area in their lives. There was no specific plan for this area of the person’s life nor was there any risk assessment or management plan. Another person’s assessment included a communication assessment by health professionals and the home. The plan gave some detail of how the individual communicates but there needs to be further development of the individual communicates and describe what tools need to used to aid communication. The plans seen lack detail, in specific areas, in the action staff need to take to support people and to minimise and promote positive risk taking. There has been some progress in promoting people’s independence and involvement in the day to day living at the home. Advice of occupational therapists have been sought to assess one person’s abilities. Each person’s file contained a brief personal profile. These were not up to date and did not give a full picture if people’s lives and who they had previously lived with and detail important milestones in their lives since and before moving into the home. It is important that these profiles are updated as at least two of the people living at the home communicate differently. This is so staff have full information about people, so they can meet all of their assessed needs and have a greater understanding of them as an individual. There is a stable staff team at the home at the moment and they know people well. However, there are plans to recruit additional staff that will not know the people who live at the home. People living at the home do not have ongoing ‘life story’ books and when people where asked if they had photos or anything to show what they had been doing they did not have anything accessible. ‘Life story’ books have photographs and items in them that show what the person has been doing in their lives. One person had a book completed with the college with photos in but this did not reflect anything that they do with the home. ‘Life story’ books have photographs and items in them that show what the person has been doing in their lives. Staff should develop ‘life story’ books/works with people living at the home, as these give a much more Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 13 interesting picture of how people have been spending their time and people may find them easier to follow than written records. This means that people can be actively involved in the monthly reviews of their plans and goals. ‘Life history’ books should be developed that includes details and photographs of their ‘history’ such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14,15,16, 17 Quality in this outcome area is good People participate in a range of social, leisure, and educational and occupational opportunities. People have opportunities to maintain their lifestyles in and outside the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the start of the inspection only one person was at home, they then went to their workplace at a charity shop. The four other people were at community day services. We spent time with all five people in the early evening. They were spending time in the lounge with all the people who live at the home, including the provider’s mother who also lives there. We observed positive family type relationships between all of the people who live at the home. People spoken with told us that they all get on well with each other. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 15 People chose to spend time in different parts of the home throughout the visit including in their bedrooms. Two of the people were going out to a community club later in the evening. Care plans now included information about people’s cultural and religious preferences. One person told us that they sometimes like to go to church with the provider’s mother. Another person who is supported by the providers who lives locally continues to visit the home. The acting manager and one person living at the home told us that they are visiting less. People told us that they can have friends over but that this doesn’t happen very often. People are supported to maintain contact with families and other important people in their lives. At least one person living at the home may benefit from guidance and support in personal relationships. Staff should be provided with personal relationship and sexuality training or information to make sure that they can safely inform and support this individual. From talking and Makaton signing with people, they told us that they can choose how to spend their time during the week and that they can do what they want at the weekend. Each person has some planned days at day services or community activities. Since the last inspection the way the home is staffed has been reviewed. The acting manager told us that a further member of staff is to be appointed to support people in the evenings to access community activities if they choose. Two people told us that they are joining the Gym and one person is going to try trampolining. Staff spoken with told us that people are needing some encouragement to try new community activities. They are continuing to try different things with individuals and will pursue them if they are successful. There are now weekly meetings between the people at the home. This includes menu planning. One person told me “I’m going to start cooking soon” another person Makaton signed ‘cooking, food and thumbs up’. This is positive that people are being encouraged to take a more active role in day to day routines in the house. This should continue for all of the people living at the home. A collection of photographs of food should be developed so that the people who communicate differently can participate in the menu planning on a weekly basis. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 16 Staff told us and menus show that they are promoting healthy eating and are ensuring that one person who is nutritionally at risk eats a healthy balanced diet. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good The health and personal care that people in this home receive is based on their individual needs. In the main medication systems in place are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were positive relationships and interactions observed between staff and the people who live at the home. The staff encouraged and supported people in a relaxed way. People and staff clearly enjoyed each other’s company, smiled, and laughed with each other and staff. Two of the people spoken with said that they like and get on well with the staff. One person signed ‘good’ when talking about staff. There is a predominately female staff group that support the people with personal care. Individual’s preferences of gender of carer for personal care are not included in their assessments or care plans. This should be recorded so Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 18 that wherever possible (dependent on the staff group) these preferences can be met. People’s health records and care plans showed that their right to good-quality physical and mental health care is being promoted. The records show that as part of promoting their health people make regular visits to a dentist, optician, specific health consultants, their GP and a chiropodist when needed. One person has seen the dietician and their plan gives information about how to supplement the individual’s diet. The individual has recently gained weight following the dietician’s advice. People do not have ‘Health Action Plans’ at the moment. There are plans to ensure that all of the people have specific health reviews with specialist nurses and the local GP practice. This should be followed up to ensure that people have accessible information from health professionals about their health. Since the last inspection, the medication policy has been reviewed. Staff are trained in the medication policies and procedures during induction and there is a now a medication training programme. Staff who have not completed medication training have been booked on course over the next month. Confirmation of these bookings was seen. Medication administration records seen were correct. However, the quantity of medication was not signed into the home. The amounts or quantity of medications must be recorded on the medication records. This is to make sure that it can be audited and that people are receiving the correct dosage of medicines. The head of care actively monitors the administration and completion of the medication records on daily basis. A monthly medication audit should be included in the quality assurance system. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate People who use the service are listened to by staff and procedures are in place to respond to complaints. More robust financial monitoring systems are needed to make sure that people are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints information has been reviewed since the last inspection. The information is in a written format and includes the name of the previous inspector as a contact. The complaints procedure should be in large print and should be supported by pictures and photographs of the people that individuals can complain to. It is also recommended that just the contact details of the commission be included in the information rather than named individuals. People told us that they would talk to ‘staff’, ‘xxx my key worker’ or ‘xxx(acting manager)’ if they were unhappy. There have been no complaints made to us about the home since the last inspection. There have been two complaints recorded in the complaints record. They were both investigated by the acting manager and showed actions taken. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 20 There has been one safeguarding referral relating to the management of peoples’ finances since the last inspection. This investigation is ongoing. Since the last inspection all of the staff and the new proposed providers have attended adult protection and safeguarding training. Staff spoken with were clear on the actions they needed to take to refer any allegations of abuse. The financial systems and policies at the home have been reviewed since the last inspection. All of the people now have individual bank accounts and they are invoiced for any expenses. This included their contributions towards their care provision and a daily rate for petrol contributions for the car. The way that people contribute towards the petrol for the car must be reviewed. At the moment everyone is charged a daily rate regardless of whether they have used the car or not or what distance was travelled. Any contributions towards the petrol for the car must be based on actual usage. People told us that they go to the bank with staff to draw their money out and that staff help them with their finances. Staff support people with their finances on a weekly basis and this is part of their care plan. There are some auditing systems in place for the money that people draw out of the bank (cash flow). There continue to be financial records in a number of separate files. There needs to be monthly audit of peoples’ finances that includes their bank account, invoices and the cash flow sheets. The individual should be part of this review where possible. This financial monitoring should be part of the quality assurance system so that the acting manager or proposed provider is able to audit the management of people’s finances. All of the people at the home have been reviewed by their funding authority and alternative arrangements for the appointees of people are being investigated. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good People live in a homely, comfortable and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lewis House is a detached family-style home on the outskirts of Corfe Mullen. There are two lounges, a kitchen, a dining area, a conservatory and garden. The acting manager and proposed providers have developed a programme of refurbishment and redecoration for the home. There is now an employee who is responsible for the ongoing maintenance at the home and the other homes in the organisation. The provider’s mother has the use of a private bedroom and shares the communal areas with the other people who live at the home. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 22 The rear garden is accessed down steep stone steps. These steps have been risk assessed since that last inspection. The risk assessment was seen and there is a notice with pictures showing that people need to hold onto the handrail. However, this sign was in the office and not at the top of the stairs as it should be. There is a warm and welcoming atmosphere in the home and at the time of the visit, it was homely, comfortable and safe. People living there were able to move around easily and freely and to go to their bedrooms if they chose. The home was clean and free from any offensive odours. People living in the home were happy to show us their bedrooms. The bedrooms reflected their individual lifestyles, interests and tastes. People at the home have not been routinely involved in cleaning and tidying of the house alongside staff. The staff are encouraging people to take a more active role in the upkeep of their home. One person said that the staff help them with their laundry. Peoples’ laundry is now done on an individual basis to make sure that people always have their own clothes. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34, 35 Quality in this outcome area is good The people living in this home are protected by robust recruitment practices and supported by a trained, stable staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the staffing at the home has been reviewed. There is more support for people in the mornings and at weekends. One of the heads of care is providing additional support for evening activities until they have recruited another staff member. The staff rotas for one month were seen. They now reflect an accurate record of what was worked. The rotas should include staff’s full name and role so it is clear who is working and in what capacity. The home has a very low turnover of staff with no staff have left the home since the last inspection. This means that a consistent staff team that they know well supports the people living at the home. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 24 As no new staff have been employed at the home, we looked at the staffing records for the whole organisation to assess whether requirements made at previous inspections have been met. The four most recently recruited staff records were seen. They included all of the necessary documentation to demonstrate that the staff are suitable to work with people at the home. There were CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks and references for all of the staff. The staff training matrix and all of the individual training records were seen. All staff have recently completed adult protection training, the acting manager is booked on this as well. Total communication and medication training is booked. Other training that has been provided since the last inspection includes, infection control, introduction to risk assessments and food hygiene. The induction programme in place does not meet the ‘skills for care’ induction standards. This means it is not clear whether staff have the right skills and knowledge on completion of their induction. The acting manager took immediate action and obtained the ‘skills for care’ induction standards. He gave a commitment for all of the staff recruited to the organisation since the last inspection to complete these induction standards. Discussion with staff, acting manager, the heads of care and records show that they had regular supervision and staff meetings. Staff spoke positively of the changes and improvements to the home since the last inspection. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42,43 Quality in this outcome area is adequate People benefit from living in an improving home. They know that their views will be listened to and that management and monitoring systems are improving. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the new providers and acting manager have applied to the commission to be registered. However, due to uncertainty about the proposed size of the organisation and other unavoidable delays the applications to be registered have not yet been re-submitted. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 26 Since the last inspection the registered providers have stepped back from the day to day management of the organisation. The proposed providers have taken over the total management of the organisation. The acting manager submitted an improvement plan following the last key inspection. However, we had to formally remind the acting manager to submit this plan. We subsequently arranged a meeting with the registered providers, the proposed providers and acting manager to go through the plan. There has been steady improvement at the home and the improvements needed following the previous inspections have been made. There is not any complete way of monitoring the quality of the service at the home. Surveys have been developed to consult relatives and people who live at the home. As identified throughout the report all information needs to be accessible to the people at the home. The proposed provider is now completing Regulation 26 monitoring visits. There are weekly meetings with the people living at the home. The quality assurance system also needs to include the monitoring of people’s finances, consultation with health and social care professionals, peoples’ assessments, care planning and record keeping, medication audits and be used to produce an annual development plan for the home. Since the last inspection the acting manager has reviewed all of the policies and procedures. Staff told us that they are required to sign when they have read and understood each one. A sample of Health and Safety records were checked. These records showed that health and safety matters are now well managed. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 3 2 Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 28 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 YA6 Regulation 14, 15 Requirement Peoples care plans must be reviewed, kept up to date, and include all the individuals needs identified in their assessments. Timescale for action 01/07/09 2 YA9 13, 14 This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. Any areas of risk identified for an 01/05/09 individual must be assessed and these assessments must include promoting independence and personal and sexual relationships. This is so that any risks are minimised and staff know what action to take to keep people safe whilst promoting positive risk taking. 3 YA20 13 The amounts or quantity of medications received into the home must be recorded on the medication records. This is to make sure that it can 01/04/09 Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 29 be audited and that people are receiving the correct dosage of medicines. 4 YA23 13 The way that people contribute towards the running costs of the cars must be reviewed. Any contributions towards the petrol for the car must be based on actual usage. This is to make sure that people only pay for what they use. The management of the home must further develop effective ways of involving people, assessing and monitoring the quality of the service. This is so that any shortfalls are identified, are improved on and the quality of the service is kept under constant review. 01/03/09 5 YA39 24 01/08/09 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 YA1 Good Practice Recommendations The service user guide should be made more accessible by using photographs the home and of key people, such as the providers and staff. This is so the information is more accessible to the two people who have different ways of communicating. Care Plans should be further developed in formats that are accessible to individuals. Goal-setting processes should be specific, measurable and time-limited. It should be clear from the plan who is responsible for supporting the individual in achieving their goals, by when and how progress will be monitored. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 30 2 YA6 Where care professionals have made recommendations regarding people’s needs this information should be clearly detailed in the person’s care plan. 3 YA6 People’s care plan profiles should be updated. This is so staff have full information about people, so they can meet all of their assessed needs and have a greater understanding of them as an individual. Staff should develop ‘life story’ books/works with people living at the home, as these give a much more interesting picture of how people have been spending their time and people may find them easier to follow than written records. This means that people can be actively involved in the monthly reviews of their plans and goals. ‘Life history’ books should be developed that includes details and photographs of their ‘history’ such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. Risk assessments should contain sufficient detail to clearly identify potential risks and specify the action that needs to be taken by care workers to keep people safe. A collection of photographs of food should be developed so that the people who communicate differently can participate in the menu planning on a weekly basis. People’s preferences for the gender of staff for personal and intimate care should be recorded so that wherever possible (dependent on the staff group) these preferences can be met. This is so their wishes are respected and their dignity maintained. Staff should be provided with personal relationship and sexuality training and/or information to make sure that they can safely inform and support people in this area. ‘Health Action Plans’ should be followed up to ensure that people have accessible information from health professionals about their health. The complaints procedure should be in large print and should be supported by pictures and photographs of the people that individuals can complain to. Just the contact details of the commission should be included in the information rather than named individuals. Audits of peoples’ finances that includes their bank DS0000026836.V374180.R01.S.doc Version 5.2 Page 31 4 YA6 5 YA6 6 YA9 7 YA17 8 YA18 9 YA18 10 11 12 13 YA19 YA22 YA22 YA23 Lewis House 14 15 YA24 YA33 account, invoices and the cash flow sheets should be completed monthly. The individual should be part of this review where possible. This should be part of the quality assurance system so that the acting manager or provider is able to audit the management of people’s finances. The sign highlighting the risk of the stone steps in the Garden should be displayed at all times. This is so that people know what action to take to keep safe. The staff rotas should include staff’s full name and role. This is so it is clear who is working and in what capacity. Lewis House DS0000026836.V374180.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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