Inspection on 21/01/08 for Lewis House

This inspection was carried out on 21st January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 14/01/09

Lewis House 21/07/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Lewis House Higher Merley Lane Corfe Mullen Nr Wimborne Dorset BH21 3EG Lead Inspector Heidi Banks Key Unannounced Inspection 21st January 2008 11:45 Lewis House DS0000026836.V358221.R02.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.V358221.R02.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.V358221.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lewis House Address Higher Merley Lane Corfe Mullen Nr Wimborne Dorset BH21 3EG 01202 887255 F/P01202 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 Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th August 2007 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. Public transport operates close to the home, taking residents into Wimborne, Broadstone and Poole. The property is a detached family style house with a family atmosphere. The home is staffed 24 hours a day. The home is owned by Mr and Mrs Elborn who also run two other care homes in the local area. Mrs Elborn’s mother and a family friend also reside at Lewis House. From information provided in September 2007, fee levels for the service range from £575 - £1050 per week. This excludes an additional payment towards fuel costs and costs for chiropody, hairdressing and personal items such as toiletries. Further information on fee levels and fair terms of contracts can be found on the website of the Office of Fair Trading; www.oft.gov.uk. Lewis House DS0000026836.V358221.R02.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 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection of the service. The purpose of the inspection was to assess the home’s progress in meeting the requirements made at the last inspection in August 2007 and the National Minimum Standards. The inspection took place over approximately seven hours on 21st January and 25th February 2008. At the time of the inspection there were six people living at Lewis House. During the inspection we were able to meet some of the people who use the service and observe interaction between them and staff. Discussion took place with Mr and Mrs Elborn and the acting manager of the home. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were given to the home for distribution among care workers in order to obtain their views of the service but none were returned. As this was the second key inspection of the service in the last year, some evidence from the last inspection has been carried forward to this report where there has been no change. A total of twenty-three standards were assessed at this inspection. What the service does well: The home enables people who live there to lead ordinary lives. People live in a home that is in-keeping with other properties in the neighbourhood. They are supported to help with a range of domestic activities and access social and leisure opportunities in their local community. People are supported to have contact with their families as they wish. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: As a result of this inspection, eight requirements have been made, three of which are repeated from previous inspections. People’s support plans show little evidence of regular review and consultation with them. This means that information may not always be up-to-date or centred around the needs and wishes of the people they belong to. In addition, support plans and risk assessments were stored in the office of the home, which is a separate building from the main house. This means they are not easily accessible to the people who use the service or the care workers who support them and risk being a ‘paper exercise’ rather than useful working documents. At the last two inspections it has been noted that one resident self-medicates. Requirements have been made for the provider to fully risk assess this to ensure that the person is getting the support they need to do this safely. The risk assessment had not been done by the time of this inspection and therefore this requirement is repeated. There are continued shortfalls in staff recruitment procedures. This means that people had started in post without all necessary checks being carried out on them. This is of serious concern as it potentially puts vulnerable people at risk. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 7 While there have been some improvements made to staff training, staff employed to work in the home since the last inspection have not undertaken an induction programme that meets the national minimum standards. This means that people who start in post are not being equipped with essential knowledge to help them work safely and effectively with people who use the service. Training records do not show evidence that care workers are accessing specialist training, for example in total communication, autism or learning disability to ensure they know how to provide support for individuals. We were informed that a new fire safety system had been installed in November 2007. However, regular checks of the system and other equipment in the home had not been carried out to ensure they are in working order. There was no evidence in training records that new care workers had received instruction on what action to take in the event of a fire on commencing employment and this must be addressed to ensure that everyone who comes to work at the home can keep people safe. Systems to ensure that the home is managed effectively are not currently in place. Although the registered providers visit the home on a regular basis there is a lack of audit and monitoring systems in place to make sure that the service is meeting the regulations and national minimum standards and that outcomes for people who live in the home are improving. The post of Registered Manager in the home remains vacant. Since the last inspection an application was submitted but later withdrawn. A requirement has been made for the provider to appoint a manager for the home who is fit to be registered with the Commission and competent to run the home in such a way that the regulations are met. Twelve recommendations have been made as a result of this inspection. These should be taken seriously by the provider in order for the home to demonstrate good practice in all aspects of their work and improve outcomes for people who live there. 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.V358221.R02.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.V358221.R02.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): These standards were not assessed at this inspection. EVIDENCE: There have been no new admissions to the home for more than two years. Therefore these standards were not assessed at this inspection. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although in practice people’s needs and choices are taken into account when providing care, documentation is not centred around the changing needs of individuals or used effectively as a working tool. EVIDENCE: At the last inspection support plans were seen to provide a general overview of individuals’ needs and preferences in relation to various aspects of their daily life. At this inspection we looked at a sample of four support plans. One had been written in 2003, one in 2004 and two in 2006 with little evidence of information within the plan being reviewed in the past year in consultation with the person using the service. The acting manager told us that he had not had the opportunity to look at the plans since he came into post in November 2007 as he had needed to prioritise other areas in order to work towards Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 11 outstanding requirements. Support plans are not in a format that is accessible to people who use the service and therefore their ownership and understanding of their plan is limited. At this inspection it was evident that care plans were kept in the office and therefore were not readily accessible to either people who live in the home or the staff who support them as a working document. The deputy manager agreed that people who use the service could be encouraged to participate in creating a support plan for themselves detailing their needs and goals and this was acknowledged as an area for further development. Observation of people in their home continues to show that they are enabled to make choices on a day-to-day basis. For example one person told us that they had made themselves some lunch and had chosen what to eat and it was evident that individuals can make choices about how they spend their time when at home. However, the absence of a robust person-centred plan which lays out individuals’ goals and how the home will help them to achieve these means that there is no written evidence to demonstrate how the home is supporting people to meet long-term goals. Service user meetings are not held on a regular basis in the home so although people are consulted on a dayto-day basis about what they want to do evidence of this consultation is limited to what is observed rather than what is recorded. At the last inspection of the service it was evident that risks to individuals had been given some consideration in their support plans and in general risk assessments. These covered areas such as use of kitchen appliances, fire safety, window openings and stranger danger. Observation of people who use the service and inspection of daily records showed that people’s independence is promoted with people accessing community activities and participating in domestic tasks. We looked at four risk assessments at this inspection. Three out of the four were dated 2006. The acting manager notified the Commission of an incident where one person had fallen during a horse-riding activity. There was no evidence that specific activities have been risk assessed by the home to ensure people’s safety in this area. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are given the opportunity to lead an ordinary life in their home and community that respects their rights. EVIDENCE: On the second day of the inspection two residents were present in the home; the other four people were out at their respective day services. Discussion with the acting manager indicated that the home continues to identify activities that people will enjoy. Daily records showed that people are supported to use community facilities, for example, leisure centres, a local market, shopping centres and restaurants. One person who lives in the home told us that they continue to go horse-riding once a week and work at a charity shop. During the inspection it was evident that two people were being encouraged to create some artwork for the walls of the home, supported by staff. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 13 Observation of people in their home indicated that they are encouraged to take responsibility for some domestic tasks, for example, doing the hoovering, tidying their rooms and going grocery shopping. This was confirmed in people’s daily records. At the last inspection it was evident from daily records that people had been supported to keep in contact with their families and this was confirmed by relatives in surveys. Discussion with one person at this inspection indicated that they had visited their family the previous weekend. There is a pay-phone situated on the stairs of the home for people to use as they wish. Observation of people in their home indicates that they can access all communal areas of the home as they wish and go to their own bedrooms when they want to have some space. Where people are able to be independent in aspects of their daily life, for example, making a cup of tea or taking their medication, this is promoted. Discussion with Mrs Elborn indicated a strong commitment to enabling people to have ordinary lives and promoting their rights to access their community fully. It was suggested to the acting manager that the home is mindful of information relating to residents at Lewis House and residents from another home owned by the provider being on display in the kitchen as this does not protect people’s confidentiality. The menu plan for the home was on display in the kitchen, this showing that people are offered a variety of meals. Daily records and discussion with service users indicated that eating out at cafes and restaurants is encouraged and they enjoy their meal-times. During the inspection, one person was helping prepare a meal for herself and other residents with Mrs Elborn. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal and health care needs are generally met by the home but written records are not always clear enough to ensure that people get the support they need. Although there have been some improvements to medication practices since the last inspection some systems are still not robust enough to fully protect people who use the service. EVIDENCE: At the last inspection of the service it was recommended that care plans should be reviewed to contain sufficient information about people’s personal care needs. For example, in one report it was noted that there was conflicting information about the support needed by the resident, one section stating that the person concerned could carry out their personal care independently, another section stating that they ‘will be prompted and supported’ in doing so. This information needs to be made clear so that anyone reading the plan knows exactly how the person wants and needs to be supported. The acting Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 15 manager has acknowledged that plans have not been reviewed since the last inspection, which was confirmed by examining a sample of plans, and therefore this recommendation is repeated. At the last inspection one relative of a person living in the home told us that the home always met the care needs of their family member, another telling us that this was usually the case. At the last inspection of the service we found that a record of medical appointments was in place for each person who lives in the home, this providing evidence that people had been supported to visit their doctor, hospital, dentist, optician and practice nurse as necessary regarding health issues. A notification made to the Commission since the last inspection indicated that appropriate action had been taken following the fall of a resident with attendance at Accident and Emergency. Discussion with the manager and the provider indicated that there was ongoing liaison taking place with health care professionals to decide on the most effective treatment given the person’s health status. Records for another service user showed that where there had been concerns about a person losing weight this had been followed up by an appointment with a dietitian in January 2008. However, as support plans have not been reviewed since the last inspection, any outcomes from this appointment have not been included in the support plan so that staff know how to provide appropriate support and monitor the situation. At the last inspection a requirement was made with regards to medication practices in the home. Since this time the provider has introduced a new system of administering and recording medicines. A local pharmacy supplies people’s medication in monitored dosage systems and also produces medication administration record (MAR) charts that are used within the home. A sample of MAR charts were seen at this inspection. Information about some medicines had been added in handwriting to the chart by staff but these entries had not been double-signed to ensure their accuracy. Not all MAR charts indicated people’s allergies or ‘none known’ where appropriate. Receipt of medicines from the pharmacy were seen to be recorded on the MAR chart. Since the last inspection people who live in the home have had medicine cabinets installed on their bedroom walls. One person continues to selfadminister their medication and has their own key to the cabinet to promote their independence with this task. The individual’s medication was seen at the inspection and checked against the MAR chart. The number of tablets removed from the monitored dosage system agreed with the records suggesting that medication had been taken as prescribed. The manager told us that audits of the system take place but there was no documentation to support this. At the last two inspections of the service it has been required that a full risk assessment must be put in place for the person who self-administers Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 16 medication. Guidance on completing a risk assessment around medication was given to the previous manager of the service and the acting manager prior to this inspection. However, it was reported that no progress had been made in this area. This must be addressed in order to ensure that all relevant risks are considered and that the safeguards in place are adequate. A medication policy was in place at the last inspection of the service but was not in the policy file at this inspection. As medication practices in the home have changed since the last inspection it would be expected that the policy is reviewed to reflect this. According to the home’s training records all staff working in the home have now attended basic training in the use of the pharmacy’s monitored dosage system. This was also evidenced by certificates on care workers’ training records. It is recommended that the home identifies further training for care workers who take responsibility for administering medication. Guidance on this subject can be found on the Commission’s website; www.csci.org.uk/professional. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 17 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 and 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are listened to on a daily basis but formal systems to ensure that their views are used to improve the service are lacking. Some policies and procedures need improvement to ensure that people are protected from abuse and neglect in their daily lives. EVIDENCE: Inspection of the home’s policy file showed that a complaints procedure is in place which care workers have signed to indicate they have read. The procedure states that people can contact the Commission at any time if they have any concerns or complaints about the home. An accessible version of the complaints procedure is not currently available to people who use the service. At the last inspection one of the two relatives responding to surveys indicated that they were uncertain whom they would contact if the provider could not resolve their concerns. Recommendations were made for the provider to ensure that relatives of people who use the service are aware of the complaints procedure and that the procedure is in a format that can be understood by people who live in the home. These recommendations are carried forward to this inspection. The provider will also need to ensure that the current complaints policy is updated to show new contact details for the Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 18 Commission so that people who use the service have up-to-date information available to them about how to raise concerns with the regulatory body. The home has a complaints book but no complaints have been recorded since the last inspection, this being confirmed verbally by the acting manager. There have been no complaints made by people who use the service or their relatives to the Commission in the past twelve months. However, the home’s Annual Quality Assurance Assessment tells us that people who use the service air their views and concerns on a daily basis. It was discussed that the home should develop a system for recording and monitoring any concerns. The manager agreed that a specific recording framework would be helpful to ensure that information recorded is consistent. Mr and Mrs Elborn have told us that they have increased the amount of time they spend at the home and, as such, are more accessible to people who use the service. This is particularly important at a time when there have been changes in the day-to-day management of the home. Observation of the providers in the home and their interaction with residents both at this, and the last inspection, demonstrated that they know the residents well and people feel happy to approach them with various issues. Inspection of the policy and procedures file at this inspection showed no evidence of a policy on safeguarding adults or whistleblowing, even though the home’s Annual Quality Assurance Assessment tells us that they are in place. At the previous two inspections of the service we have been told that the majority of staff have accessed training in abuse awareness although there have been no certificates on file to evidence their attendance. The acting manager provided us with a training spreadsheet on 18th February 2008 which indicates that both he and one member of staff have attended training in this area in the past three years. The spreadsheet also indicates that all other staff have been booked onto this training scheduled for March 2008. The Commission has not been notified of any safeguarding issues at the home in the past twelve months. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 19 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Lewis House provides a clean, homely and comfortable environment for people to live in. EVIDENCE: Lewis House is a detached family-style home on the outskirts of Corfe Mullen. There are two lounges, a dining area, a conservatory and garden for use by residents. The garden is accessed down steep stone steps. The kitchen is fitted in a domestic style such as that you would expect to see in an ordinary family home. People who live in the home have their own bedrooms, each of which has a hand basin. One bedroom is situated on the ground floor of the home with remaining bedrooms on the first floor which is accessed by stairs. At the last inspection, a tour of the home showed that people have been encouraged to personalise their bedrooms with their own belongings and where redecoration had taken place people had been able to make choices Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 20 about colour. In the past twelve months some redecoration has taken place in the home. At this visit the lock on the toilet door on the ground floor was noted to be ‘sticking’ making it difficult to lock properly. This meant that people’s privacy could not always be promoted. Staff spoken with told us that there was not usually a problem with this but a service user stated that they had also experienced some difficulty. The acting manager agreed to address this issue. The office space in the home is separate from, but attached to, the main house and is accessible from the rear garden. There is a driveway at the front of the home which accommodates the home’s vehicle and there is additional space for parking outside the home. Laundry facilities are situated in the basement of the home. Entrance to the laundry room is via the rear garden. Their location means that it is necessary for people who use the facilities to go up and down the steep stone steps. The provider is reminded of the need to review risk assessments regarding the steps on a regular basis and ensure that safeguards are implemented. At the last inspection, relatives commented on the ‘family-type atmosphere’ within the home which was also evident at this inspection. The home presented as clean and an infection control policy which was last reviewed in June 2007 was seen in the policy file. This gives guidance to staff on the prevention of contamination, dealing with laundry, emergency procedures, cleaning and disinfection. The acting manager reported that all staff had been booked onto external training in infection control and food hygiene in February 2008 in order to promote their awareness of good practice. The training record supplied by the manager confirmed this. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 21 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, 34 and 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service do not always benefit from care workers who have been thoroughly checked and who have received the training they need at the start of their employment to be safe and effective workers. EVIDENCE: Discussion with the acting manager indicated that two care workers have been employed since the last inspection. We looked at both sets of records, both of which contained a letter confirming an offer of employment on 10th December 2007. For one person, no references had been received at the time their employment commenced. A PoVAFirst check had been completed the day before the person’s employment started but not at the time their letter confirming employment had been sent. An employment history dating back five years had been included in the person’s application form and proof of identity was seen on file. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 22 For the second person two references and a PoVAFirst check had been completed before the offer of employment was confirmed and there was proof of identity on file. One reference was from a colleague at the person’s previous workplace rather than their employer. At the time of the inspection there was no documentation in place to evidence receipt of a satisfactory disclosure from the Criminal Records’ Bureau although the checklist at the front of the file indicated this was in place. A copy of the disclosure was obtained by the end of the inspection process. The home’s training and development policy says ‘All new members of staff will be put through an induction training programme through the ARC training and development programme in association with LDAF’. The acting manager told us that he had developed an induction checklist that identifies areas that new staff should be introduced to at the start of their employment. This includes reading policies, procedures and guidelines. The checklist did not refer to fire safety so there was no evidence that the two new care workers had received fire instruction at the start of their employment. Discussion with the acting manager indicated that there is no other induction framework in place at the home as stated in their policy and there were no records on file to show that people had undertaken an induction programme to meet ‘Skills for Care’ specifications. The staff training record supplied to us by the acting manager on 18th February 2008 indicates that one person who works at Lewis House is qualified to National Vocational Qualification Level 2 standard and three care workers have been booked onto this training since the last inspection. The deputy manager at the home has recently started her NVQ Level 4 in Care. We looked at training records in the home which indicated that the person who has a NVQ Level 2 was awarded this in Child Care which would not be relevant for her role at Lewis House. According to the training record at the home the majority of staff have now completed training in challenging behaviour. Certificates for some staff were seen on their training files but it is recommended that the provider ensures that copies of all certificates are on record to evidence people’s attendance. Certificates on training files indicated that some staff have attended training in administering oxygen which enables them to be competent in supporting a person who uses oxygen in the home. The acting manager told us that this training would be arranged for people who had not attended previously. The home’s training record indicates that the acting manager and deputy manager have undertaken training in Makaton but there was no evidence to indicate that others had attended total communication training which would help them to understand and respond to the non-verbal communication of one person who lives in the home. The acting manager and deputy manager have recently undertaken training in depression and the Mental Capacity Act although this has not yet been rolled out to the staff team. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 23 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, 40, 42 and 43 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although the home has made some progress in meeting outstanding requirements management systems are inadequate to ensure that the home is able to monitor and improve itself to promote best outcomes for people who live there. EVIDENCE: The registered providers of Lewis House are Mr and Mrs Elborn who also own two other care homes in the local area. At the last two inspections a requirement has been made that the provider must submit an application to register a manager with the Commission. Since the last inspection an application has been submitted but later withdrawn. Therefore the post of registered manager continues to be vacant. There is an acting manager in Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 24 post and the providers have recruited a deputy manager to assist with the management of their care homes. Mr and Mrs Elborn reported that they are more actively involved in the running of the home as a result of concerns highlighted at previous inspections. This was confirmed by the acting manager who told us that the providers are supporting him in implementing change within the home. However, some shortfalls identified at this inspection, which have also been identified at previous inspections, indicate that the provider must undertake regular checks and audits of systems in the home to ensure that the regulations are consistently being met. At the last inspection there was evidence that the views of people who use the service about the care they receive had been sought by means of surveys. People had been asked for their views on their care workers, choices available to them, activities and outings, meal-times, their relationships with the people they live with and the way in which the home is run. Responses from people who live in the home were seen to be very positive. It was suggested that the provider expands the quality assurance process to include people who visit the home such as relatives and care professionals. An annual development plan for the home based on responses from the surveys had not been developed. There was no evidence at this inspection that these areas have been followed up or that the provider is using internal quality assurance systems as a tool for monitoring how well the home is meeting the needs and wishes of people who live there. The home has a series of policies in place which were in two files. These include policies on assisting people with personal care, risk assessment, training and development, recruitment and selection, food hygiene, infection control, confidentiality and equal opportunities. These had been signed by care workers to indicate that they had read them. However, some policies which we would expect to be in the files were not there, for example, a policy on dealing with violence and aggression, the death of a service user, missing persons and management of service users’ money, valuables and financial affairs. This was highlighted with the acting manager who agreed to undertake a review of all policies to ensure that all necessary procedures are in place and easily available to staff for reference. The content of a sample of policies was reviewed at this inspection. The home’s policy on personal care contained some general guidance for staff, for example, ‘Help client transfer to bath or step in the shower. Assist with washing hard-to-reach areas’. However, this does not reflect the diversity of individuals’ needs and preferences and information of this nature should be contained within people’s personal support plans rather than in a policy document. The home’s policy on risk assessment tells us that ‘the findings of risk assessments are recorded on Form HS11. The health and safety risks identified are communicated to staff by the safety officer and head of Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 25 department through training and in written form by memo’. This does not reflect the practice of this care home which does not have a ‘safety officer’ or ‘head of department’ and provides potentially confusing information for care workers who need to know how risks are identified, assessed and recorded. The moving and handling policy seen contains unsafe guidance; ‘Seat client in a chair facing the bathtub…have the client hold onto the grab bars or edge of the bath to bring him / herself to a sitting position on the edge of the tub. Help the client lower him / herself into the bath…if necessary, you can assist by holding him / her around the waist. If the client has trouble getting out of the tub, help him to his hands and knees.’ Such guidance does not take into account the individual needs of people who use the service or individual risk assessment. At the last inspection there was evidence that this policy had been reviewed. However, the original policy was the only one seen on file at this visit. The content of policies was an area highlighted with the acting manager at the conclusion of the inspection who was advised that policies should reflect practice and be based on current legislation in order to ensure care workers have the information they require to keep people safe. Significant progress has been made by the provider in ensuring care workers receive suitable health and safety training to equip them for their role. A staff training record supplied to us by the acting manager indicated that staff have either attended, or been booked onto, training in food hygiene, health and safety, emergency aid, infection control and moving and handling. The home has a fire safety policy which states that ‘Instruction is given to staff within one month of appointment or as soon as possible after employment. All staff are given refresher training at least once every three months and the management give fire appliance instruction to all new members of staff’. The record of a member of staff employed to work in the home since the last inspection did not show evidence that any fire safety training had been given to them at the start of their employment. A sample of five other care workers’ fire training records showed that three of the five had undertaken training in January 2007, one in May 2006 and one showed no evidence of training in fire procedures. This was highlighted to the acting manager on the first day of the inspection who contacted a training agency during the inspection to organise training for all staff. The manager told us on the second day of the inspection that staff had now attended this training. Inspection of certificates on a sample of training records showed that most care workers had completed the training on 4th February 2008. The training record supplied to us by the acting manager indicated that two care workers who had not attended the training have been booked onto a course in April 2008. It was not clear from any records seen whether one other member of staff had either attended, or been booked onto, the training. Therefore care must be taken to ensure that training Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 26 records in the home are accurate and consistent in the information they provide and there is a system in place to identify when staff require updates. On the first day of the inspection there was no written record available to evidence the last fire drill or test of alarms and equipment taking place in the home. The acting manager told us that he had archived previous records and that testing of the system and drills had not been carried out since the installation of a new fire detection system in November 2007. The acting manager told us that senior staff in the home would be meeting with the agency responsible for installing the new system later that week to look at how it works after which tests and drills could begin. A fire risk assessment was in place at the time of the inspection dated 19th November 2007. Individual evacuation plans for each resident had not been included in the risk assessment. A chart to record refrigerator temperatures on a daily basis was seen in the kitchen. A few gaps were noted on the chart where temperatures had not been recorded. Lewis House DS0000026836.V358221.R02.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 X 2 N/A 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 2 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 2 33 X 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 X 2 1 X 2 2 Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 28 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. 1. Standard YA6 Regulation 15(2)(b) Requirement The service user plan, and any associated risk assessments, must be kept under review in consultation with the person using the service. This helps ensure that information about people’s needs is up-to-date and the care provided by the home continues to meet their needs and preferences. 2. YA20 13(2) The risk assessment for one service user who self-medicates must contain sufficient detail to ensure that all relevant risks have been considered and adequate control measures are put in place. This will help ensure that people who use the service benefit from safe medication practices and their healthcare needs are met. This requirement is repeated from the last two inspections of the service as the previous Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 29 Timescale for action 30/04/08 30/04/08 timescales of 01/07/07 and 31/12/07 have not been fully met. 3. YA34 19 The registered providers must ensure that there is full and satisfactory information available in relation to all persons working in the care home in accordance with Schedule 2 of the Regulations before people start work in the home. This helps ensure that people who use the service are fully protected by the people employed to provide their care. This requirement is repeated from the inspections of the service on 21/06/06 and 28/08/07. The previous timescale of 01/12/07 was not fully met. 4. YA35 18(1)(c) The registered person must ensure that the persons employed to work at the care home receive induction training that meets ‘Skills for Care’ specifications and training that reflects the diverse needs of service users. This will help ensure that care is provided safely and effectively to people who use the service and they benefit from a skilled and qualified workforce. This requirement is repeated from the last two inspections of the service as the previous timescales of 01/07/07 and 31/12/07 have not been fully met. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 30 01/04/08 30/04/08 5. YA37 26 The registered provider must make visits to the care home at least once a month to carry out the duties listed in Regulation 26 and prepare a written report on the conduct of the care home after each visit. The registered provider shall supply a copy of the report to the Commission. The registered provider shall establish and maintain a system for evaluating the quality of the services provided at the care home. This must provide for consultation with service users and their representatives and take into account how the home is responding to requirements and recommendations made by the Commission. 30/04/08 6. YA39 24 01/06/08 7. YA42 23 This will ensure that the home is meeting the needs of people who live there and is complying with the regulations. 01/04/08 The provider must ensure that fire drills and fire safety checks are carried out in line with the home’s fire risk assessment and clear records are kept to evidence this. All new care workers must receive appropriate instruction on fire safety procedures at the start of their employment which must be clearly recorded. This will help ensure that people’s safety is maintained in the event of an emergency. Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 31 8. YA43 8(1)8(2) To comply with Section 11 of the Care Standards Act (2000) the registered provider must submit an application to register a manager with the Commission for Social Care Inspection. This will promote clear lines of accountability for people who use the service. 01/06/08 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 YA6 Good Practice Recommendations Service user plans should be developed in consultation with service users and their representatives. Those involved in the formulation of the plan should sign to indicate that they agree with the content. 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. 2. YA9 Risk assessments should contain clear strategies for staff regarding the management of specific risks. Risk assessment documentation should show evidence of regular review. 3. Lewis House Individual plans should contain sufficient information about DS0000026836.V358221.R02.S.doc Version 5.2 Page 32 YA18 service users’ personal care needs so that it is very clear what care workers need to do to support them effectively and meet their needs. Individual support plans should contain sufficient information about people’s health care needs so that care workers know what they should do to support them effectively. The home’s medication policy should be kept in an easily accessible place. Handwritten entries on medication administration record (MAR) charts should be double-signed by two members of staff to ensure that information is accurate. Regular audits of medication should be carried out and a record of these checks kept on file. Individuals’ allergies should be specified on their medication administration record (MAR) charts or state ‘none known’ as appropriate. Further accredited training in medication administration should be identified for care workers who take responsibility for this. The home’s complaints procedure should be in a format that is accessible to people who use the service. The home should consider ways in which day-to-day concerns that may arise are documented and responded to in order to provide a clear audit trail of how positive outcomes for service users are achieved. The home should ensure that relatives of people who use the service are aware of the complaints procedure. 4. YA19 5. YA20 6. YA22 7. YA23 The home’s safeguarding and whistle-blowing policies should be kept in a place that is accessible to staff. All staff should undertake training in abuse awareness and certificates to evidence this should be kept on file. The registered providers should ensure that all staff have at least an NVQ 2 qualification in Care or are working towards one. The provider should ensure that references obtained for prospective care workers are sufficiently robust to ensure DS0000026836.V358221.R02.S.doc Version 5.2 Page 33 8. YA32 9. YA34 Lewis House that decisions made to employ people are based on suitable information. 10. YA39 The home should have an annual development plan reflecting the aims and outcomes for service users. 11. YA40 The care home should develop policies, procedures and / or codes of practice appropriate to the setting on the topics set out in Appendix 2 of the National Minimum Standards. The home’s policies and procedures should reflect practice within the home and be based on current legislation and best practice. Policies and procedures should be signed, dated, monitored, reviewed and amended. All staff working in the home should have regular opportunities to take part in fire drills / practice evacuations. Individual support plans should include a plan for evacuation in the event of an emergency. Systems should be put in place to ensure that care workers receive update training in fire safety at intervals determined by the home’s fire risk assessment. 12. YA42 Lewis House DS0000026836.V358221.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection 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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