Inspection on 21/07/08 for Lewis House

This inspection was carried out on 21st July 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 17 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 21/01/08

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 19/12/2008.

CARE HOME ADULTS 18-65 Lewis House Higher Merley Lane Corfe Mullen Wimborne Dorset BH21 3EG Lead Inspector Heidi Banks Key Unannounced Inspection 21st July 2008 10:25 Lewis House DS0000026836.V365970.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.V365970.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.V365970.R02.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 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 Post Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st January 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. Mrs Elborn’s mother also resides at Lewis House. From information provided in September 2007, fee levels for the service range from £486.88 - £1070.60 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.V365970.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 inspection took place over approximately twelve hours on three days in July and August 2008. The lead inspector was accompanied by Tracey Cockburn, Regulatory Inspector, on two days of the inspection. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the eight requirements made at the last key inspection in January 2008. At the time of the inspection there were five 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, members of the current management team in the home and some care workers. 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 sent to the home before the inspection for distribution among people who use and have contact with the service. We received a total of two surveys from people who use the service, three surveys from relatives of people who use the service and one survey from a health care professional who has contact with the service. We have also spoken with a relative of a person who lives in the home. Before the inspection we requested that the provider complete an Annual Quality Assurance Assessment to give us some written information and data about the home. However, this was not returned to us within the set timescale. Twenty-eight standards were assessed at this inspection. What the service does well: During the inspection we spoke with people who use the service about their experience of living in the home. People who live at Lewis House have been there for several years and see it as their home. People we spoke with were happy and settled there. There is a sociable, family atmosphere in the home and people who use the service appear to get on well with each other. The environment is homely and comfortable and there is enough space for people to spend some time on their own or in the company of others. People have Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 6 personalised their bedrooms with their own belongings to make their space their own. We observed some positive interaction between people who use the service and care workers. People who returned surveys to us told us ‘(There is) a nice family feel with good atmosphere between staff and residents’ (Relative) ‘X is happy, that tells me her needs are met, she enjoys living there and does not want to change’ (Relative) ‘The staff are very nice and friendly to me and help me when I want help. They make me happy’ (Service user) What has improved since the last inspection? What they could do better: We have seen some evidence of the service putting systems in place to address shortfalls identified at previous inspections. However, the progress they have made to date has not always been enough to fully meet the Regulations. The new manager of the home showed awareness of some of these areas which he reports he plans to address. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 7 For example, the recruitment process does not always ensure that there is enough information on which to base sound decision-making about the appointment of new care workers. There are still some serious gaps in training for care workers and we were concerned that the rota shows that individuals with limited training have been allocated to work alone. Staffing levels also need review to ensure there are always enough care workers on duty to fully meet the needs of people who live in the home. The home’s rota is not an accurate record of who worked in the home on specific days and this needs to be addressed to ensure that clear, accurate records are maintained. The home needs to show a more pro-active approach to meeting people’s personal and health care needs. There needs to be clearer information in people’s care plans about people’s requirements to ensure that care workers know how to support them. Where care professionals have written assessments about people’s needs this information should be included in the plan. In addition, there needs to be a clear written record of all the health care appointments attended by individuals so that there is evidence about how their needs are being met, for example with regards to dental check-ups or chiropody. Some areas of medication practices and training also need review to ensure that systems are robust and effectively audited. Although progress has been made in relation to updating the care plans and risk assessments for some people who live in the home this piece of work is not fully completed. The risk assessments we looked at were not detailed enough to inform care workers of identified risks and the level of support people need to ensure risks are minimised. The manager has told us that these are a work in progress and that staff with responsibility for completing risk assessments will be given training to promote their competence in this area. Information on handling people’s money in the home is limited. There is no policy about this in the home and a lack of information about arrangements in place for each service user. The home must implement a system of regular audits to ensure the safe management of people’s money. There are some areas of the home environment that need to be risk assessed. For example, the stone steps in the rear garden are very steep and people may be at risk of slips and falls. A system for recording health and safety checks in the home has not been fully established and therefore it was not always clear how the home is promoting people’s welfare in this area. We asked the home to complete an Annual Quality Assurance Assessment before the inspection but this was not submitted to us within the timescale set. It is a legal requirement for the registered provider to ensure we have this information when we request it. We have been informed by the providers that they intend to handover the running of the home to the new management team already in place. We have Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 8 made an urgent requirement that applications for registration are submitted to the Commission by 31st August so that their fitness to run and manage the home can be established formally through the registration process. We have made fourteen requirements as a result of this inspection. The registered provider must take action to meet all the requirements within the stated timescales. We may take enforcement action if the registered provider fails to meet these requirements. We have also made sixteen recommendations. Recommendations are good practice and should be given serious consideration by the provider to improve outcomes for people who live in the home. 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.V365970.R02.S.doc Version 5.2 Page 9 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.V365970.R02.S.doc Version 5.2 Page 10 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 and 2 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. There have been no new admissions to the home for more than one year, which means this outcome area could not be fully assessed. However, the service has ensured that they have some information they can give prospective residents about the home so that they can make an informed choice about whether it is the right place for them. EVIDENCE: There have been no new admissions to the home for more than one year. At this inspection we saw that there is a new Residents’ Admissions Policy in place in the home. The policy states that its purpose is to ‘describe what system is in place for the admission of residents into the home’. The policy focuses on what happens on the first day the person moves into the home. There was not enough information on how people’s needs will be assessed before they are admitted, transition visits that will be offered to enable people to ‘test-drive’ the service and reviews that may be carried out during the first few months to ensure the person is settling into their new home and is Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 11 satisfied with their placement. Some of this information has been included in the home’s Statement of Purpose. During the inspection we also saw a revised Residents’ Guide. This provides prospective service users with some information about the home including their rights, the aims and values of the home and the complaints procedure. Although effort has been made to include some use of symbols in the Guide, the format is not fully accessible to people with learning disabilities. The home’s Statement of Purpose is also not in an accessible format. We noticed that the Guide was on display in the home so that people could look at it if they wanted. Both the Service User Guide and Statement of Purpose refer to the National Care Standards Commission in places instead of the Commission for Social Care Inspection. The Statement of Purpose gives the wrong contact telephone number for the Commission. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 12 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 and 10 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 given choice but more evidence is needed to demonstrate that this is followed through consistently. Care plans and risk assessments are not always detailed enough to ensure that people’s specific needs are identified and met. EVIDENCE: We looked at a sample of people’s care plans. A requirement was made at the last key inspection for the care plans to be reviewed to ensure that information they contain is up-to-date. Care plans we looked at had been reviewed. They are not currently in a format that is accessible to people who use the service. Care plans showed some consideration of people’s likes and dislikes and how they make choices in their daily lives, for example, ‘If you show X the tea and coffee he will point to which one he would like’. However, information in some Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 13 areas was limited. We noted that two people’s plans indicated that they were Christian and belong to the Church of England but there was no further information about what this means for the individual in terms of church attendance or their lifestyle. Both plans also went onto say that the home was uncertain of their wishes in the event of their death and there was no information on file about the action care workers needed to take in the event of them becoming seriously ill to ensure that their faith needs are met. The plans we looked at also showed some consideration of individuals’ goals but, again, this was limited. For example, one person’s aspiration was documented as to go down the pub and attend social clubs. This is not specific enough to indicate to the reader how often the person wishes to go to these places, who will be responsible for making this happen and how progress towards the goal will be monitored. For another person, the care management plan written in February 2008 by the local authority indicated that the service user is able to complete simple tasks around the home and should be supported to expand on this area. The care plan written by the home did not account for this, instead stating that the person was ‘unable to participate in any household chores…X’s independent living skills are very limited’. There was no information to tell staff how they should support the person in developing their skills. The communication needs of people were referred to in their care plans, for example, one person was detailed as using ‘a nod or thumbs up for likes and a shake of his head for dislikes’. However, the care plan did not incorporate information from a speech and language therapy assessment which gave further advice about the person’s communication, such as the need to gain eye contact before speaking to them and recommendations that staff use sign, gesture, pictures and symbols to supplement what they say. The use of these total communication approaches was not referred to in the care plan. We noted that for another person with communication needs the care management care plan written in February 2008 by the local authority contained some good information about their emotional and communication needs but this had not been incorporated into their plan. We saw a copy of minutes from a residents’ meeting held in June 2007. There were no other minutes on the file. There was evidence that discussions had taken place about holidays, activities and menu choices. However, there was not enough evidence to show how people’s ideas were being followed up. For example, people had suggested trips to Poole Quay, visits to the fire or police station and a concert but it was not clear that plans were in place to action these. The manager was advised to ensure that ideas put forward in residents’ meetings are followed up promptly and the outcomes are clearly documented so that people know their choices are listened to and acted upon. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 14 Care plans we looked at showed some consideration of some risks. However, these were not generally in enough detail to ensure that care workers knew what to do to minimise risks. For example, ‘X needs support and oversight when out in the community…support is required at all times in this area’ does not tell the care worker the exact nature of the support required to promote the person’s safety. The manager told us that specific risk assessments were in the process of being drawn up. We looked at two risk assessment documents that had been completed to date. There was not enough detail to provide enough information to care workers about people’s individual needs and a serious risk that had been identified had not been assessed in enough depth. Words such as ‘supervised’ and ‘supported’ had been used which did not provide enough information to the care worker about the action they need to take. The manager told us that he was looking to provide staff with responsibility for writing risk assessments with the necessary training to be able to do so effectively. During the inspection we observed that a person who uses a service but who does not live at Lewis House was frequently present in the home. During the visit we observed the person talking to both residents and staff who she clearly knows very well. We noted that she knew a lot of personal information about individual residents at Lewis House including their health appointments and a member of staff was seen talking to her as if she were a colleague. We informed the manager that this was inappropriate and needed to be addressed to ensure people’s confidentiality and personal information is protected. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 15 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 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 happy and settled in the home. However, a more proactive, individualised approach to supporting people with their personal development is needed to ensure that they reach their optimum potential. EVIDENCE: Some of the people who live at Lewis House attend day services in the community. We looked at two people’s support plans both of which contained timetables about what they did each day. Each person attended day centres five days a week. For one person their timetable showed they had free time four evenings a week ‘to watch TV and look through magazines’, the fifth evening spent at a club for people with learning disabilities. The other person’s timetable indicated that they had free time three evenings a week; ‘free time Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 16 to socialise within the home’. We looked at a sample of daily records. We noted that for one person, many of the entries referred to the person sitting and watching television in the evenings. It was not clear from the care plan and timetables that individuals have the freedom to engage in community-based activities spontaneously in the evenings especially given that the rota for the home shows that there is generally one member of staff on duty from 5pm onwards. This potentially restricts opportunities for people to pursue individual interests outside the home. One relative we spoke with expressed a concern that, when it comes to activities, either ‘everyone goes or none of them go’. Another relative commented in a survey that they feel their family member ‘needs to be more occupied…by some extra work placement. Extra physical exercise would be beneficial’. One person we observed in the home who does not attend day services told us that they worked in a charity shop on one morning a week and went horseriding. On our visits to the home we observed them spending time with staff doing household tasks, for example, making cups of tea and helping to write a shopping list before going to the supermarket. The person told us that they would like to do different things. People’s support plans and daily records indicated where they have had contact with their families. Of the three relatives who responded to the survey, two indicated that the home always helps their family member to keep in touch with them and one indicated that this was usually the case. Some people told us that they have friends with people who live at another care home owned by the registered providers and we were told that one person from Lewis House would be joining their friend from the other home on a shopping trip for their birthday. The atmosphere in the home when we visited was sociable and there was evidence of care workers interacting positively with people who use the service. Observation indicated that people who live in the home have unrestricted access to all communal areas and can access their bedrooms as they wish. We observed that three of the people who live in the home eat together at the dining room table. We also observed that one person chooses to eat in the kitchen and one person chooses to eat in the small lounge. Their needs and wishes were respected. The minutes of a recent residents’ meeting showed that people had been consulted about menu choices. We observed at this, and at previous inspections of the home, that people have opportunities to be involved in meal preparation and where individuals are able to prepare snacks and drinks for themselves independently this is promoted. Both service users who responded to our survey indicated that they usually like the meals at the Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 17 home. One person told us ‘I’m quite a fussy eater but staff try and give me what I like all the time’. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 18 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 but a more robust system is needed to ensure that individuals always get the support they need in a way that respects their privacy and dignity. EVIDENCE: The sample of care plans we looked at gave some basic information about people’s personal care needs but this was not always detailed enough to inform care workers about the action they need to take to ensure the person’s needs are fully met. For example, ‘X requires full support to have a bath’ does not describe the nature of the support required or if there is anything the person can be encouraged to do for themselves. Likewise, the care plan stated that the person is reluctant to allow staff to assist in choosing clothes where for example, their selection may be inappropriate due to the weather or the activity for the day. However, it does not tell staff what to do in order to Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 19 encourage the service user to make a more appropriate selection without disempowering him. Two out of three relatives of people who use the service told us in surveys that the home always kept them up-to-date with important issues affecting their family member. One relative told us that they felt they would benefit from more information as their family member was not able to communicate with them. Two relatives told us in surveys that the home always gave the support to their relative that they expected, one indicating that this was usually the case. We spoke with another relative of a person who uses the service. They told us they had concerns that their family member often looked ‘scruffy’. They felt that their relative needed more support with their personal care than they were getting to ensure that they always looked smart and tidy. They also told us there had been occasions when their laundry had been mixed up and they had ended up wearing someone else’s clothes. This is not respectful of people’s dignity. During the inspection the provider showed us a card from a relative of a former service user thanking them for the ‘love and extra care’ provided to their son; ‘I’m so very grateful that he came to you’. We looked at the health care records for a sample of people who use the service. We noted that a new framework for recording health appointments has been implemented since the last key inspection. For one person, there were no entries on the new record. The previous record was on file but this did not contain any entries since March 2006 when they attended a dental appointment. The support plan for the person indicated that the client needs to attend a chiropodist but there was no record of appointments to evidence that this was taking place. For the second person there was a record of a recent doctor’s appointment although this had not been signed by the person making the entry. The previous appointment records were not on file so we were unable to ascertain when the person had last attended a dentist or chiropodist even though the need for them to receive foot care was identified in their care plan. A health care professional responding to a survey told us that they felt the home was responsive to people’s needs and would ask for help if there were any problems; ‘Staff demonstrate a keen sense of responsibility to identify and manage patients’ needs’. They also told us that the home could improve by establishing an ‘annual checklist care review process on a more formal basis’ with the local surgery to ensure individuals’ needs are met. We were also told by a health care professional that on occasions they have been asked to see two patients together when only one member of staff has been available to accompany them to the surgery. Although it was also Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 20 indicated that in all these cases the clients have been agreeable this is not good practice and does not respect individuals’ rights to privacy. Two people at the home are prescribed regular medication. Since the last key inspection the home has changed its medication practices and there is now a lockable metal cabinet on the wall of people’s bedrooms where they can store their own medication. Keys are held by staff for safe-keeping. Medication is supplied by a local pharmacy, generally in monitored dosage systems, and Medication Administration Record (MAR) charts are also produced by the pharmacy for use in the home. People’s support plans contained some evidence about their medication needs. For example, one person’s plan stated ‘X’s medication is currently in tablet form and she takes it willingly when it is placed in her hand with a small glass of water’. For another person, the plan stated that ‘X requires staff to continue dispensing her medication for her due to her lack of understanding of dosage’. However, discussion with the service user and care worker indicated that they were self-administering an ointment that had been prescribed for them. This had not been documented on the MAR chart or support plan and there was no risk assessment seen to indicate that the service user was able to do this without staff intervention or support. There were two gaps in recording on the MAR chart where medication that had been given to the service user had not been signed for. Another person who lives in the home receives medication from a box. Two doses of this medication had not been signed for on the medication administration record chart. We counted the number of tablets left in the box. This indicated that the medication had been given as prescribed although not signed for. The induction programme in place in the home offers an introduction to medication administration procedures in the home. Of the eight care workers employed to work shifts between 14th – 27th July, six are recorded as having undertaken specific training in medication administration. However, three of the six had received training from their previous places of employment and this may not be relevant to the system used in this home. The manager told us that all care workers would be expected to gain the same accredited qualification in medication administration. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 21 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 by staff and procedures are in place to respond to complaints. However, more robust systems are needed to ensure that people are fully protected in all aspects of their lives. EVIDENCE: The home’s new complaints procedure is in the Residents’ Guide. However, during the inspection we saw that an ‘old’ complaints procedure was still on display on the stairway with information that is now out-of-date. Both of the people who use the service indicated in surveys that staff listened to them and acted on what they say. Both of them also indicated that they knew who to speak to if they wanted to make a complaint. Of the three relatives responding to the survey, however, one said they knew how to make a complaint, one said they did not know and one could not remember. Two relatives told us that the home always dealt with any concerns appropriately, one indicating that this was usually the case. The complaints record in the home shows no evidence of any concerns or complaints being raised. We saw evidence that the home has obtained a copy of the multi-agency safeguarding adults policy and this is in place in the home. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 22 We looked at a rota for the two week period from 14th – 27th July. Of the eight staff allocated to shifts during this period, five had completed some form of training in abuse awareness since 2004. The manager has told us that they are liaising with Dorset County Council to ensure that all staff attend this training as soon as possible, although allocations are limited and therefore it may take time for this to be completed. The induction framework in the home includes information on safeguarding adults. There have been no safeguarding investigations in the home in the past twelve months. At the last inspection we noted that there was no policy in place in the home with regards to the handling of people’s money. We were not able to locate a policy at this inspection. At this inspection we looked at a sample of records about the handling of people’s money. The manager told us that three people who use the service have the registered providers as their appointee. The manager told us that each service user is given a sum of money as their personal allowance each week. The manager told us that all service users now have bank accounts in their own name. It was not clear how people had been involved in choosing a bank or building society to keep their money safe. We were told that individuals’ benefits get paid directly into their bank accounts but contributions from funding authorities are paid directly into the home’s business account. There was no clear written guidance on who is responsible for cashpoint cards and personal identification numbers. The manager told us that only senior staff have access to this information. There was no evidence of an audit being in place to ensure that receipts of money spent by residents tally with the amounts taken from their float. We also noted that where people’s money had, until recently, been held in the corporate account there was no evidence of checks being made to ensure that there is no money remaining in the home’s corporate account that belongs to a service user. Service users’ financial records are kept together in a file with those of residents from the provider’s other home. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 23 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Lewis House provides a homely and comfortable place for people to live. However, some areas of the home need risk assessment to ensure that people’s safety is always promoted. 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 rear garden is accessed down steep stone steps. We did not see any evidence of this having been risk assessed to ensure they are safe for people to use. 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 a flight of stairs. A tour of the home showed that people Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 24 have been encouraged to personalise their bedrooms with their own belongings. In the past year some redecoration has taken place in the home. However, we noted that the kitchen was in need of some maintenance to ensure that all cupboards have handles so that they can be opened easily. It was also noted that work surfaces were cracked and discoloured. The window in the small toilet on the first floor was not restricted and a small window in one bedroom was not restricted and the catch was broken. We were advised by the manager that the home has employed a person responsible for maintenance. 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 some steep stone steps. We did not see a risk assessment in place to identify how risks associated with the steps could be minimised, thus promoting people’s safety in accessing the garden. At the time of our visits the home presented as clean. Both of the people who use the service told us that the home is always fresh and clean. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 25 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 and 36 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. Recruitment procedures and staff training continue not to meet the required standard. This means that people who use the service do not always benefit from care workers who are recruited on the basis of full and satisfactory information or who receive all the training they need to meet individual needs. EVIDENCE: We looked at the rota for the two week period from 14th – 27th July. This indicates that care workers are employed to work shifts from 9am – 5pm or 5pm – 9am which includes sleeping-in. At the time of the inspection there were five people living in the home. According to the rota, the majority of shifts are covered by one member of staff. It was difficult to see how the care needs of five people could be met at ‘peak’ times, for example in the mornings (7am – 9am) when people are getting ready for their respective day centres. The manager told us that additional support was provided by the Heads of Care at these times. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 26 However, this is not stated in the home’s rota. We noted that the rota does not show the hours worked in the home by the manager or the registered providers. Therefore the rota is not an accurate reflection of staffing presence in the home. As indicated in the section on ‘Personal and Health Care Support’ a health care professional has commented that on occasions people who use the service have had to attend appointments together due to lack of staff being available to accompany each person. This is not good practice. The manager also told us that staffing levels would be reviewed to ensure that there are enough staff on duty at any one time to meet individual needs. We were told that the manager is hoping to introduce a change in the current shift system so that it can better meet the needs of people who use the service. We looked at a sample of care workers’ files for evidence of safe recruitment procedures. Files were well-organised and there was a checklist in the front of each file to indicate the information that had been received. We saw that checks with the Criminal Records Bureau had been undertaken by the home for each care worker. However, for one person the full disclosure had not been received until after their start date. Although a PoVAFirst check had been done to ensure they were safe to work with vulnerable adults there was no evidence that appropriate supervisory arrangements had been in place prior to the full disclosure being received. Two references had been obtained for each employee. However, for one person a written reference had not been taken up from a relevant employer in the care field before they started work. For another person a reference contained some information that needed to be followed up with their previous employer but there was no evidence that this had been done. Gaps in employment history were evident in one record we looked at and there was no evidence that these had been explored at interview. Since the last inspection an induction programme has been introduced and there was evidence of staff working through the programme. There was some evidence of completed documentation on staff files. The rota showed that one member of staff who was reported to be working through their induction pack at the time of the inspection was allocated to work alone in the home, without supervision, for one shift (5pm – 9am) between 14th and 27th July. The home has developed a training matrix which enables them to see where gaps in training exist. This indicates that two care workers have achieved a National Vocational Qualification at Level 3 standard and two are currently working towards their Level 2. The training matrix shows many gaps in training which need to be addressed to ensure that staff have the knowledge and skills they need to work effectively with people who use the service. There are people living at the home who have communication needs and one person has a diagnosis of epilepsy even though this is reported to be ‘well-controlled’ by medication. In the period between 14th and 27th July only two people recorded on the rota Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 27 as providing care had undertaken some training in total communication and only one person had done some epilepsy awareness training in their previous employment. We were told by the manager that a senior member of staff has been given responsibility for completing risk assessments for people who use the service. We were shown some of the risk assessments that had been completed by this person. However, the person’s training record did not show that they had undertaken training in risk assessment to be competent in doing so. We saw written correspondence to show that the home is identifying training courses appropriate to their staff team, including training in learning disability, risk assessment and total communication although not all had been confirmed at the time of the inspection. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 28 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. The home has a new management team who are taking steps to respond to shortfalls and put systems in place to meet the regulations and improve the service. Gaps continue to exist in some areas, however, where progress to date has been limited and which put people who use the service potentially at risk. EVIDENCE: Since the last key inspection the registered providers have appointed a new management team. We have been informed by the provider that they plan to hand over responsibility of running the home to the new management team Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 29 who will be applying for registration with the Commission. We have made an urgent requirement that relevant applications for registration are submitted to the Commission by 31st August 2008. The new manager reported that he is ensuring that he communicates on a daily basis with the registered provider so that they are kept up-to-date with issues in the home. This was echoed by the provider who told us that he felt more informed about things in the home than ever before. During the inspection we observed that the registered providers make regular visits to the home and have contact with people who use the service. At the last key inspection in January we required that the providers make a monthly visit to the home reportable under Regulation 26. We received their first report in June 2008 and a further report for July. We noted that the first report encompassed information about both homes owned by the provider when each home requires a separate report. This had been addressed in the most recent report. We requested that the provider completes an Annual Quality Assurance Assessment in June 2008. The provider was given 28 days to send us a completed assessment. We sent them a reminder letter with a timescale of 1st August but this was not met. We received the completed document on 28th August 2008. Although a service user meeting has taken place and people are encouraged to share their views on an informal basis, a formal quality assurance process in the home has not been established and an annual development plan is not currently in place. We looked at a sample of health and safety records. We saw a copy of a fire risk assessment which had been completed by an external agency earlier this year. Inspection of a sample of records indicated that a comprehensive record-keeping system to document fire safety checks in the home has not been established. We were advised that a person responsible for maintenance has been employed by the home to ensure that checks are carried out as identified in the risk assessment. The manager told us that they are awaiting a specific ‘key’ from the manufacturer to be able to test individual alarms as the previous key could not be found. We looked at a sample of refrigerator and freezer temperature records in the home. These were found to be up to date. We have been advised at previous inspections that thermostats are in place to ensure the safety of water temperatures. However, inspection of records did not show that regular checks are being made on water outlets to ensure that the thermostats are working properly and water temperatures remain within a Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 30 safe range. The manager has alerted the home’s maintenance person to carry out regular checks on temperatures. We were unable to locate a portable appliance testing certificate as evidence that all portable electrical items in the home have been tested for safety. The home’s accident book is now kept in the house and therefore accessible to care workers. One accident had been recorded since the last inspection in relation to a visitor to the home. We looked at the training records for all eight staff who were employed to work shifts between the 14th and 27th July as stated on the rota. Ten shifts out of a total of twenty-eight had not been covered by someone trained in first aid. Four out of the eight staff had undertaken training in Health and Safety and five had undertaken training in food hygiene although one person was recorded as having done this in 1997. All staff in the home take responsibility for preparing food with and for people who use the service and therefore should receive training in food safety practices. The home’s new induction programme incorporates an introduction to fire safety and the manager told us that he has introduced questionnaires on fire safety to test care workers’ knowledge. We were told by the manager that all staff working at Lewis House have completed the questionnaires. We noted at the last key inspection that some policies in the home did not reflect current practice and contained advice that did not reflect best practice. We also noted that some policies that needed to be in place were not in place. The manager has told us that he is aware that they need to be reviewed. As previously stated under ‘Concerns, Complaints and Protection’ the home has not developed or maintained an appropriate system regarding the management of people’s finances. The failure to audit records of financial transactions may place people at risk of financial abuse. As stated under ‘Staffing’ there are still gaps in the home’s recruitment procedures despite requirements made at three previous inspections. This means that new care workers are not always recruited on the basis of full and satisfactory evidence. The registered provider has not taken appropriate steps to ensure that there are staff on duty at all times with the necessary training to be able to meet people’s needs fully and safely. This potentially places people who use the service at risk and must be addressed as a matter of urgency. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 31 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 2 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 2 X 1 2 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 32 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 YA9 YA42 Regulation 15(2)(b) Requirement The service user plan, and 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. Progress has been made in relation to this requirement but continued work is needed to ensure that comprehensive care plans and risk assessments for all people using the service have been completed. The previous timescale of 30/04/08 has been extended until 01/11/08 so that the service can ensure that this requirement is fully met. Timescale for action 01/11/08 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 33 2. YA20 13(2) The home’s medication policy must be reviewed so that it contains accurate information about existing practices in the home. All care workers must have appropriate training to be able to administer medication safely. Medication that is administered to people who use the service must be signed for on the MAR chart at the time of its administration. 01/11/08 3. YA23 13(6) The registered providers must 01/11/08 ensure that their role as appointee for specific people who use the service is reviewed in conjunction with their respective placing authority. The registered providers must ensure that there is a policy in place in relation to handling people’s money and that there are clear procedures in place by which money is put into and withdrawn from people’s accounts. Arrangements for handling individuals’ money must be clearly stated in their support plans. Regular audits must be carried out on people’s money against records to ensure that they have the amount that is owed to them. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 34 4. YA24 13(4)(a) The registered provider must ensure that all parts of the home to which people who use the service have access are, so far as reasonably practicable, free from hazards to their safety. This will help ensure that people are safe in their home environment. 15/10/08 5. YA33 17(2) Sch.4 6. YA33 18(1)(a) The home’s rota must be kept up-to-date and be an accurate record of people employed to work in the care home on each day. The registered provider must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 22/09/08 15/10/08 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 35 7. 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 and 21/01/08. The previous timescale of 01/04/08 has not been fully met. 22/09/08 8. YA34 19(11) The registered provider must ensure that where a full disclosure has not been received from the Criminal Records’ Bureau in relation to an individual care worker but a PoVAFirst check has been done, the person is appropriately supervised by a qualified and experienced member of staff until a satisfactory disclosure is received. 22/09/08 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 36 9. YA35 18(1)(c) The registered person must ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. This includes training in the following areas: • • • • • First Aid Food Hygiene Risk Assessment Abuse Awareness and safeguarding procedures Training that reflects the specific needs of service users 01/11/08 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. 10. YA36 18(2) For the duration of a new worker’s induction training a member of staff who is appropriately qualified and experienced must be appointed to supervise the new worker. As far as practicable the staff member must be on duty at the same time as the new worker. 22/09/08 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 37 11. YA37 YA39 24 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. This will ensure that the home is meeting the needs of people who live there and is complying with the regulations. This requirement is repeated from the last inspection of the service as the previous timescale of 01/06/08 has not been met. 31/12/08 12. YA42 13(4)(c) A system for carrying out and recording health and safety checks in the home must be implemented to ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 22/09/08 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 38 13. YA43 9 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 ensure that they satisfy the requirements of the Regulations. This will also promote clear lines of accountability for people who use the service and leadership for the people who work there. This requirement is repeated from the last inspection of the service as the previous timescale of 01/06/08 has not been met. An urgent requirement was made on 28/07/08 for an application to be submitted to the Commission by 31/08/08. 31/08/08 14. YA43 7(1) To comply with Section 12 of the Care Standards Act (2000) the person who wishes to be registered as the provider of the home must make an application to the Commission. This will ensure that they satisfy the requirements of the Regulations. This will also promote clear lines of accountability for people who use the service and leadership for the people who work there. An urgent requirement was made on 28/07/08 for an application to be submitted to the Commission within the stated timescale. 31/08/08 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 39 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 Residents’ Admissions Policy should be reviewed so that it contains more information about the process of assessment, transition visits and review. The Residents’ Guide and Statement of Purpose should be reviewed to ensure they are in a format that is fully accessible and meaningful to people who use the service. References to the National Care Standards Commission in the Residents’ Guide and Statement of Purpose should be amended so they refer to the Commission by its current name. The contact telephone number for the Commission in the Statement of Purpose should be corrected. 2. YA6 Care Plans should be developed in a format that is accessible to service users and their ownership of these should be promoted. Care plans should contain more detail about people’s spiritual and faith needs and what this means to them. Goal-setting processes should be specific, measurable and time-limited. It should be clear from the plan who is responsible for supporting the service user in achieving their goals, by when and how progress will be monitored. Where care professionals have made recommendations regarding people’s needs this information should be clearly detailed in the person’s care plan. 3. YA7 The home should ensure they can demonstrate that people are able to make choices about what they do on a daily basis and that these choices are followed up by the people who work with them. Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 40 4. 5. 6. 7. YA9 YA10 YA12 YA18 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. The home should ensure that confidential information about service users is not shared with people who live in other homes owned by the registered provider. The home should review the occupational, leisure and social opportunities available to people who use the service to ensure their needs, wishes and personal goals are met. Individual plans should contain sufficient information about 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. Systems for doing people’s laundry in the home should be reviewed to ensure that items of clothing do not get mixed up and individuals always have their own clothes to wear. 8. YA19 There should be a clear record of all health care appointments attended by people who use the service. Records of appointments should be signed by the person making the entry. The home should ensure that each individual has a health action plan which details the health care interventions they require and how these are to be met. The home should ensure that there are enough staff on duty to accompany each person to their health care appointments individually so that their privacy and rights to confidentiality are promoted. Where individuals are able to self-administer their medication or apply creams for themselves arrangements should be clearly recorded on the MAR chart and in the person’s support plan. Regular audits should be carried out on medication practices in the home to ensure that medication is being given as prescribed and that this is recorded effectively. A record of this audit should be maintained. Copies of the home’s previous complaints procedure on display in the home should be replaced by copies of the revised procedure. The home should ensure that relatives of people who use the service are aware of the complaints procedure. 9. YA20 10. YA22 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 41 11. YA23 12. YA24 People who use the service should have access to their personal financial records and should be empowered to have control over their money as far as practicable given their individual needs and abilities. The home should undertake a risk assessment on window openings in the home to identify the need for restrictors to be in place. Cracks in kitchen work surfaces should be repaired to ensure that they are hygienic. The registered providers should ensure that all staff have at least an NVQ 2 qualification in Care or are working towards one. The registered provider should ensure that written references obtained from care workers’ previous employers are verified by telephone and any issues arising from the reference are discussed with the previous employer and documented. The home should have an annual development plan, reflecting the aims and outcomes for service users. 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. 13. YA32 14. YA34 15. 16. YA39 YA40 Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 42 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. Extracts may not be used or reproduced without the express permission of CSCI Lewis House DS0000026836.V365970.R02.S.doc Version 5.2 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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