Inspection on 21/06/06 for Lewis House

This inspection was carried out on 21st June 2006.

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

The inspector found 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 13 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 21/01/08

Lewis House 28/08/07

Lewis House 07/03/07

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 June 2006 09:40 Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lewis House DS0000026836.V301323.R01.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 01202 887255 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jillian Elborn Mr John Francis Elborn Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2006 Brief Description of the Service: Lewis House is a care home offering accommodation to a maximum of six adults who have a learning disability. The premises are located in a quiet semi-rural setting in the village of Corfe Mullen. Local amenities are close by and include churches, a supermarket and a public library. Public transport operates close to the home, taking residents into Wimborne, Broadstone and Poole. The property is a detached family style house with a family atmosphere. The home is staffed 24 hours a day by a small staff team. Mr and Mrs Elborn own the home and Mr Elborn is the Registered Manager although their son, Simon Elborn, manages the home on a day-to-day basis. Mrs Elborns mother and a family friend also reside at Lewis House. Mr and Mrs Elborn and their family also run two other homes in the local area, Woodside House and a self contained flat. Lewis House offers care and support to service users who are moving towards increasing their independence. The minimum basic fee level for the home is £550 per week. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of 6.5 hours on a weekday. There are currently six service users living at Lewis House. The purpose of the inspection was to assess all key national minimum standards and to go through the recommendations and requirements made at the last inspection to assess progress made. Information for this report was obtained from discussion with the manager, conversations with four service users and two members of staff on duty, inspection of service user records and medication records and a guided tour of the home with access to one of the residents’ bedrooms with their permission. As part of the inspection process comment cards were sent to the home and then distributed to service users, relatives, General Practitioners and social care professionals in order to obtain their views of the service. Comments from these sources will be reflected throughout the report. A total of twenty-one standards were assessed at this inspection. What the service does well: What has improved since the last inspection? The home’s medication policy was updated in May 2006 to include procedures around obtaining medication, storage, administration of medication, medication errors, self-administration, disposal of medication, recording procedures and training. This offers guidance to staff on safe practice. The majority of staff attended formal fire training in May 2006 to ensure that they have the knowledge and skills to respond effectively to a fire outbreak and promote service users’ safety. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 6 What they could do better: As a result of this inspection thirteen requirements and sixteen recommendations have been made. Of the thirteen requirements five are repeated from the previous two inspections of the home as previous timescales have not been met. There was evidence that not all support plans had been reviewed on a regular basis to ensure that information they contain is accurate and reflect service users’ current needs and goals. The way in which service users are supported to make decisions and meet their personal goals is unclear. Staff need to be trained in total communication approaches to ensure that all service users can participate in decision-making. Service user plans should be in a format that is meaningful to them and should show evidence of consultation with the service user and their representatives. At present not all service users living at the home have their own bank account. Each service user must be supported to have their own bank account to ensure that their rights and best interests are protected. Any restrictions to this should be clearly documented and agreed with the service user and / or their representative. More comprehensive risk assessments are needed to ensure that staff have adequate information about potential hazards and the action to take to protect service users from harm. Individual plans need to be updated on a regular basis to ensure they remain valid in terms of addressing service users’ personal and health care needs and again, provide enough information to staff. Lack of a specific care plan, training and procedures for staff in the administration of oxygen for one service user is cause for concern and this must be addressed for the service user to be fully protected. Records of health appointments should be kept up-to-date and outstanding issues followed up to ensure service users’ health care needs are met. Medication practices should be reviewed to ensure that they fully protect service users. Accredited training should be in place for all staff who take responsibility for administering medication and the risk assessment for a service user who self-medicates must be reviewed on a regular basis to ensure that his safety is maintained. The home’s complaints procedure requires review to ensure that anyone wishing to raise concerns is fully aware of the options available to them when doing so. Two of the three service users responding to the survey did not know how to make a complaint and comment cards received from relatives indicated that they are not always aware of the home’s complaints procedure. Therefore a copy of the procedure must be provided to service users and their relatives / representatives to ensure that they know the process by which they can raise concerns. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 7 Recruitment procedures are not sufficiently robust to ensure that appropriate checks are always carried out for prospective staff before they commence employment within the home. Therefore service users are not fully protected. Training for staff remains inadequate to fully meet the needs of service users. Induction and foundation training for staff has yet to be implemented and there was insufficient evidence on staff files to demonstrate that staff had received timely updates in first aid, food hygiene and infection control training. The majority of staff are reported to have undertaken abuse awareness training with the local authority but there were no certificates on file to evidence this. There is a lack of training in place to meet the individual needs of service users, for example, training in total communication and autism. The quality assurance process in the home has not been implemented to monitor the home’s success in achieving its objectives and an annual development plan is recommended to ensure that aims and outcomes for service users are met. A number of the policies, procedures and risk assessments inspected had not been reviewed on a regular basis. This included the fire risk assessment, water temperature risk assessment, infection control policy and manual handling policy. Although the majority of staff have recently attended fire training, all staff must receive regular fire training from a competent person so that they know how to respond effectively in the event of a fire and are able to keep service users safe. Fire drills need to be documented in more detail to ensure that they provide a meaningful record and to ensure that all service users and staff have the opportunity to take part in drills during the year and at times of the day when staffing levels are reduced. Risk assessments regarding the hot water supply in the home should be undertaken for each service user to ensure that the risks of scalding are minimised. The home’s accident book should be easily accessible to staff on duty so that contemporaneous entries can be made in the event of an incident occurring. 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. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Standard 2 is not applicable as there have been no service users admitted to the home for more than two years. Lewis House DS0000026836.V301323.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Support plans need further development to ensure they contain up-to-date information about the needs and wishes of service users and that consultation with service users is demonstrated. Service users’ involvement in decision-making both on an individual and group basis needs to be more clearly demonstrated to ensure that they have a say in what they do and how the home is run. Risk assessments need to be reviewed and updated on a regular basis to ensure that they contain enough information to minimise potential hazards and that service users are fully protected. EVIDENCE: A sample of two service user support plans were seen. One support plan had been written in January 2004 and provided information on the service user’s living environment, health, mobility, personal care, social life, work / occupation and personal relationships. It had been signed by the manager of the home but not by the service user, service user’s representative or any Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 11 other individual involved in the care planning process. There was no evidence to demonstrate that the service user plan had been reviewed since January 2004. The second support plan was in the new format adopted by the home. This covered daily support requirements, weekly programme, strengths, needs, likes and dislikes, health, medication, communication, mobility, self-care, independent living skills, finances, psychological and emotional needs and leisure and social activities. Some consideration of risk and safety factors had been included in the support plan. The plan had not been signed by the service user or those involved in its compilation. A review date had been set for January 2007. It was evident that information on eating and drinking had not been included in the support plan. Staff reported that no one at the home has specific dietary needs but in order for support plans to be more comprehensive it is suggested that likes and dislikes around eating and drinking are included. Two service users were spoken to about their involvement with decisionmaking at the home. Service users at Lewis House do not have allocated keyworkers so it was difficult to ascertain who takes responsibility for supporting them with meeting their goals. One service user reported that she has asked the manager on more than one occasion if she can go horse riding as part of her weekly schedule but this had not been actioned. All three service users responding to the survey indicated that they only sometimes make decisions about what they do each day. There was no evidence that service user meetings are held within the home to support decision-making processes. It was not clear how service users with non-verbal communication are involved in decision-making as staff have not had training in total communication approaches. Support plans included limited information on service users’ ability to manage their own finances, for example ‘X remains in control of his own money’. There was insufficient information to identify how this works in practice and how much support, if any, is required from staff. The manager had reported that although he is trying to activate personal bank accounts for all service users, in practice this had been difficult and therefore the benefits of some service users are still paid directly to the home’s account. This needs to be specified clearly on individual support plans with agreement from the service user and their representatives. In the two support plans sampled brief consideration had been given to risk factors. For example for one service user it had been identified that aggression may result if she becomes anxious and therefore issues around her mood needed to be considered prior to social activities. A sample of general risk assessments were seen, for example the risks of service users permitting entry of unauthorised persons to the home if staff do not hear the doorbell, but these were written in May 2003 and there was no evidence of these being reviewed since this time or individualised risk assessments being in place to assess personal risks. Lewis House DS0000026836.V301323.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Regular reviews of individual plans with service users are needed to ensure that they are working towards their goals and their individual preferences are being considered in the provision of activities. Service users are encouraged to be part of their local community and lead ordinary lives. Service users are supported to maintain links with family and friends so that they have networks of support outside of their home. Daily routines in the home protect the rights of service users and promote their independence. There is a flexible approach to meal-times which promotes service users’ wellbeing and enjoyment of their meals. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 13 EVIDENCE: On the day of the inspection, five service users were at the home while one was undertaking community-based activities. A weekly schedule on the kitchen wall lists the activities undertaken by service users on a daily basis. Service users attend a range of activities including local day services, horse riding, work experience and community-based activities. One service user reported that she works in a charity shop once a week for two hours but she would like to do more activities. She also reported that she does not enjoy group activities with other service users or socialising with residents from the proprietors’ other homes and prefers 1:1 activities with staff. It was not clear from discussion that these opportunities are being provided for her on a regular basis. The support plan of another service user states that she enjoys music and dancing but it was unclear from daily records how she was being supported to develop this interest. Daily records showed that service users access the community on a regular basis, for example, visiting local parks, pubs, town centre and the supermarket. Service users also have opportunities to attend a local club for service users with learning disabilities and one service user attends band practice to pursue his interest in music and the gym where he does weightlifting. Joint events such as barbecues are arranged with residents from the proprietors’ other home. Staff on duty reported that they feel that between the two homes there are generally enough staff to facilitate activities in the community. However, one service user reported that the majority of activities are done on a group basis and therefore individual choice can be limited. Service users spoken to reported that they maintain links with members of their family through visits and telephone calls. Two comment cards from relatives indicated that staff welcomed them in the home at any time. There is a payphone in the home which is situated on the stairway. It was noted that the location of the payphone did not offer service users privacy when making or receiving telephone calls and could cause an obstacle on the stairway. One service user has a fiancée and spoke of how staff support him in maintaining contact with her. Two service users stated that they have formed friendships with service users who live at the proprietors’ other home and are able to maintain these friendships through joint outings and events. A policy is in place in the home ‘Expressing Sexuality and Relationships’ which refers to the need for staff to support the personal relationships of service users including sexual relationships’ and also indicates that professional advice may be sought where necessary to ensure service users are given appropriate support in this aspect of their lives. Service users have their own rooms where they can spend time by themselves and have unrestricted access to all communal areas of the home. Daily Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 14 routines are flexible in that during the inspection one service user who had attended his day service that morning and who had become unwell was collected by staff and returned to the home where he could recover. Another service user had a chest infection and had stayed at home that day with staff support. Service users are encouraged to participate in aspects of maintaining the home environment in terms of helping with cooking and doing household tasks with assistance from staff. Service users reported that the food at Lewis House is good although one service user stated that at times the menu lacks variety. Service users are encouraged to participate in grocery shopping and food preparation. Service users report that on occasions they go out for lunch and have take-away meals which they enjoy. Inspection of kitchen cupboards showed that there were large selection of breakfast cereals for service users to choose from. Service users can access the kitchen as they choose and there was evidence of each service user being asked what they would like in their sandwiches at lunchtime during the course of the inspection. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Updates to individual plans will help ensure that service users’ personal care needs are met and their independence continues to be promoted. Lack of up to date plans regarding the assessed health care needs of individual service users and associated risks means that service users may not be fully protected. Further development of medication procedures and training is needed to ensure that service users are fully protected by practices within the home. EVIDENCE: A policy is in place entitled ‘Assisting clients with personal care – best practice’ which refers to the need for staff to respect the privacy, safety and preferences of the individual when delivering personal care. Personal care issues are given consideration in service users’ individual plans which includes information about their level of independence in undertaking self-care tasks. However, some service user plans require updating to ensure that the information they contain remains valid and meets the service users’ needs. Two relatives indicated through comment cards that they are satisfied with the overall care Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 16 provided by the home. Two out of three service users responding to the survey indicated that they are treated well by staff with one service user indicating that they are only ‘sometimes’ treated well. Support plans sampled refer to the health care needs of individuals although one support plan, written in January 2004, requires updating to ensure that it contains up-to-date information regarding the service user’s needs. It was clear from an admission assessment undertaken in 2002 that one service user at the home requires oxygen available for his use at all times and indicates that staff must be trained it its use. The assessment goes onto say that there must be guidelines for staff informing them when they should call for an ambulance and they must be able to recognise when the service user is unwell or beginning to tire and act accordingly. During the inspection staff were asked where a care plan could be found regarding the administration of oxygen, including instructions on how to use the equipment. Staff reported that they had been shown how to use the equipment at the start of their employment by more experienced staff but had not received any formal training and were not aware of any specific instructions about using the equipment. The service user’s support plan did not contain adequate information regarding this health care need or the symptoms that he presents which may be cause for concern. Personal Health Records are in place for service users but were incomplete. Records of health appointments for two service users were inspected. One service user had attended the hospital for a heart check in March 2006 and the entry in the records stated that the doctor would inform the service user by post of the result of a blood test and any subsequent treatment required. There was no further information on record to indicate that this had been received or followed up. Records for another service user indicated that she had been observed to have a chesty cough one weekend and this had been followed up with a GP appointment the following week when antibiotics were prescribed. A medication policy is in place which includes information on obtaining medication, storage, procedures for administration, medication errors, selfadministration, disposal of medicines and use of non-prescription medication. Medication records showed evidence of medication entering and leaving the home being documented, a homely remedies list and patient information leaflets for those medicines taken by service users. The home uses their own Medication Administration Record (MAR) charts but these had not been countersigned to indicate that a second authorised member of staff had checked them for accuracy as recommended in the Royal Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 17 Pharmaceutical Society’s guidance ‘The administration and control of medicines in care homes and children’s services’. Medication is stored in a locked wooden cupboard in the home’s kitchen. It was noted that there was a tube of ointment on top of the cupboard during the inspection. The medication cupboard was full. The date of opening was not recorded on boxes of medication to provide an audit trail. The manager stated that all staff take responsibility for administering medication for service users but only senior staff had done accredited training in the safer handling of medicines. A risk assessment is in place for one service user who self-medicates. However, this was written in May 2003 and although a review date was set for November 2003 there was no evidence of this having taken place. The service user’s ability to self-medicate is mentioned in his support plan but there is insufficient detail regarding how this is arranged. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Greater clarity in the home’s complaints procedure and distribution to all parties is needed to ensure that service users and their representatives know how to raise concerns. Service users are generally protected by the home’s policies and procedures on abuse. EVIDENCE: The home has a complaints procedure which states that any complaint will be acknowledged within twenty-four hours and responded to within seven days. The complaints procedure also states; ‘if a complaint remains unresolved then it may be passed on to the NCSC but this should not usually occur until internal procedures have been exhausted without reaching a satisfactory conclusion’. It does not state that, in fact, individuals can approach the Commission for Social Care Inspection at any stage of the process to raise concerns and complaints about the service. The home’s complaints procedure also states that the home’s complaints book should be used to record all complaints. Staff on duty at the time of the inspection did not know where they could locate the complaints book. Out of the three service user surveys received all three service users indicated that they knew who to speak to if they were not happy. However, only one of the three indicated that they knew how to make a complaint. Of the two comment cards received from relatives one stated that they were not aware of the home’s complaints procedure. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 19 The home has a copy of the multi-agency guidance ‘No Secrets’ in relation to the protection of vulnerable adults. The home also has a whistle blowing policy although this would benefit from being updated. The manager confirmed that the majority of staff at the home have received adult protection training from the local authority but not all staff files showed evidence that they had attended this training. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lewis House provides a homely environment in which to live that promotes the independence of service users. Although the home is clean, development of policies and training in infection control will help ensure that service users live in an environment which is of a high standard. EVIDENCE: Lewis House is a family-style property and is furnished in a homely way. There is a conservatory and spacious garden for residents’ use. Kitchen areas are equipped with domestic-style appliances. A guided tour of the premises showed that residents’ bedrooms are personalised to their own taste. The home has an infection control policy, written in 2003, which emphasises that personal hygiene, food hygiene and housekeeping are critical in the fight against the outbreak of infection. The policy should be updated to include recent guidance from the Department of Health. There was evidence that some staff had attended basic food hygiene training but some were due for an Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 21 update. Although some staff had attended health and safety training there was no evidence of staff receiving specific training in infection control. Two out of three service users responding to the survey indicated that the home is always fresh and clean, one indicating that it is only ‘sometimes’ clean. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although staff are being supported to undertake NVQ qualifications, inadequate specialist training for all staff means that they are not fully able to meet the assessed needs of service users. Recruitment procedures are not sufficiently robust to fully protect service users. EVIDENCE: Staff employed at Lewis House also work at the proprietors’ other home in the area. Five of the fifteen staff in the homes have achieved an NVQ qualification. There are plans for two further staff to commence an NVQ award in the near future. One member of staff on duty at the time of the inspection reported that he had recently completed his NVQ Level 3 qualification. Two care worker files were inspected for evidence of recruitment documentation. Both showed evidence of two written references and proof of identity. However, it was evident that both staff had commenced employment without PoVAFirst or Criminal Records Bureau (CRB) checks being in place. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 23 An induction and foundation training package has been purchased by the homes that meets Skills for Care standards. However, these have yet to be implemented. Discussion with staff on duty and inspection of service user files indicated that service users at Lewis House have a range of needs including one service user who uses oxygen due to a heart complaint, one service user who has a hearing impairment, one service user who uses some Makaton signs to communicate and another who has autism. It was not evident from discussion or inspection of staff records that staff have been given adequate training in these areas to meet the specific needs of service users. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Statutory requirements must be addressed in order for the home to be considered run to the benefit of service users. The home’s quality assurance process has not been fully implemented to ensure that service users’ needs and preferences are taken into account in service development. Shortfalls in aspects of health and safety practice within the home means that service users may be put at risk. EVIDENCE: The home is owned by Mr John Elborn, Mrs Jill Elborn and their son, Mr Simon Elborn. Mr John Elborn is the Registered Manager but has recently written to the Commission for Social Care Inspection to advise that he is gradually withdrawing from his role as day-to-day manager of the home, this role being Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 25 taken on by Simon Elborn. This has yet to be formalised by the Commission. Staff and service users spoken with during the inspection reported that Simon and Mr and Mrs Elborn are approachable and accessible. It was evident at the last inspection of the home on 13th February 2006 that five requirements had been repeated from the previous inspection of the home as the timescale set for addressing the requirements had not been met. Although limited progress has been made towards meeting some of these requirements they have not been met in full and therefore are repeated for the third time at this inspection. Repeated failure to comply with the regulations will result in enforcement action. To date the home’s quality assurance process has not been implemented. It was evident that questionnaires are being developed to be sent to service users and their relatives / representatives to ask for feedback about the service provided by the home. This will form part of the home’s quality assurance process. A sample of health and safety records were sampled. A fire risk assessment had been carried out in April 2002 although this had not been signed by the person undertaking the assessment. This stated that the assessment would be reviewed after six months or following any significant changes. There was no evidence that this had been done. Records showed evidence of weekly and monthly fire safety checks. Records indicated that alarm points had been tested but did not indicate which point was tested on which week. A fire drill was recorded as having taken place in May 2006 but there was insufficient detail to specify the time of the evacuation, the service users and staff present and the time taken to evacuate the building. One service user spoken with during the inspection demonstrated knowledge of the fire procedure in the home. The manager had stated that fire training by an external agency had been carried out in May 2006 which the majority of staff had attended but this had not been recorded on the fire safety records. There was evidence of servicing certificates for the fire alarm system and fire equipment but the records were poorly organised and therefore it was difficult to identify when the last services were carried out. A recommendation had been made at a fire equipment service in February 2006 that extinguishers should be wall-mounted but a guided tour of the premises showed that this had not been actioned. A risk assessment was seen to be in place for water temperatures at sinks, baths and basins but this had been written in May 2003 and there was no evidence that it had been reviewed as planned in May 2004. The home’s manual handling policy was examined. This was written in May 2003 and there was no evidence that this had been reviewed since this time. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 26 The policy states that ‘all service users have a handling and mobility assessment on admission. This is carried out by senior, experienced members of staff’. There was no evidence on file to support that this had happened. Further information on supporting service users with their mobility needs was seen in the home’s policy ‘Assisting clients with personal care; best practice’. This states ‘if necessary, you can assist by holding him / her around the waist’ and also ‘if client has trouble getting out of the tub, help him to his hands and knees. From that position he can use the grab bar / edge of bath to help pull him / herself up’. This information does not take account of the individual needs of service users and therefore provides misleading and potentially unsafe guidance. Staff on duty at the time of inspection were not certain where they would find the home’s accident book should they need to record an incident although they believed it would be in the manager’s office. They stated that they would respond to an accident by informing management. There was evidence on files inspected to demonstrate that the majority of staff had undertaken basic food hygiene training and emergency first aid training but some were due for updates to ensure their continued safe practice in these areas. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 X 1 X 1 X X 1 X Lewis House DS0000026836.V301323.R01.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. Standard Regulation Requirement Each service user must have an up to date care plan, detailing how the home is to meet their day-to-day needs. Assessments and Care Plans must be regularly reviewed. This requirement is repeated for the third time as previous timescales of 01/08/05 and 01/05/06 have not been met. The registered providers must support service users to have their own bank accounts, so that their money is paid into this account and not the homes account. A clear record must be made, and agreed with the service user and/or their representative, for when restrictions are placed on the service users rights, choice and freedom. This requirement is repeated for the third time as previous timescales of 01/08/05 and 01/05/06 have not been met. Risk assessments must be completed and made available to staff for when a risk is identified, detailing how the risks are to be DS0000026836.V301323.R01.S.doc Timescale for action 1. YA6 14, 15 01/10/06 2. YA7 20 01/10/06 3. YA9 13 01/10/06 Lewis House Version 5.2 Page 29 4. YA19 12 5. YA20 13 6. YA22 22 7. YA34 19 minimised. This requirement is repeated for the third time as previous timescales of 01/08/05 and 01/05/06 have not been met. The registered providers must ensure that there are clear procedures in place for the use of oxygen for one service user in the home. This should include guidance for staff on how to check that the equipment is working properly and when they should call emergency services. Appropriate training should be given to staff regarding the use of oxygen in the home. The registered providers must make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The risk assessment and support plan for one service user who self-medicates must be reviewed on a regular basis. The registered providers must ensure the home’s complaints procedure makes clear that people can raise concerns or complaints with the Commission for Social Care Inspection at any stage of the complaints process. The registered providers must ensure that they supply a written copy of the complaints procedure to all service users and any person acting on behalf of a service user. 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. DS0000026836.V301323.R01.S.doc 01/10/06 01/10/06 01/10/06 01/10/06 Lewis House Version 5.2 Page 30 8. YA37 10 (1) 9. YA39 24 10. YA42 23 11. YA42 23 12. YA42 13 13. YA42 13 The registered providers must carry on or manage the care home with sufficient competence so as to ensure that the regulations are met. The registered providers must ensure that they review the quality of care provided by the home regularly. This requirement is repeated for the third time as previous timescales of 01/08/05 and 01/06/06 have not been met. Staff must receive regular fire training from a competent person. This requirement is repeated for the third time as previous timescales of 01/08/05 and 01/06/06 have not been met. The fire risk assessment for the home must be reviewed on a regular basis to ensure information is up-to-date. The registered providers must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The Registered Providers must ensure that a comprehensive risk assessment is carried out for each service user regarding risks from hot water in the home. The registered providers must ensure that the home’s manual handling policy is reviewed on a regular basis to reflect practice within the home. 01/10/06 01/10/06 01/10/06 01/10/06 01/10/06 01/10/06 Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations There should be a clear record made of the service users goals and aspirations and how the home is to help to meet these. Care Plans should be developed in a format suitable to the needs of service users. This recommendation is carried forward from the inspections in June 2005 and February 2006. 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. Service user involvement in decision-making processes should be clearly documented. The registered providers should demonstrate how all service users are supported to find and keep appropriate jobs and/or take part in valued and fulfilling activities that meet their individual needs and personal wishes. There should be a clear record kept, and made available to staff, of the service users personal care needs and their preferences to how they would like to be guided. This recommendation is carried forward from the inspections in June 2005 and February 2006. Records of health appointments should be updated as appropriate to provide a clear and accurate record of the service user’s health care needs. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. When MAR charts are printed in the home or handwritten, a second competent person should sign to confirm that all the details of prescribed medicines are correct. Medication storage should be reviewed to ensure that it is adequate in size to meet the needs of service users. All staff with responsibility for administering medication to service users should undertake accredited training. The date on which boxed medication or bottles of medication are opened should be recorded to provide an audit trail. DS0000026836.V301323.R01.S.doc Version 5.2 Page 32 1. YA6 2. 3. 4. YA6 YA7 YA12 5. YA18 6. YA19 7. YA20 Lewis House 8. 9. YA23 YA30 10. YA32 11. YA35 12. 13. 14. YA39 YA42 YA42 15. YA42 16. YA42 The registered providers should ensure that all staff access training on abuse awareness and that certificates are held on file to evidence their attendance. The home’s infection control policy should be updated and suitable training in infection control should be made available to all staff. The registered providers should ensure that all staff have at least an NVQ 2 qualification in care or are working towards one. The Registered Providers need to ensure staff have training in autism, challenging behaviour and communicating with service users who have a learning disability. This recommendation is carried forward from the inspections in June 2005 and February 2006. New staff should complete appropriate induction training within 6 weeks of appointment, and foundation training within 6 months. The home should have an annual development plan, reflecting the aims and outcomes for service users. This recommendation is carried forward from the inspections in June 2005 and February 2006. All staff working in the home should be able to access the home’s accident book. The registered providers should ensure that all staff have access to timely updates in first aid, food hygiene and infection control training. Recording of fire drills should be more comprehensive and include details of the date and time of the drill, the staff and service users present at the time of the drill and the time taken to evacuate the building. A fire drill should take place when staffing levels are reduced, for example, in the late evening, at night or in the early morning. Lewis House DS0000026836.V301323.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V301323.R01.S.doc Version 5.2 Page 34 - 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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