Inspection on 23/01/10 for Lewis House

This inspection was carried out on 23rd January 2010.

CQC found this care home to be providing an Good 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 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 10/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Lewis House Higher Merley Lane Corfe Mullen Wimborne Dorset BH21 3EG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tracey Cockburn     Date: 2 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Lewis House Higher Merley Lane Corfe Mullen Wimborne Dorset BH21 3EG 01202887255 01202888820 lewis.house@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jillian Elborn,Mr John Francis Elborn care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home only - Code PC To service user of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 7 Brief description of the care home area. The registered providers mother also lives at the home. She is not included within the registered numbers permitted at the home. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service without telling them we were coming and we visited at the weekend. We spoke to people who use the service, we spoke to the staff who support them and we spoke to the acting provider who is managing the service. We looked at care plans which tell us how people are supported, we looked at information which tells us how staff are employed and if the service does this safely. We looked at training records so we could see that staff know what they are doing. We looked round the home to see that it was well looked after and we asked to look in some bedrooms to see that people can bring their own items in to make the room homely. Care Homes for Adults (18-65 years) Page 6 of 28 We looked at information which tells us if the home is sorting out all the things that were not right the last time we visited. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their Representatives have the information needed to choose a home that will meet their needs. Evidence: One recommendation made in this outcome area at the last key inspection, the service user guide needed to be more accessible using photographs of the home and key people so that the people who live in the home and use different methods of communication would have access to the document. we were shown the updated guide and could see that photographs had been used. Two people have moved into the home in the past few weeks from another home owned by the provider which is possibly closing. We looked at the pre admission assessments of one person and could see this information was completed when they moved into the previous home and an update sheet had been completed when they moved to Lewis house. Both people had the support of familiar staff who also moved to working at Lewis House thus offering the individual some continuity and support. We spoke to one person who recently moved in and they were keen to show us their Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: pictures and their room. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and play a role in planning the care and support they receive. Evidence: Two requirements at the last key inspection and five recommendations. We looked at two care plans and could see that work has been done to ensure that care plans are reviewed and kept up to date. Work has also been done on risk assessments and they are more comprehensive. There is still work to be done on developing care plans in different formats and in goal setting, however individual profiles have been updated and work is beginning in developing life story books, we looked at photographs one family had supplied to support the development of one persons life history and we could see that staff are beginning to use digital camera when people are out and about enjoying activities to record progress and add to their story. Risk assessments are more detailed. We could see in one section that the heading titled wishes and aspirations was not Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: completed and the acting provider told us they were planning on changing this to more clearly reflect each persons goals. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style and are supported to develop their life skills. Evidence: Throughout our visit we could see that people who use the service had good relationships with staff, there was lots of laughter and while staff are on shift they focus on the people living in the service. During our visit which was at a weekend, one person was out with family and other people were having a relaxed morning and were planning to go out after lunch. We spoke to people who told us they were able to relax in-their room if they wished or watch television. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: One person was reading in their room and another person was helping with lunch. We were told that people enjoy gong out for meals, going to clubs and taking part in activities which interest them. One person was very keen to have a tour round the new police station in Poole and he said a member of staff was going to try and arrange it for him. One recommendation at the last key inspection regarding a collection of photographs of food to support people who communicate differently in participating in menu planning, this has been achieved and is being added to all the time. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Evidence: People who use the service told us they are able to get up when they want to and are supported to wear the clothes they like. We could not find any evidence that peoples gender preferences for staff are recorded anywhere and the recomendation has been repeated. We looked at the care records for two people and could see there was evidence that people are having their health needs met. After each appointment a medical appointment form is completed which details the outcome of the appointment and any action which is needed, this then informs the care plan review which is updated monthly. The home have been provided with new health records which use an accessible format and people will be able to complete the information themselves and keep it updated after each health appointments. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: One requirement and three recommendations at the last key inspection. Medication are clearly recorded when they come into the home specifically the quantity. Staff have been undertaking training in understanding personal relationships and sexuality. Work has also been done on ensuring that people who use the service have updated health action plans. In the annual quality assurance assessment provided by the home they state that nutritional assessments are not completed and that staff do not receive this training as it is not applicable. It is important that each persons nutritional needs are assessed and that staff receive training in this area so they are able to spot concerns and take advice accordingly. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to an effective complaints system. Evidence: One requirement at the last key inspection it was necessary for the service to review how people contributed to the running cost of the car this has been achieved and people only pay for the miles they travel rather than a lump sum. The complaints procedure is now in large print and the contact number of the commission is included, each person has their own bank account and this is audited each month against their bank statement and all receipts are kept. Since the last key inspection there have been two safeguarding investigations. all seven permanent staff who work in the home have completed safeguarding training. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in comfortable surroundings which are in the process of being improved. Evidence: The home is a large detached house with a large garden accessible only via steep stone steps. One recommendation made that there is a clear sign highlighting the risk the stone steps in the garden pose. This has been done and quotes have been sought to re do the steps making them less of a risk. This work will begin shortly. There is a lounge and dining room as well as a smaller lounge where staff have access to a computer as well as the people who use the service, during our visit on person was using the computer to search for a particular item of clothing. The lounge is homely with enough comfortable seating for all the people who use the service. In a corner of the lounge all the filing and paperwork is kept the service acknowledge in their annual quality assurance assessment that: More organised and secure files in the lounge. At present the storing of confidential paperwork is not secure enough and it intrudes into peoples personal space. We asked one person who lives in the home to show us their room which they were happy to do. The room had been recently decorated and the person was involved in the choice of colour and furnishings. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: Another person was keen to show us their room which was also very personalised. We noted that the carpet was worn and the wallpaper torn in places. We were told by the provider that a programme of improvement is underway and this was also clearly stated in the annual quality assurance assessment. The home was clean and people who use the service are involved in this. All staff working in the home have completed infection control training. The laundry room is accessed down the steep flight of stone steps which people who use the service should not be doing carrying laundry unless it has been risk assessed. The laundry room itself is in need of refurbishment as the paint work is peeling from both the walls and the ceiling. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained,skilled and in sufficient numbers to support the people who use the service. Evidence: One recommendation at the last key inspection that the rota has the staff members full name and role. This has been done. Shifts have been changed to give more flexibility to people. The head of care who used to work at anther home owned by the same provider is responsible for ensuring that all staff are up to date with training. Each person has a training record and certificates all staff have had epilepsy training, all staff have medication training, adult protection training, challenging behaviour and total communication. There is always someone on shift who is a trained first aider. Six staff have completed Mental Capacity Act training. We looked at the recruitment records for one new member of staff namely the manager, we noted that all the appropriate documentation had been sought as outlined in schedule three. The new manager had not yet started work in the home as the CRB disclosure had not yet been returned. The acting provider told us of the training they were putting in to place for staff and this included Total communication training, autism, challenging behaviour and person Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: centred planning. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration of the home has improved and is based on openness. More work is needed to develop the quality assurance system so that peoples views form the basis of the development of the service. Evidence: A new manager has been appointed and will start work when her CRB has been returned. The acting provider told us that the manager is very experienced but has not worked in a service for younger adults before. The acting provider told us that new manger was only appointed on the understanding they would complete a training course in Learning Disability. The quality assurance process is still in development and therefore the requirement remains. All staff have completed mandatory training. Substances hazardous to health were stored safely. We looked at health and safety documentation, a fire risk assessment had been completed on 18/11/09. there had been a fire drill on 22/01/10 and the fire alarm was last tested on 19/01/10. Care Homes for Adults (18-65 years) Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 14, 15 Peoples care plans must be 01/07/2009 reviewed, kept up to date, and include all the individuals needs identified in their assessments. This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. 2 9 13, 14 Any areas of risk identified 01/05/2009 for an individual must be assessed and these assessments must include promoting independence and personal and sexual relationships. This is so that any risks are minimised and staff know what action to take to keep people safe whilst promoting positive risk taking. 3 20 13 The amounts or quantity of 01/04/2009 medications received into the home must be recorded on the medication records. This is to make sure that it can be audited and that people are receiving the correct dosage of medicines. Care Homes for Adults (18-65 years) Page 24 of 28 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 23 13 The way that people contribute towards the running costs of the cars must be reviewed. Any contributions towards the petrol for the car must be based on actual usage. This is to make sure that people only pay for what they use. 01/03/2009 5 39 24 The management of the 01/08/2009 home must further develop effective ways of involving people, assessing and monitoring the quality of the service. This is so that any shortfalls are identified, are improved on and the quality of the service is kept under constant review. Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 24 The management of the 30/04/2010 home must further develop effective ways of involving people in assessing and monitoring the quality of the service. It is important that people who use the service have a say in how it develops. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 18 Peoples preferences for the gender of staff for personal and intimate care should be recorded so that wherever possible these preferences can be met. This is so their wishes are respected and their dignity maintained. The registered provider should ensure that any people who use the laundry room should not carry a load of laundry down the stone steps in their current state as their is a risk they could fall. A risk assessment should be completed. The manager of the service should undertake training to ensure they have up to date knowledge of current good practice in the learning disability sector. Page 26 of 28 2 30 3 37 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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