Inspection on 28/08/07 for Lewis House

This inspection was carried out on 28th August 2007.

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 6 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 07/03/07

Lewis House 21/06/06

Lewis House 13/02/06

Lewis House 08/06/05

Lewis House 22/02/05

Lewis House 25/08/04

Lewis House 18/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Lewis House Higher Merley Lane Corfe Mullen Nr Wimborne Dorset BH21 3EG Lead Inspector Heidi Banks Key Unannounced Inspection 28th August 2007 1400 Lewis House DS0000026836.V349458.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.V349458.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.V349458.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 F/P01202 887255 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jillian Elborn Mr John Francis Elborn Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2007 Brief Description of the Service: Lewis House is a care home offering accommodation to a maximum of six adults who have a learning disability. The home is located in a quiet semi-rural setting on the outskirts of Corfe Mullen. Local amenities are close by and include churches, a supermarket and a public library. Public transport operates close to the home, taking residents into Wimborne, Broadstone and Poole. The property is a detached family style house with a family atmosphere. The home is staffed 24 hours a day. Mr and Mrs Elborn own the home and Mr Elborn is the Registered Manager although their son 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 also run two other homes in the local area, Woodside House and a self-contained flat for one service user. From information given at the inspection, fee levels for the service range from £575 - £1050 per week. This excludes an additional payment towards fuel costs and costs for chiropody, hairdressing and personal items such as toiletries. Further information on fee levels and fair terms of contracts can be obtained from the Office of Fair Trading; www.oft.gov.uk. Lewis House DS0000026836.V349458.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 of the service. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since the last key inspection of the service in March 2007. The inspection took place over approximately fourteen hours on 28th and 29th August and 6th and 13th September. On 6th September the lead inspector was accompanied by a Pharmacist Inspector who inspected medication procedures in the home. The Pharmacist Inspector returned to the home on 16th October to examine procedures again. At the time of this inspection there were six people living at Lewis House. During the inspection we were able to take a tour of the home, meet people who use the service and observe some interaction between them and staff. Discussion took place with the registered providers, Mr John Elborn and Mrs Jillian Elborn, Mr Simon Elborn who manages the home on a day-to-day basis and some members of the staff team. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Following the last inspection, an improvement plan was produced by the provider outlining actions they planned to take to improve the service. Prior to the inspection, an Annual Quality Assurance Assessment (AQAA) was also completed by the provider and submitted to the Commission. Surveys were distributed by the home to people who use the service, their relatives, care workers in the home, care managers and health care professionals on behalf of the Commission. A total of two surveys were received from relatives and information from these sources is reflected throughout the report. A total of twenty-four standards were assessed at this inspection. What the service does well: The service continues to promote people’s independence in their home and community enabling people to live ordinary lives. The home encourages a person-centred approach to activities and people are enabled to do things that interest them. People are supported to make decisions and choices on a daily basis and they are given opportunities for personal development. The home promotes a family-style atmosphere and people are able to access all areas of the home as they wish. Staff spoken with indicated that the Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 6 registered providers are approachable and supportive. One relative commented in a survey that ‘They are good and helpful’. Another relative commented ‘You couldn’t wish to meet nicer people’. What has improved since the last inspection? The provider has made progress in meeting the majority of the requirements made at the last inspection. This indicates their commitment to make improvements to the service. Procedures have been written regarding the use of oxygen for one person and training has been arranged for some staff on this to ensure that they can support the service user effectively. Discussion with the providers indicated that procedures are in place to respond to challenging behaviours of people who use the service although these have not been clearly documented. Review of incident records indicated that procedures are put into practice by staff to promote people’s safety in the community. An accident book that meets legal requirements is now in place in the home to help ensure that there is clear documentation of accidents that may occur and further protect service users. Redecoration of some areas of the home has commenced with the aim of ensuring that people have a pleasant place in which to live. Some policies have been reviewed by the provider since the last inspection to ensure that they contain up-to-date information that is based on best practice. This helps ensure that staff have the information they need to provide care safely. One-to-one supervision with care workers has also been implemented to ensure that staff are supported in their role and have the opportunity to discuss their training, development and practice on an individual basis with the manager. There was evidence at this inspection that the home has sought people’s views about the home and the care they receive. This helps ensure that their needs and wishes are central to service delivery. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lewis House DS0000026836.V349458.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.V349458.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: There have been no new admissions to the home since the last inspection. Therefore these standards were not assessed at this inspection. Lewis House DS0000026836.V349458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual plans take account of people’s needs and choices in relation to their care but there is room for development of goal-setting and risk assessment processes. EVIDENCE: A sample of people’s care plans were inspected. These were seen to provide a general overview of individuals’ needs and preferences. The support that people need to make choices has also been given consideration; ‘X is able to make informed decisions but will become quickly confused if too many options are available…’ Care plans are not in a format that is accessible to people who use the service and therefore it is unclear how much they understand about the content of their plan and to what extent they own their plan. The relative of one service user commented in a survey that they felt more regular Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 11 meetings could be held between the home, service user and their relatives and friends to discuss their present and future needs. Personal goals have been given some consideration in the plan. One plan noted that the person would like to access various work opportunities in the future but this was ‘not possible at this time’. For one goal it was noted in June 2007 that the home was waiting for a response from a potential work placement but there was no evidence that this had been followed up. For another person their goal was stated to be ‘to get married’ but again there was no information on file to indicate how the service was supporting the individual to build and maintain personal relationships to work towards this goal. Discussion with Mr and Mrs Elborn indicated that they have a very good understanding of individuals’ needs. They have known the people who live in the home for some time and as a result have built good relationships with them. Observation of people in their home and discussion with them indicated that they are enabled to make decisions and choices on a day-to-day basis. For example, where one person did not like the proposed evening meal, the provider had supported them in going to the local shops to find an alternative. Discussion with one service user indicated that they had been able to choose new décor for their bedroom which had pleased them. Service user meetings have been held in the past at the home but discussion with the provider indicated that these had not been particularly productive and therefore were not being held on a regular basis. Risks to individuals are given some consideration in their plans, for example risks of accessing the community and road safety issues and risks around people’s vulnerability. General risk assessments have been completed for each person which provide some information about their ability to use appliances in the home and risks associated with fire safety, window openings and stranger danger. A requirement was made at the last inspection that specific risk assessments must be completed and made available to staff where a particular risk has been identified. It was noted at the inspection that a risk assessment had not been completed for one service user where incident reports had indicated that they could become agitated in the community or in a vehicle. Discussion with the provider indicated that strategies were in place for managing such situations, for example, the presence of two staff who will carry a mobile telephone to enable the service user to return home if necessary, but this had not been written down in the care plan. Following the inspection, a risk assessment has been completed by the home but this does not contain sufficient detail to inform care workers of actions they must take to prevent or minimise the risk of a potentially challenging situation. Risk assessments had not always been reviewed by the date specified in the documentation. Lewis House DS0000026836.V349458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service continue to enjoy positive lifestyles in their home and community. Their right to an ordinary life is promoted by the service. EVIDENCE: Review of daily records and discussion with people who use the service indicated that they are enabled to undertake a range of activities to meet their individual needs. The record for one person showed that during August they had been supported to go horse-riding, to pubs, a local market, Poole town centre, a club for people with learning disabilities and a local farm café for a drink. Records also indicated where the person had helped with putting together a shopping list for groceries and joined in a barbecue with people from the provider’s other care home. Other service users attend various day services in the local area and on the day of the inspection returned home with Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 13 certificates indicating their participation in a road safety awareness day. One service user told us that he was a member of the county marching band and had recently been to France for a week where they had performed in various concerts. Around the time of the inspection the majority of people were going on holiday to the provider’s villa in Spain. Arrangements had been made for one service user to go in a smaller group earlier in the year where this was preferable giving them the opportunity to go on an aeroplane journey for the first time. The provider was aware that some people wanted to find work in their community but this was proving difficult to achieve. Daily records showed where people had been in contact with friends and family either by visits home or through telephone calls. There is a pay-phone situated on the stairs of the home for people to use as they wish. People told us that a service user who had previously lived in the home had recently had a birthday party which they had been able to attend. Two relatives responding to the survey felt that the home either always or usually helped their family member keep in touch with them. Observation of people who use the service showed that they are able to access all communal areas of the home and their own bedrooms as they wish. Those people who are able to prepare drinks and snacks for themselves are enabled to do so using the kitchen and a person who is able to self-administer their medication is also given the opportunity to do this. People were observed being encouraged to participate in domestic tasks around the home. Discussion with one relative of a service user indicated that they felt the home did well in promoting people’s independence and choice. The menu plan for the week was on display in the kitchen and records of meals eaten by people in previous weeks were seen. These showed that a variety of food is offered to people. One person told us that she disliked a certain meal – it was evident from discussion with the provider that efforts were made to offer an alternative where this was the case. Daily records and discussion with people who use the service indicated that they are supported to eat out at local pubs and cafes on a regular basis. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are generally met by the service but procedures for storing and recording administration of medication need improvement to protect residents and ensure that their healthcare needs are met. EVIDENCE: The sample of care plans seen gave some information about people’s needs and preferences in relation to personal care, for example, ‘X will always make staff aware when he feels that his nails need cutting. Staff currently cut X’s fingernails but he sees a chiropodist for toe nail care’. However, one plan seen contained some potentially conflicting information stating in one part of the plan that the person ‘will be prompted and supported to carry out personal care’ and later in the plan that the person ‘performs all aspects independently’. Two surveys were received from relatives of people who live in the home. One indicated that the care home always meets the needs of their relative, the other indicated that this was usually the case. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 15 One response indicated that they would like to see their relative ‘more presentable at times…i.e. clean shaven and help in choosing clothes to wear’. Each service user had a ‘Personal Health Record’ document in their file which provides space for recording information about people’s needs and routines. However, these had not been fully completed. Instead, information on people’s health requirements had been incorporated into their care plans. One care plan was seen, this showing a good overview of the person’s needs in relation to a specific medical condition, associated risks and actions to be taken by staff to minimise risks. Training in the safe use of oxygen has recently taken place in the home for some staff who support one individual with this. A record of medical visits has been maintained for individuals in a separate file. These showed evidence that people have been supported to attend a range of health appointments to meet their needs including appointments at the hospital and with the GP, dentist, optician and practice nurse. Where one person had experienced mood swings there was evidence that their GP had been consulted and a change in medication had been implemented as a result. There was correspondence on record to indicate that one person had been invited to attend a health screening appointment at their local surgery but no evidence to show that this had been followed up by the home. One resident in the home was self-medicating but the risk assessment was not sufficiently comprehensive and storage arrangements needed improvement. Information about people’s medication in files and support plans was not kept up to date. Most medicines were provided in monitored dose cassettes labelled for individual residents but medicine records were unclear and incomplete. For example one person’s antibiotic eye drops were recorded on a separate piece of paper rather than on the printed Medicine Administration Record (MAR) chart and were not signed as given for 6 days. The quantity remaining for two of three medicines checked agreed with the records. The provider said that they were implementing a new monitored dosage system next month. There was evidence of some staff having medication training but it was not consistent. The provider said that the new supplier would be providing medication training for all staff who give medicines. Medicines were stored in a locked cupboard but it was very small. Oxygen was stored appropriately but there was no risk assessment for its use on the person’s file. The manager sent one to us by e mail following the inspection. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures and some training are in place to help safeguard people who use the service but further development of systems is needed to ensure positive outcomes for service users are achieved. EVIDENCE: The home has a complaints procedure which was revised in October 2006 to state that people can contact the Commission at any time if they have any concerns or complaints about the home. Discussion with the manager of the home indicated that he was aware that more work was needed to ensure that the current complaints procedure was fully accessible to people who use the service. Of two surveys received from relatives, one indicated that they were aware how to make a complaint about the care provided by the home if they needed to. The other respondent indicated that they could not remember how to make a complaint but would always discuss any problems directly with the providers to resolve the situation. They were, however, uncertain whom they would contact if the provider could not resolve their concerns. Discussion with two people who use the service indicated that their views had been taken into account in different situations. It was evident from observing interaction between service users and the providers that people feel able to approach them with issues that are important to them. The Annual Quality Assurance Assessment submitted by the home states that ‘concerns and Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 17 complaints are aired by our service users on a daily basis’. It goes on to say that ‘more serious complaints’ are recorded in the complaints log together with details of action taken and outcomes. The complaints record for the home indicated that no complaints have been recorded since the last inspection. There have been no complaints made to the Commission about the home. Concerns that may arise on a day-to-day basis do not appear to be recorded by the home. Although it was reported that house meetings had been held in the past, they are not held on a regular basis at Lewis House at the present time. At the last inspection of the service there was evidence that the home had a copy of the multi-agency guidance ‘No Secrets’ in relation to safeguarding vulnerable adults and a whistle-blowing policy. The Annual Quality Assurance Assessment produced by the home indicates that these are still in place and that staff training is provided in abuse awareness. At the last inspection of the service it was reported by the manager that the majority of staff had received adult protection training from the local authority although they had not received certificates to evidence their attendance. At this inspection it was reported that more staff had recently attended this training although again there were no certificates on file to evidence this. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lewis House provides a clean, homely and comfortable environment for people to live in. EVIDENCE: Lewis House is a detached, family-style home on the outskirts of Corfe Mullen. There are two lounges, a dining area, a conservatory and a spacious garden for use by residents. The rear garden is accessed down steep stone steps. The kitchen is equipped with domestic appliances. All service users have their own bedrooms, each of which has a wash hand basin. One bedroom is on the ground floor with the remaining bedrooms being situated on the first floor. A tour of the home evidenced that people have been able to personalise their bedrooms with their own belongings as they wish and two people spoken with had recently been involved in choosing new décor for their rooms. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 19 At the last inspection of the home it was noted that some areas of the home would benefit from redecoration. There was evidence at this inspection that this was in the process of being addressed. The office area of 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 house which accommodates the home’s vehicle and there is additional space for parking outside the home. There are laundry facilities situated in the basement of the home. Entrance to the laundry room is via the rear garden. Their location means that it is necessary for people who use the facilities to go up and down the steep stone steps. One relative responding to the survey commented that the home ‘provides a friendly, caring, safe environment. There is a family-type atmosphere’. A homely and welcoming atmosphere was evident at the inspection. At the time of the inspection the home presented as clean. People are encouraged to participate in domestic chores with staff support. Since the last inspection the home’s infection control policy has been updated and refers to the most recent guidance from the Department of Health. Inspection of a training plan indicated that five out of fourteen care workers employed at the home have completed knowledge papers in infection control. The provider has told us in their Annual Quality Assurance Assessment (AQAA) that this training will be ongoing in the next twelve months. Out of six staff training records seen, two showed evidence of them having completed training in food hygiene although this was in 1997 and 2003 respectively which means that update training is overdue. All care workers at the home take responsibility for preparing meals for service users. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment procedures and staff training remain inadequate to ensure that the service operates in a way that fully protects service users. EVIDENCE: Care workers employed at Lewis House also work at the provider’s other care home in Merley. At the time of the inspection it was reported that there were fourteen care workers employed to work at both homes. Three care workers were new to the service. Discussion with two of them indicated that they had been introduced to policies and procedures in the homes but had not yet commenced a formal, structured induction programme. Both care workers had previous experience of care work although not always with people with learning disabilities. Discussion with one member of staff indicated that they had felt well supported by senior staff on commencing employment in the home. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 21 Out of fourteen staff, one person has recently commenced their National Vocational Qualification (NVQ) Level 4 in Care, two people are working towards their NVQ Level 2 and one person who has come to work at the home already has their NVQ Level 2 qualification. The provider has acknowledged in their Annual Quality Assurance Assessment (AQAA) that staff training is an area of ongoing concern and all staff would benefit from more regular training days. They have indicated that their plan for improvement in the next twelve months is to continue to provide relevant training for staff. The staff training records were inspected, these being well-organised. The home has purchased an in-house training package to fill gaps in people’s knowledge and there was some evidence on the training plan to show that some staff have embarked on knowledge papers in some areas including medication and infection control. Some specialist training has been undertaken by some staff in the past, for example, ‘Dealing with Challenging Behaviour’ and training in ‘Foot Care’ and ‘Oral Health’ but a more consistent approach to training is needed to ensure that all staff undertake all the training they need to undertake their work with service users and meet their individual requirements. The records for three care workers were examined, all of whom had commenced employment since the last inspection. These demonstrated that PoVAFirst checks had been completed prior to them commencing in post. One member of staff spoken with indicated that they had been supervised in their work until their full disclosure from the Criminal Records’ Bureau had been received. There was appropriate proof of identity on file for all three care workers. However, two application forms did not show a clear employment history and two files examined showed evidence of only one written reference having been received prior to commencing employment. Both care workers had been working at the home for several weeks at the time of inspection. Once this was highlighted with the provider efforts were made to obtain the missing references, one of which was seen by the conclusion of the inspection. The third file examined contained two references, one personal and one professional. The professional reference was not from the manager of a previous workplace and the reference was not on headed paper. In addition, references had not been obtained from the person’s two most recent employers. Discussion with the manager indicated that a supervision process is in place for staff. This was reported to take place on a one-to-one basis and records were seen of notes taken during supervision meetings. Staff spoken with during the inspection indicated that the providers were approachable and they felt able to discuss both work and personal issues with them. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the service is not robust enough to ensure that the home fully meets the regulations and protects people who use the service. EVIDENCE: Although progress has been made to meet most of the requirements made at the last inspection of the service, six requirements are being repeated where previous timescales have not been met. This reflects negatively on the management of the home. For some time the day-to-day management of the home has been delegated to a relative of Mr and Mrs Elborn. At the last inspection a requirement was made that the provider must ensure that an appropriate registration application is submitted to the Commission to Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 23 formalise this arrangement with a timescale of 01/07/07. At the time of writing, this has not been received. It is unclear how the care providers are keeping up-to-date with recent changes in legislation and developing themselves in order to be able to provide direction and guidance to the home’s manager. At the time of the inspection, the appointed manager of the home had recently commenced his NVQ Level 4 in Care / Registered Manager’s Award. Since the last inspection the views of people who use the service have been sought by the provider by means of surveys. Efforts have been made to make the surveys accessible to service users. People were asked for their views on their care workers, choices available to them, activities and outings, food, their relationships with the people they live with and the way in which the home is run. Responses from service users were seen to be very positive. It is recommended that the provider expands the quality assurance process to include people who visit the home such as relatives and professionals. An annual development plan based on responses from the surveys has not been developed although the manager confirmed that where people had highlighted particular issues these had been responded to on an individual basis. The provider has told us in their Annual Quality Assurance Assessment that the majority of policies and procedures are in place although review dates have not been specified. A policy on management of service users’ money, valuables and financial affairs is not in place and this needs to be addressed to ensure that practices in the home protect service users. A sample of policies was seen. Following a requirement made at the last inspection that the provider must review their moving and handling policy in order to promote safe practice in the home there was evidence that this has been done. A revised infection control policy has also been produced. There was evidence in some policy documents that in the past care workers had signed to indicate that they had read the policy. This system has since lapsed. Following a requirement made at the last inspection an accident book that meets legal requirements has been purchased by the home. No accidents have been recorded. The provider confirmed that there have been no accidents occurring in the home. A sample of fire safety records was seen. Some gaps in the recording of weekly alarm checks were noted where the manager of the home had been away. It was discussed that arrangements must be made for regular checks to be carried out in the manager’s absence. Records of fire drills were inspected. Times of drills and the initials of staff present had been recorded. Times of practices recorded ranged between 0945 hrs and 1840 hrs. It was noted that, out of the staff team, people present for the drills tended to be the same on each occasion. This indicates a need for the provider to ensure that all staff within the home have the opportunity to participate in an evacuation during Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 24 the course of a year to ensure that they are aware of the procedures and know what action to take in the event of an emergency. Fire training records were reviewed. In 2006 an external fire safety company had been commissioned to provide staff training in the home. The training records for six staff showed that half had undertaken this training in the past year. Two had last undertaken the training in May 2006. One showed no evidence of having undertaken training in fire safety. Out of six staff training records seen, none showed evidence of people having completed training in emergency first aid. As staff frequently work alone in the home this is identified as an area of risk to people who use the service. Thermostats to regulate the temperature of hot water in the home have been installed since the last inspection which helps minimise the risk of scalding. At the present time a system of monitoring the temperatures of hot water from various outlets to check that the thermostats are working effectively is not in place. Records to monitor the temperatures of the refrigerator and freezer in the home showed a number of gaps where temperatures had not been recorded. This issue was discussed with the manager who reported that he had put in place a new framework for recording this information that day and would be reminding staff of the need to record temperatures on a regular basis. Since the last inspection, the manager of the home has completed a knowledge paper on the ‘Principles of Risk Assessment’. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 25 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 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 X 2 2 X 1 2 Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 26 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 YA20 Regulation 13(2) Requirement 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 for one service user who self-medicates must contain sufficient detail to ensure that all relevant risks have been considered and adequate control measures are put in place. This requirement is repeated from the last inspection of the service as the previous timescale of 01/07/07 has not been fully met. In addition: All staff who administer medicines must have appropriate medication training; Accurate records must be kept of the receipt and administration of all medicines. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 27 Timescale for action 31/12/07 This will help ensure that people who use the service benefit from safe medication practices and their healthcare needs are met. 2. 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. 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 inspection of the service on 21/06/06. (The standard could not be assessed at the last inspection of the service as there were no new staff to evidence safe recruitment procedures). 3. 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 is to include induction training, accredited health and safety training (including first aid, food hygiene and infection control) and training that reflects the diverse needs of the service user group. This will help ensure that care is provided safely and effectively to people who use the service and Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 28 01/12/07 31/12/07 they benefit from a skilled and qualified workforce. This requirement is repeated from the last inspection of the service as the previous timescale of 01/07/07 has not been met. 4. YA37 10(1) The registered providers must carry on or manage the care home with sufficient competence so as to ensure that the regulations are met. This helps ensure that people who use the service are protected. This requirement is repeated from the last inspection of the service as the previous timescale of 01/07/07 has not been fully met. 5. YA42 23 All staff must receive regular fire training from a competent person. This helps ensure that all care workers know what to do in an emergency and are able to keep people safe. This requirement is repeated for the fourth time as previous timescales of 01/08/05, 01/06/06, 01/10/06 and 01/05/07 have not been fully met. 6. YA43 8(1) 8(2) To comply with Section 11 of the Care Standards Act (2000) the registered provider must submit an application to register DS0000026836.V349458.R01.S.doc 31/12/07 01/12/07 31/12/07 Lewis House Version 5.2 Page 29 a manager with the Commission for Social Care Inspection. This will promote clear lines of accountability for people who use the service. This requirement is repeated from the last inspection of the service as the previous timescale of 01/07/07 has not been met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Service user plans should be developed in consultation with service users and their representatives. Those involved in the formulation of the plan should sign to indicate that they agree with the content. There should be a clear record made of the service users goals and aspirations and how the home is to help to meet these. Care Plans should be developed in a format suitable to the needs of service users. These recommendations are repeated from previous inspections of the service. 2. YA9 Risk assessments should contain clear strategies for staff regarding the management of specific risks. Risk assessment documentation should show evidence of regular review. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 30 3. YA18 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. This recommendation is repeated from the last inspection of the service. The provider should ensure that invitations for service users to attend preventative health screening appointments are followed up appropriately. The home’s complaints procedure should be in a format that is accessible to service users. This recommendation is repeated from the last inspection of the service. The home should consider ways in which day-to-day concerns that may arise are documented and responded to in order to provide a clear audit trail of how positive outcomes for service users are achieved. The home should ensure that relatives of people who use the service are aware of the complaints procedure. The registered providers should ensure that all staff access training on abuse awareness and that certificates are held on file to evidence their attendance. This recommendation is repeated from the last two inspections of the service. 4. 5. YA19 YA22 6. YA23 7. YA32 The registered providers should ensure that all staff have at least an NVQ 2 qualification in care or are working towards one. This recommendation is repeated from previous inspections of the service. 8. YA34 9. YA39 The provider should ensure that references obtained for people are sufficiently robust and that adequate evidence of a full employment history is obtained prior to people starting work in the home. The home should have an annual development plan reflecting the aims and outcomes for service users. This recommendation is repeated from previous inspections of the service. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 31 10. YA40 The registered providers should ensure that all policies and procedures are monitored, reviewed and amended to ensure they are up-to-date and contain valid information. This requirement is repeated from the last inspection of the service. The provider should be able to demonstrate that policies and procedures in the home have been read and understood by staff. A policy and procedure on the management of service users’ money and financial affairs should be developed by the home. 11. YA42 A fire drill should take place when staffing levels are reduced, for example, in the late evening, at night or in the early morning. This recommendation is repeated from the last inspection of the service. All staff working in the home should have regular opportunities to take part in fire drills / practice evacuations. Lewis House DS0000026836.V349458.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset BH17 0NF 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.V349458.R01.S.doc Version 5.2 Page 33 - 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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