Inspection on 07/03/07 for Lewis House

This inspection was carried out on 7th March 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lewis House 23/01/10

Lewis House 14/01/09

Lewis House 21/07/08

Lewis House 21/01/08

Lewis House 28/08/07

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 Announced Inspection 7th March 2007 10:30 Lewis House DS0000026836.V329789.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.V329789.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.V329789.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.V329789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 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 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 and their family also run two other homes in the local area, Woodside House and a self contained flat for one service user. The minimum basic fee level for the home is £550 per week. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection undertaken with two days’ notice. It was the second key inspection of the service to take place between April 2006 and March 2007. The purpose was to assess the home’s compliance with the Regulations and key National Minimum Standards and the progress made in relation to thirteen requirements and sixteen recommendations made at the last inspection. The inspection was conducted over 6.5 hours on the 7th March 2007. There are currently six residents living at Lewis House. The inspection included discussion with the son of the proprietors who manages the home on a day-to-day basis and shall be referred to in this report as ‘the manager’. Two service users and two members of the care staff team were also spoken with. Time was spent inspecting a sample of staff and service user records, including medication records, and taking a guided tour of the home accompanied by a service user. A total of twenty-three standards were assessed at this inspection. What the service does well: What has improved since the last inspection? All service users now have an individual plan and risk assessment which offer some information about their needs and preferences in their daily lives. House meetings are held on a regular basis to encourage service users to participate in decision-making and air their views as a group. There was evidence that one service user, who had wanted to take up new interests at the last inspection, had been supported in doing so. This respects her right to make choices and do activities that are meaningful to her. Records of service users’ health care appointments were up-to date showing how their health issues have been followed up. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 6 Evidence has been obtained that the home’s gas installations have been serviced which promotes service users’ safety. A rolling programme of fire safety training has been implemented in the past ten months. This is facilitated by an external agency and helps ensure that staff have the knowledge and skills to support service users effectively in the event of an emergency. What they could do better: As a result of this inspection, seventeen requirements and fourteen recommendations have been made. Of these, seven requirements and eight recommendations have been repeated from previous inspections where timescales have not been met. The provider must be aware that the Commission may take enforcement action where requirements made at inspection are persistently not met. Many shortfalls identified are around aspects of health and safety including risk assessment, staff training and review of policies and procedures to ensure staff know what they must do to keep service users safe. Risk assessments need to contain more detail about potential hazards in the home and control measures that must be put in place to minimise risks to service users. There is not enough training available to staff to ensure that they are fully aware of health and safety in the home, for example, in infection control, food hygiene and first aid. Inadequate training in meeting service users’ individual needs has also been noted and the home must provide this to ensure staff have the knowledge and skills to support service users safely and effectively. This includes ensuring that service users are protected from aggression by other residents through the development of clear strategies for documenting, reporting and managing incidents. Although staff report that they feel supported by management, it was evident that support offered tends to be informal. Formal arrangements are needed to ensure that staff receive the supervision and guidance they need to work well with service users and develop themselves in their role. The home also needs to put systems in place to identify future objectives for the service based on the views of service users. This will enable them to improve outcomes for the people they support. Although the majority of staff have attended fire safety training in the past year, the home must ensure that all staff access this training to ensure they know what action to take in the event of an emergency. Risk assessments for individual service users with regards to hot water within the home must be more detailed to ensure that control measures in place are adequate to protect service users from harm. Policies in the home must be reviewed to reflect legislation and these need to be implemented fully so that the home follows best practice in all areas. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 7 A series of recommendations have been made which will help promote good practice in the home. These include development of service user plans to make them accessible and person-centred. Service users’ participation in their plans should be promoted with staff being able to access total communication training to maximise opportunities for people with non-verbal means of communicating to make choices and decisions about their lives. Some shortfalls in medication practices have been identified which should be addressed for service users to be fully protected. Staff should be able to undertake a National Vocational Qualification (NVQ) in Care to equip them with the knowledge they need to meet the needs of people with learning disabilities. All staff should also access training in abuse awareness so that they know how to respond appropriately if they are at risk of harm. Fire drills should take place at variable times of the day, in particular when staffing levels are reduced, and attention should be given to the recording of drills to ensure that all relevant information is documented. 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.V329789.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.V329789.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 service users admitted to Lewis House for more than two years. Therefore this standard was not assessed at this inspection. Lewis House DS0000026836.V329789.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 are in place for all service users but do not show enough evidence of how service users are being supported to work towards their goals and are not in a format that service users can understand. Service users with verbal communication are supported to make decisions about their everyday lives but further consideration needs to be given to people with non-verbal communication to ensure they are equally wellsupported in this area. Risk assessments lack the detail required for them to provide specific guidance to staff about the action they should take to protect service users from harm. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 11 EVIDENCE: The support plan for one service user was inspected. The plan was dated November 2006 and was signed by a manager of the service but not the service user himself. The plan gave information about the service user’s weekly programme, general health, medication, communication, mobility, selfcare and independent living skills and a summary of risk factors. Overall, the plan offered some useful information about the service user’s needs and abilities. The service user’s personal goals were listed as wanting to meet his girlfriend for a meal and to go to the cinema on a more regular basis. Discussion with staff indicated that the service user had been supported to meet with his girlfriend as stated but this was not reflected in the plan with information about how the service user was being supported to work towards his goals. Support plans are not currently in a format that is accessible to service users. Discussion with service users showed that they are enabled to make choices in their daily lives. Regular house meetings are held which give service users the opportunity to contribute to decision-making. Minutes of a meeting showed that service users had been involved in discussion about the admission of a new person to the home. They had stated that they did not want this to happen and their choice was respected by the management. Another service user reported that he did not like going on holiday with his peers as there were ‘too many arguments’. It was not clear from conversation with him that he would be able to choose a separate holiday but discussion with the manager indicated that this possibility would be looked into. It is suggested that the home continues to give consideration to how they involve service users with non-verbal communication in making decisions. The majority of service users now have bank accounts into which their benefits and allowances can be paid. A risk assessment process has been introduced to the home. The assessment document has been developed by the manager of the home and covers risks to service users within their home environment and community. This included the use of electrical appliances, cleaning products, kitchen utensils, ability to judge water temperatures, fire awareness, stranger awareness, using public transport and money skills. Risks are judged as ‘no risk’, ‘low risk’; ‘medium risk’ and ‘high risk’ and there is space for additional information to be recorded. Risk assessments for two service users were examined. These had been completed in the past four months. It was noted that information was sometimes too general to give sufficient information about service users’ needs Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 12 in specific areas. For example, the risk of one service user being aggressive to others was stated to be ‘high’; ‘X can become very frustrated or agitated…and at these times can lash out at other service users. Staff to be aware of X’s mood at all times and remove other service users when necessary’. An incident report seen indicated that the same service user had hit out at a passenger in a vehicle. There was no risk assessment to cover the action to be taken by staff in the event of the service user becoming agitated in different environments, for example, in the car or the community. A risk assessment for another service user stated ‘X’s bath water needs to be checked. Also duration in bath needs to be monitored’. Again there was no information available to guide staff what exactly they need to check and the recommended time limit for the service user to be in the bath. It was reported by the manager that all staff had been involved in contributing to the risk assessment process. There are no staff at the home with specific training in risk assessment. It is suggested that the provider consults guidance on writing risk assessments produced by the Health and Safety Executive to ensure good practice in this area. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 13 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. Service users have an appropriate programme of activities and are encouraged to access the local community on a daily basis ensuring they have a range of social, leisure and educational opportunities available to them. The home is sensitive to and supportive of service users’ personal relationships and welcomes their family and friends into the home. Service users’ rights are respected and choice and freedom of movement are promoted in the home. The home provides a varied selection of food that meets service users’ preferences. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 14 EVIDENCE: A timetable of service users’ occupation and leisure activities is on display in the kitchen. This shows that service users are supported to participate in activities to meet their individual needs and preferences including attendance at local day services, work experience and community-based activities. Since the last inspection it was apparent that one service user had been supported to take up horse-riding and swimming at a local leisure centre. Another service user spoke of how he enjoyed going to play snooker at the local pub. Minutes of a house meeting were seen which indicated that various choices of leisure activities had been discussed including attendance at ‘Snap Club’ – a local club for people with learning disabilities and planning of the Christmas party. Conversation with staff indicated that service users from Lewis House join those from the owners’ other residential care home, Woodside House, at weekends to go out for meals or for joint events such as barbeques. The home has a vehicle to enable service users to access their local community. Service users spoken with during the inspection reported that they have regular contact with their family through visits and telephone calls. The home has a pay-phone to enable service users to contact their family and friends as they wish. This is located on the stairway of the home which raises a possible issue with regard to privacy. The manager reported that this had never been identified as a problem by the service users but that if they preferred, they would be able to use the home’s portable telephone to make a personal call. One service user has a girlfriend who lives elsewhere. Discussion with the service user concerned and the manager evidenced that he is supported to have contact with her on a regular basis and had recently gone out for a meal with her to celebrate St. Valentine’s Day. Service users have access to all communal areas of the home and their bedrooms are respected as their personal space. Service users are supported to take responsibility for aspects of their own care and their environment as they are able. Staff were seen interacting fully with service users during the inspection and asking for their opinions on things. Two service users spoken with during the inspection commented that they were happy with the food provided for them at Lewis House. Meals are generally prepared by staff at the home but it was noted that service users were able to make choices about what they wanted. Service user plans also indicate that they go grocery shopping with staff. They are also supported to go out for meals. Following the inspection, Mrs Elborn confirmed that service users have access to fresh fruit. At the end of the inspection, service users were gathering to eat their dinner. There was a convivial atmosphere with service users and staff eating together at the table and sharing news about their day. Lewis House DS0000026836.V329789.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. 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. Basic procedures are in place to support service users with their personal care, health care and medication needs. However, support plans and staff training need further development to ensure that the specific needs and preferences of service users in relation to these are fully identified and met. EVIDENCE: Service users’ records showed evidence that individuals’ personal care needs had been noted. Where service users were independent in aspects of their care this had also been recorded; ‘X…maintains his oral hygiene to a very good standard. He brushes his teeth at regular intervals throughout the day’. This information corresponded with health records which indicated that the same service user had recently had a check-up with the dentist which had been satisfactory. For a service user requiring more support, there was also information on file about her morning routine; ‘X wakes early in the morning but will not get out of bed until prompted by staff. X requires full support in selecting clothes and in dressing. Full support is also required with washing Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 16 and personal care.’ Although this gives basic information to the reader it is recommended that the home provides more information about service users’ preferences, especially where a service user has non-verbal communication, to ensure that care workers can provide consistency of care. A service user’s support plan has been expanded to include more information about his health care needs in relation to the administration of oxygen. This now details the action staff should take if the service user becomes breathless or displays cyanosis. However, there is still no information available about how to operate the equipment used to supply oxygen or how to ensure it is working appropriately. Since the inspection the home has been supplied with some information on the safe storage and use of oxygen so that they can develop a risk assessment for its use and produce guidelines for staff. As stated in the last inspection report for the service, the care management assessment undertaken prior to the admission of the service user in 2002 indicates that staff at the home must be trained in the use of oxygen. There is no evidence on file to show that staff have been deemed competent in this area. A record of health care appointments has been maintained for each service user. This shows that service users have been supported to attend their local GP surgery, dentist, optician and hospital appointments as appropriate. 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 medicines entering and leaving the home being documented, a homely remedies list and patient information leaflets for those medicines taken by service users. The home continues to use their own Medication Administration Records (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 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. At the time of inspection, a box of tablets, no longer in use, was being stored in a cupboard in the lounge. The date of opening had not been recorded on the box. It was recommended to the manager that if medicines are no longer required by service users they should be returned to the pharmacy. A sample of medication administration record charts was seen. There was one gap where medication had not been signed for by the member of staff responsible for administration. One service user in the home self-medicates. The risk assessment for the service user was updated in November 2006 and states that the risk of the Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 17 service user self-medicating is ‘medium’. However, the risks have not been clearly identified. The risk assessment goes onto say that the service user ‘needs to be reminded about taking his medication’ and refers the reader to the support plan. The service user plan indicates that ‘staff will seek confirmation that relevant medicines have been taken and record accordingly’ but how this is confirmed needs to be clearly documented, that is to say, whether staff confirm this verbally with the service user or by a visual check of his medication. The home has been sent some information on developing a risk assessment on self-medication to ensure that all areas of risk are covered. All staff working at Lewis House currently administer medication. The training records for nine staff were examined. Six of the nine had undertaken some form of training in the administration of medication. The manager reported that those who had not attended training were currently completing a correspondence module in the subject. Lewis House DS0000026836.V329789.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. 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. Systems are in place for service users to express their views. Development of systems for service users with communication needs should be explored to ensure that their views are also considered. Policies are in place to safeguard service users from abuse but it is not clear what action has been taken to protect service users from the challenging behaviours presented by peers. EVIDENCE: Two service users spoken with during the inspection stated that they would talk to a member of staff if they had any concerns about their care in the home. A key worker system is not in place in the home but service users spoken with indicated that they would approach any member of staff if they had a problem. House meetings are in place for service users to discuss any issues that are important to them and minutes of a previous meeting demonstrated that this had been done successfully. The home’s complaints procedure has been revised since the last inspection so that it now advises the reader that they can contact the Commission at any time if they have concerns about the home. The manager reported that all service users and their relatives have been provided with a copy of the revised procedure. The procedure is not currently in a format that is accessible to Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 19 service users and it is unclear how service users who have communication needs are supported to express their views. The home has a copy of the multi-agency guidance ‘No Secrets’ in relation to the protection of vulnerable adults and a whistle-blowing policy. The majority of staff are reported to have received adult protection training from the local authority in the past year although certificates have not been received by the home and therefore were not available on file. The manager reported that there have been no adult protection issues at the home since the last inspection. Since the last inspection there have been two recorded incidents of a service user hitting out at another service user. There was no evidence on file that these incidents have been reported to Social Services or that any action has been taken in response to these incidents to minimise the risk of harm. Lewis House DS0000026836.V329789.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. 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 is homely and comfortable but would benefit from redecoration in some areas to provide a smarter environment for service users to live in. The home presents as clean although gaps in training in infection control mean that staff may not be fully aware of how to prevent the spread of infection. 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 the use of 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 on the first floor. A guided tour of the home evidenced that service users have personalised their bedrooms with Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 21 their own belongings. There is a shared bathroom on the first floor and toilet facilities on both floors. Some areas of the home, particularly the hallways, would benefit from redecoration. 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 separate room for laundry in the basement of the house which is also accessed from the rear garden. There is a driveway at the front of the house which accommodates the home’s vehicle and there is some additional space for parking outside the home. At the time of the inspection the home presented as clean. Service users are encouraged to participate in domestic chores with staff support. The home’s infection control policy was seen. This states that it was reviewed in November 2006 although there was no evidence that the content of the policy had been updated to include the most recent guidance from the Department of Health as suggested at the last inspection. Specific training in infection control has not been made available to staff. Lewis House DS0000026836.V329789.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff would benefit from further training to support them in meeting the specific care and communication needs of service users living at Lewis House. There have been no staff recruited since the last inspection of the service and therefore a requirement in relation to ensuring recruitment procedures are robust has been carried forward from the last inspection. EVIDENCE: Staff employed at the home generally work at both Lewis House and Mr and Mrs Elborn’s other care home, Woodside House. Discussion with the manager indicated that at present, three of the fifteen members of staff who work at Lewis House have a National Vocational Qualification (NVQ) in Care to Level 2 standard. Of the staff files examined, only one member of staff had documentation on record to evidence this. The manager stated that the home has linked up with a local NVQ training centre since the last inspection and plans are in place for one senior member of staff Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 23 to undertake an NVQ Level 4 in Care. Two further care workers will commence their NVQ Level 2. The manager reported that these courses will commence in May 2007. The manager of the home reported that there have been no new staff employed by the home since the last inspection of the service in June 2006. Therefore, a requirement made at the last inspection with regard to recruitment procedures has been carried forward. The proprietor has been provided with a copy of ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ published by the Commission which provides guidance to providers on safe recruitment procedures. Training records for nine Support Workers were examined. Training logs have been put in place to record training undertaken by individuals. The majority of staff have recently undertaken training in challenging behaviour with an external agency. Conversation with staff indicated that they had found this training useful. The home has purchased an induction training package although as there have been no new staff recruited to the home this has not been implemented to date. No other formal training reflecting the specific needs of the service user group has been arranged for staff. Staff spoken with during the inspection process reported that they feel wellsupported by the proprietors and manager of the home who they say are accessible and approachable. Staff spoken with did not appear to have regular formal, one-to-one supervision sessions and there was no documentation seen on file to indicate that individual supervision is taking place on a regular basis. Lewis House DS0000026836.V329789.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. 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. Although some progress has been made in meeting some requirements since the last inspection, the service is not being proactive in monitoring and developing its own performance and demonstrating that they are actively improving the service for their service users. Policies, procedures, health and safety training and risk assessments are not sufficiently robust to protect service users. Management arrangements for the home must be confirmed with the Commission with the submission of an application for registration so that lines of accountability are clear. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 25 EVIDENCE: Lewis House is owned by Mr John Elborn and Mrs Jillian Elborn. Mr John Elborn is currently the Registered Manager of the home but has informed the Commission that his son takes responsibility for the day-to-day management of the home and plans to take over as the Registered Manager. It is now required that he submits an application to the Commission for registration as manager of Lewis House. The majority of Support Workers work at both Lewis House and the Elborns’ other home, Woodside House. Staff spoken with indicated that they feel able to approach the owners of the home at any time for advice or support. Although some progress has been made towards meeting some of the requirements made at the last inspection, shortfalls continue to exist in some areas. These must be addressed in order for the home to fully meet the Regulations and National Minimum Standards and demonstrate that they are fully promoting the safety and welfare of service users. Enforcement action may be taken by the Commission where requirements are repeatedly not met by the service. A requirement has been made at the last three inspections for the provider to implement a process by the quality of the service is regularly reviewed. To date this requirement has not been met. The manager reported that they are currently investigating meaningful ways in which service users can be engaged in a quality assurance process, for example, through the use of computer software packages in a format that service users understand. The home has implemented regular service user meetings to encourage service users to share their views as a group. There is currently no system in place to gain feedback from relatives and visitors to the home and from various other stakeholders with whom the home has contact. The home does not have an annual development plan. A sample of the home’s policies was examined. This included the accident policy, confidentiality policy, food safety and hygiene policy and procedures on assisting clients with personal care. All policies had a sticker on them indicating that they had been reviewed in November 2006 but there had been ‘no change’. The home’s policy on ‘Assisting Clients with Personal Care – Best Practice’ continues to contain general, and potentially unsafe guidance about supporting service users with moving and handling. This issue was raised at the last inspection of the service but has not been addressed to date. The home’s policy on recording accidents states; ‘All accidents will be recorded in the accident report log and an accident report form completed’. Discussion with the manager indicated that accidents would usually be recorded in an ordinary notebook for this purpose. The home does not use an approved Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 26 accident book which has a structured format for recording essential information and which is a legal health and safety requirement for employers that employ more than ten people. Since the inspection the home has been given information about how to obtain an approved accident book from the Department for Work and Pensions / Health and Safety Executive. It was discussed with the manager that written policies and procedures in the home should clearly reflect practice in the home and current legislation and be updated on a regular basis to ensure their validity. Fire safety records were examined. A fire risk assessment had been undertaken by the manager in October 2006. The assessment indicates that it is due for review in April 2007. Records showed that weekly checks of fire alarms and a visual inspection of fire-fighting equipment had been carried out in the home. Monthly checks on emergency lighting had also been documented. A service of the fire safety systems had taken place by an external company in February 2007. It was noted that a recommendation that fire extinguishers are wall-mounted which had been made in February 2006 had been repeated. Regular fire drills were documented but entries were variable in terms of information content; some stating the time of the drill and initials of service users and staff present and others not. Therefore there was insufficient evidence to demonstrate that fire drills are being carried out at times of day when there are reduced staffing levels as recommended at the last inspection. A rolling programme of fire safety training has been organised for all care workers. This is facilitated by an external agency. In the past year two sessions have been held, in May 2006 and January 2007, each covering different aspects of fire safety. Certificates from the sessions are held on file. Out of nine staff records seen, three staff had attended both sessions, five staff had attended one session and one had no record of attending the training. The manager reported the home has purchased a fire safety training package for those who miss the formal training but there was no record on file to show that that this had been completed. An up-to-date gas servicing certificate was seen on file. Individual thermostats have not been installed at water outlets. Therefore, running water from taps may be in excess of 43 degrees Centigrade. There was no evidence to indicate that water temperatures from outlets are checked by the home. Holding a hand under taps in the bathroom and a service user’s bedroom indicated that water was too hot to be able to do so comfortably. Risks posed by water temperatures have been considered in service users’ risk assessment documentation but information is not always clear enough to state the specific action that needs to be taken by staff to minimise the risks. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 27 Nine training records for Support Workers were reviewed. Three of the nine had an emergency first aid certificate issued within the last three years. Four records showed evidence of the care worker having undertaken training in basic food hygiene although only one had been within the last three years. Two of the nine records examined showed evidence of the worker undertaking training in safe moving and handling in 2005. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 28 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 X 1 1 X 1 2 Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 29 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 YA9 Regulation 13(4)(c) Requirement The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Risk assessments must be completed and made available to staff for when a risk is identified, detailing how the risks are to be minimised. This requirement is repeated for the fourth time as previous timescales of 01/08/05, 01/05/06 and 01/10/06 have not been fully met. 2. YA19 12(1)(a) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The registered providers must ensure that there are clear procedures in place for the use of oxygen for one service user in Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 30 Timescale for action 01/06/07 01/07/07 the home. This must include guidance for staff on how to check that the equipment is working properly. Appropriate training must be given to staff regarding the use of oxygen in the home. This requirement is repeated from the last inspection of the service as the previous timescale of 01/10/06 has not been fully met. 3. YA19 13(4)(c) The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The registered provider must ensure a risk assessment is in place with regards to the storage and use of oxygen in the care home. 4. YA20 13(2) 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. 5. YA23 13(6) The registered person shall make 01/06/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed DS0000026836.V329789.R01.S.doc Version 5.2 Page 31 01/06/07 01/07/07 Lewis House at risk of harm or abuse. The home must have clear strategies for responding to the challenging behaviour exhibited by service users to ensure that other service users are protected. Incidents must be clearly documented and reported to appropriate agencies. 6. YA30 13(3) The registered person shall make 01/07/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person must ensure that the home’s policy is updated in accordance with the most recent infection control guidance from the Department of Health. All staff must be provided with suitable training in infection control and food hygiene. 7. YA34 19 The registered providers must ensure that there is full and satisfactory information available in relation to all persons working in the care home in accordance with Schedule 2 of the Regulations. This standard could not be assessed at this inspection as there have been no new care workers employed at the home since the last inspection. The requirement is therefore carried forward. 8. YA35 18(1)(c) The registered person must ensure that the persons DS0000026836.V329789.R01.S.doc 01/05/07 01/07/07 Lewis House Version 5.2 Page 32 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 and training that reflects the diverse needs of the service user group. 9. YA36 18(2) The registered person shall ensure that persons working at the care home are appropriately supervised. The registered person must ensure that there are formal systems in place for providing staff with appropriate supervision. 10. 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 requirement is repeated from the last inspection of the service as the previous timescale of 01/10/06 has not been met. 11. YA39 24 The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. The registered providers must ensure that they review the quality of care provided by the home regularly. This requirement is repeated for the fourth time as Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 33 01/07/07 01/07/07 01/07/07 previous timescales of 01/08/05, 01/06/06 and 01/10/06 have not been met. 12. YA42 23(4)(d) The registered person shall, after 01/05/07 consultation with the fire authority, make arrangements for persons working at the care home to receive suitable training in fire prevention. All staff must receive regular fire training from a competent person. The home has now made arrangements for training from an external agency to take place in the home. Although the majority of staff have undertaken this training, one member of staff has no record of receiving training in the past year. This requirement is repeated for the fourth time as previous timescales of 01/08/05, 01/06/06 and 01/10/06 have not been fully met. 13. YA42 13(4)(c) The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered providers must ensure that all staff have initial training in health and safety including first aid and are provided with timely updates. 14. YA42 13(4)(a) The registered providers must ensure that all parts of the home to which service users have access are so far as reasonably DS0000026836.V329789.R01.S.doc 01/07/07 01/06/07 Lewis House Version 5.2 Page 34 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. This requirement is repeated from the last inspection of the service as the previous timescale of 01/10/06 has not been fully met. 15. YA42 13(5) The registered person shall make 01/07/07 suitable arrangements to provide a safe system for moving and handling service users. The registered providers must ensure that the home’s manual handling policy is reviewed on a regular basis to reflect practice within the home. This requirement is repeated from the last inspection of the service as the previous timescale of 01/10/06 has not been met. 16. YA42 17(2) Sch. 4 The registered person shall maintain in the care home the records specified in Schedule 4 of the Regulations. The registered providers must ensure that they have an accident book in place that meets legal requirements. 17. YA43 CSA 11 Any person who carries on or manages an establishment or agency of any description without being registered under this Part in respect of it (as an establishment or, as the case DS0000026836.V329789.R01.S.doc 01/05/07 01/07/07 Lewis House Version 5.2 Page 35 may be, agency of that description) shall be guilty of an offence. An application for registration from the person who has day-today responsibility for the management of the service of the service must be submitted to the Commission for Social Care Inspection. 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 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 repeated from previous inspections of the service in June 2005, February 2006 and June 2007. 2. YA6 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. This recommendation is repeated from the last inspection of the service. 3. YA7 Staff should receive training in total communication so that they can support service users who have non-verbal communication in making choices and decisions. Individual plans should contain sufficient information about service users’ personal care needs so that it is very clear DS0000026836.V329789.R01.S.doc Version 5.2 Page 36 4. YA18 Lewis House what care workers need to do to support them effectively and meet their needs. 5. YA20 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. 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. These recommendations are repeated from the last inspection of the service. Medicines that are no longer required by service users should be returned to the pharmacy. 6. 7. YA22 YA23 The home’s complaints procedure should be in a format that is accessible to service users. 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 inspection of the service. 8. 9. YA24 YA32 The registered provider should consider redecoration of the home as part of their overall maintenance plan. The registered providers should ensure that all staff have at least an NVQ 2 qualification in care or are working towards one. This recommendation are repeated from previous inspections in June 2005, February 2006 and June 2007. 10. YA39 The home should have an annual development plan, reflecting the aims and outcomes for service users. Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 37 This recommendation is repeated from previous inspections of the service in June 2005, February 2006 and June 2006. 11. 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. 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. This recommendation is repeated from the last inspection of the service. 13. 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. 14. YA42 Risk assessments should be carried out by someone who is appropriately qualified to do so. 12. YA42 Lewis House DS0000026836.V329789.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole 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.V329789.R01.S.doc Version 5.2 Page 39 - 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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