CARE HOME ADULTS 18-65
Leyland House 22 Leyland Avenue St. Albans Hertfordshire AL1 2BE Lead Inspector
Louise Bushell Unannounced Inspection 21st December 2005 10:00 Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 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 Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 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. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Leyland House Address 22 Leyland Avenue St. Albans Hertfordshire AL1 2BE 01727 763 707 01727 763 707 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) New Link Residential Homes Association Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th April 2005 Brief Description of the Service: Leyland House is an end of terrace property in a cul-de-sac in a residential area of St Albans, and provides a home for three service users who may be of either sex. The current people have been resident at Leyland House for between seven and twelve years. The home is domestic in size and character, having an open-plan living area, a kitchen and bathroom on the ground floor; three bedrooms, a toilet, a small office and a staff sleeping-in room on the first floor. There is a small area to the front for car parking and a rear garden with lawn and flower beds.There are local shops in the vicinity and the city centre is within walking distance. Public transport services are available nearby. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second of the year. Time was spent with two service users, the manager, deputy and other support staff on duty. The inspection aimed to focus only on the outcomes for the service users for the remaining standards not previously inspected. Where information has remained the same it will be brought forward to this report or the reader will be referred back to the last report for more details. What the service does well:
From the remaining standards inspected the home does well at ensuring that all service users know that the home is able to meet their individual needs. Specialist services are offered and are demonstrably based on current good practice, and reflect current and relevant guidance. During the inspection staff on duty were also able to show that they were able to support and communicate with service users effectively. Staff actively support service users in maintaining family links, friendships and relationships outside of the home. Service users were able to discuss the involvement with family openly. During the inspection, the inspector spoke with a parent of one of the service users who openly praised the commitment, support and the work of the home. Service users rights are respected and recognised in their daily lives. Each service user is encouraged and empowered to maintain as much independence as possible. Daily routines are structured however meet the individual needs of all those residing. Any restrictions on rights are clearly documented in the individual’s plan of care. Service users receive personal support in the way which they prefer. Direct feedback and indirect observation determined that service users were happy with the care being provided and that personal preferences and choices were being met. Services users are supported by competent and qualified staff. Following the last inspection the manager and deputy manager have both completed their Registered Managers Award and one of the day staff has completed their NVQ level II. With other relevant qualifications and experience this means that 80 of the team are NVQ trained or hold transferable qualifications. Good links are also maintained with the Adult Care Services Learning & Development Training Programme and many staff are currently attending a programme of training made available through this resource. There are clear polices and procedures in place which are currently under review, which ensures that all service users rights are safeguarded and protected. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 7 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 Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Current and prospective service users are aware that the home is able to meet specialist need, demonstrating the individualised care that can be offered and tailor made ensuring preferences and choices are advocated. EVIDENCE: All service users are offered an individualised package of care to ensure that their needs can be constantly reviewed and monitored. All service users are supported in the Care Programme Approach (CPA) framework, with clear evidence of interventions being integrated into the home that are based on current good practice and reflect relevant specialist and clinical guidance. CPA reviews were occurring with clear actions documented and reviewed at each case meeting. Service users seek and receive intensive support by the clinical teams in the community. Service users have information and independent support available to them as they require. Staff and service users were seen to interact with each other in an appropriate manner. Staff were clearly skilled in supporting and meeting the specific needs of the service users. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Service users are supported to take risks as part of an independent life style, thus encouraging the completion of daily living skills and independence, however risk management must occur regarding the hot water. EVIDENCE: Staff enable and support service users to take responsibility and actively manage risk as part of an independent live style. Staff support service users to make active decisions and choices regarding elements of risk in every day living, ensuring that they have accurate information to guide their decisions to inform them of the risks. A multitude of risk assessments are available that ensure risk is identified, minimised and management internally, seeking external remedies as required. Each risk assessment is reviewed and signed. There is a need for a risk assessment to be completed for the control and regulation of the hot water temperatures to ensure safety for all. See also Standard 42. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 & 16 Service users are supported to maintain personal and family links, empowering service users rights, dignity and privacy. Daily living promotes independence and ensures that service users rights are respected. EVIDENCE: Direct feedback from service users determined that they are encouraged, supported and empowered to maintain positive family links and friendship, inside and outside the home. The inspector spoke directly to a parent of a resident who confirmed that the home welcomes visitors at all times and that they feel welcomed by all. The home maintains positive links with all family members seeking their input and support as appropriate. Service users attend a variety of social and day activities as well as integrating into the local community. The home is centrally located in busy city and service users are encouraged and empowered to make positive links with the local community. Service users are appropriately supported in maintaining intimate relationships of their choice, information and specialist guidance is available and are provided to help service uses make appropriate decisions. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are supported on an individual basis, with a care package tailored to meet their specific needs, ensuring that they receive personal support in a way they prefer and require. EVIDENCE: Detailed care plans are in place that refers to the individual needs, preferences and wishes. Care plans do not restrict the service users in any way. Where restrictions are imposed clear documentation is available and evident with consistent reviewing and support from a multi disciplinary team. Service users are supported with a named key worker system, feedback from service users determined that they have and maintain positive links with their key worker and that they are there to support them. Each service user is encouraged to maintain and develop individuality and style; this is reflective in personal appearance and their private space. A culturally diverse staff team ensuring specific needs can be meet as required supports service users. The ethos of good practice ensures that staff ensure consistency and continuity of support through the key worker system, sound working relationships with families, friends and partners, including other professionals. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home must ensure that evidence is available for suitable checks to be made on the employment of staff, thus ensuring that service users are protected appropriately. EVIDENCE: Robust procedures are in place to ensure that service users are protected from abuse and harm. Staff receive suitable and adequate Protection of Vulnerable Adults (POVA) training, which is currently occurring within the home. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Four staff personnel files were inspected, however some of them did not contain all suitable evidence to ensure that CRB checks had occurred on all staff. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 27 The home’s bathroom is in need of some redecoration and works throughout, to ensure it functions as a homely, comfortable, safe environment for the service users. EVIDENCE: The home appears safe and appropriate to meet the needs of the service users living at the home. All service users have been actively involved in the choice of colours and furniture and carpets for the home. Following the last inspection improvements have been made to the home with some of the communal space being redecorated and all skirting boards and doorframes repainted, presenting the home better. There is one main bathroom in the house and a single toilet. The bathroom is on the ground floor. Tiles are coming off the walls in the bathroom, behind the radiator the plaster is peeling away. The windows are rotten and require urgent attention. The bath and the shower are tired. The general feel to the bathroom is that is extremely worn and requires some major works to ensure that the home is well maintained, homely and comfortable and meets service users needs. Following discussions with a service user it was determined that
Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 14 there is also a need for a shower to be installed as this will then offer choice for the service user. Feedback determined that they would like to have a shower if were available. The manager of the home stated that the works on the bathroom will commence in April 06. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 36 Training is encouraged, ensuring that service users are supported by a competent and qualified staff team. The home must ensure that evidence is available for suitable checks to be made on the employment of staff, ensuring that service users are protected appropriately. Annual appraisals are occurring thus ensuring a well-supported staff team. EVIDENCE: Services users are supported by competent and qualified staff. Following the last inspection the manager and deputy manager have both completed their Registered Managers Award and one of the day staff has completed their NVQ level II. With other relevant qualifications and experience this means that 80 of the team are NVQ trained or hold transferable qualifications. Good links are also maintained with the Adult Care Services Learning & Development Training Programme and many staff are currently attending a programme of training made available through this resource. Positive links are also maintained with the Joint Training and Work Place Development Unit, which support in the further provision of training. The staff spoken with during the inspection confirmed that they are supported and encouraged to attend a variety of training courses available. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 16 Records showed and direct feedback determined that all staff have recently received an annual appraisal, this supports the running of the home in ensuring that all staff are suitably guided and supported. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Four staff personnel files were inspected, however some of them did not contain all suitable evidence to verify that CRB checks had occurred on all staff. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41, 42 & 43 The home must ensure that evidence is available for suitable checks to be made on the employment of staff, ensuring that service users are protected appropriately. Service users are supported to take risks as part of an independent life style, encouraging the completion of daily living skills and independence, however risk management must occur regarding the hot water. EVIDENCE: In general the records required by regulation were in order and well maintained. Following the last inspection much work has been completed with regards to risk management. Risk assessments must be generically and individually completed for the control and maintenance of hot water, these must also be recorded at each water outlet site to ensure service users are protected from scalding. Service users have access to their records and information about them and individual records are maintained securely. Robust procedures are in place to
Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 18 ensure that service users are protected from abuse and harm. Staff receive suitable and adequate Protection of Vulnerable Adults (POVA) training, which is currently occurring within the home. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). As alreadt stated some of them did not contain all suitable evidence to verify that CRB checks had occurred on all staff. Following the last inspection a business plan has been completed following the requirements made at the last inspection, however there is a need for this to contain documents for the purpose of considering the financial viability of the home. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 19 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 3 4 X 5 X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X X X X X 2 2 2 Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 YA42YA9 Regulation 13(4) (c) Requirement Individual and generic risk assessment for the health and safety management of hot water systems must be in place. Records of hot water temperature must be recorded. Staff records must be available for inspection and suitable adequate checks and clearances must have occurred for all. This requirement has been carried forward from the last inspection. Failure to comply may result in enforcement action being taken. The bathroom must be maintained in good working order and kept reasonably decorated to promote a homely environment. • Tiles to be replaced. • Windows to be replaced / repainted. • Walls to be painted. • New flooring to be
DS0000019446.V274797.R01.S.doc Timescale for action 15/02/06 2 YA41YA34YA23 17(2) Sch 4(6) 15/02/06 3 YA27YA24 23(2) (b) (c) & (d) 01/05/06 Leyland House Version 5.1 Page 21 4 YA43 25 (2) (3) (c) fitted. • Radiator to be repainted. • Shower to be installed. The business and financial plan must contain documents for the purpose of considering financial viability of the home. This requirement has been carried forward from the last inspection. Failure to comply may result in enforcement action being taken. 31/01/06 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 YA27 Good Practice Recommendations It is recommended that a new bathroom suite is installed. Leyland House DS0000019446.V274797.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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