CARE HOME ADULTS 18-65 Leyland House 22 Leyland Avenue St Albans Herts AL1 2BE
Lead Inspector Louise Bushell Unannounced 07 April 2005 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 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 Stationary 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Leyland House Address 22 Leyland Avenue St Albans Herts AL1 2BE 01727 763707 01727 763707 Telephone number Fax number Email 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 Mr Keith Hung Care Home 3 Category(ies) of MD Mental disorder - 3 registration, with number of places Leyland House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20 October 2004 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first unannounced of this year. It took place in the morning to mid afternoon. The inspector spent time talking to all staff on duty, and two service users who were at home during the inspection. Time was spent with the service users, deputy manager and the manager discussing progress and plans for the future, looking through records and care plans. Time was also spent touring the building and the grounds. This was a positive inspection in terms of the needs of the service user being met. What the service does well:
The home has clear policies and procedures that are well organised and maintained and accessible to all. The atmosphere throughout the inspection was calm and friendly, promoting a good relationship between staff and service users. Staff spoken with during the inspection were very complimentary of the management style within the home and the ethos of working openly, honestly and with a transparent approach appears to be effective. Two service users was present throughout the inspection and participated fully, giving clear indications that they were happy and relaxed within their environment. The home has a high ratio of staff to service users ensuring that individual and complex needs can be met. The home has an extremely stable staff team to promote continuity for the service users. All service users are supported within the Care Programme Approach framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the care plans of each individual are owned by the individual, those service users spoken to during the inspection were aware of their individual care plans, one spoke of the support she receives from outside services. The home is vibrantly decorated and the service users have made the choices for decoration collectively. Service users meetings occur within the home which are recorded and details service users choices and suggestions which have been acted upon The home has a robust policy and procedure in place to support the safe administration, storage and receipt of medicines. All staff receives training prior to being deemed competent to administer medication. All staff have received a series of mandatory training course in order for them to meet the complex needs of the service users. Training includes Protection of Vulnerable Adults, food hygiene, risk assessment, challenging behaviour, first aid, mental health, personality disorder, epilepsy, foot care, loss and bereavement, feeding awareness, relating to people
Leyland House Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
The home must implement a quality assurance monitoring system within the home to ensure that the views of the service users are reviewed, recorded and acted upon fully. The home requires some environmental adjustments to be made in terms of redecoration in the home. Area’s that require attention are the bathroom, including windows, bathroom suite, radiator, windows, skirting and remaining paint works. The communal area’s of the home require touching up including all skirting boards and door frames. A maintenance, renewal and redecoration plan / audit is required in order to ensure works are completed so the home can remain a suitable, safe, homely environment for the service users. One of the service user bedrooms have been divided off with a false wall, however there is a 6 inch gap at the top of the wall which does not allow the service user privacy and dignity. The gap must be blocked off. The Statement of Purpose and the Complaints Procedure require minor adjustments to ensure that all visitors, staff and service users have the correct details and information. Records required for inspection must be held within the home at all times. All records within the home must be accurate and maintained to a high standard. Leyland House Version 1.10 Page 7 Correction fluid must not be used on medication administration records as these are legal records. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Leyland House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Leyland House Version 1.10 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4, 5 Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service user and the home to continuously review the individual’s care package provided. Information provided to the service user about the home and its terms is suitable to meet their needs and therefore enables the service user to make an informed choice about where to live. EVIDENCE: A comprehensive Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. The Statement contains information for the service user to make an informed choice about where to live. The content is suitable to meet individual needs. The Statement of Purpose requires minor amendments to include the correct address of the Commission Full assessments of each service users needs and aspiration are made before the service user moves into the home. The assessments carried out within the home are continuously occurring supporting and monitoring individual progress and needs identified. Qualified and competent people complete the assessments. The home also receives and seeks external specialist support to meet the individual service users needs. Whole life reviews occur within the Leyland House Version 1.10 Page 10 home to support the service users in achieving and reviewing individual needs, goals and aspirations. The admissions procedure to the home includes trial visits for the service users to make an informed choice about where to live. A contract is then drawn between the home and the service user. The contract includes the terms and conditions within the home and the rights of the service user. The admissions policy is to be forwarded to the Commission for Social Care Inspection. Leyland House Version 1.10 Page 11 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 standard(s) 6, 7, 8, 10 Individual needs and choices within the home are being promoted to encourage and empower user self-determination. EVIDENCE: All service users have an individual care plan and an allocated key worker and co key worker to support them in the home. Individual daily notes and guidelines for the service users where observed within the home. All service users are supported within the Care Programme Approach framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the care plans of each individual are owned by the individual, those service users spoken to during the inspection were aware of their individual care plans, one spoke of the support she receives from outside services. Within the home each service user is encouraged to join in daily living tasks, for example being supported with meal preparation, washing up, laying the table, shopping. The staff and the service users have devised a rota, which following discussions with the service users, is effective and they enjoy being part of the running of the home. The home is vibrantly decorated and the choices for decoration have been made collectively by the service users.
Leyland House Version 1.10 Page 12 All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. Leyland House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 13, 16, 17 Personal development opportunities are encouraged for all service users ensuring interactions within the local community and that individual rights and responsibilities are recognised and supported. EVIDENCE: Service users attend a variety of different day centres and colleges accessing courses suitable to their individual needs and aspirations. Discussions with the service users determined that they have a variety of day activities to be involved within. Access to transport occurs with the use of local transport where appropriate support is provided to individuals. Staff support and encourage all service users to maintain and develop social, emotional, communication and independent living skills. The involvement of the service users in a variety of tasks was observed throughout the inspection. All service users are encouraged and supported to maintain links to the local community. The home is central to the city centre and is within a residential area of the city. The home values and seeks to reflect racial and cultural diversity of service users through celebration of, and awareness of different cultures, religions and festivities. During the inspection staff and service users were observed to interact equally with one another. Routines within the home
Leyland House Version 1.10 Page 14 promote service user independence. Service users are unrestricted in their movement around the home and are able to access all communal areas. Menus within the home are offered on a flexible basis, with service users making choices over the meals daily. Service users are involved in meal preparation with appropriate support provided. All service users are provided with external nutritional advice and assessments and monthly weights are recorded. Meals observed were unrushed and relaxed. Leyland House Version 1.10 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. EVIDENCE: All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. Assessments and reviews are continuously completed ensuring that the approach adopted by the home is person centred and holistic to each service users needs. Service users needs are supported with all aspects of their physical and emotional health and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice is provided to all services users regarding general health issues. The home has a robust policy and procedure in place to support the safe administration, storage and receipt of medicines. All staff receive training prior to being deemed competent to administer medication. The home uses Taylor’s pharmacy and has a good working relationship with them. Contracts are present between the pharmacy and the home and pharmacy inspections are carried out frequently. The home uses a Nomad Doset box system for safe administration. Records showed that correction fluid had been used on the Medication Recording Records.
Leyland House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. Robust policies, procedures and training are in place to ensure service users are protected and safe. EVIDENCE: The home has a comprehensive complaints procedure in place, which details that all complaints are responded to within 28 days. A record is maintained within the home of complaints made, detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure. This is also on display within the home. The complaints procedure requires updating to include the correct contact details of the CSCI. 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). Staff personnel files were unable to be inspected due to not being held on site. Leyland House Version 1.10 Page 17 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 standard(s) 24, 25, 26, 28, 30 The home is in need of some redecoration and works throughout, to ensure it functions as a homely, comfortable, safe environment for the service users. Individual bedrooms were personalised which promoted independence and choices and preferences 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. The painting has not been completed by professionals and many area’s within the home are in need of redecorating in order to ensure a homely, comfortable feel for the service users. Doorframes and skirting boards require painting. The homes provides sufficient lighting, heating and ventilation. A maintenance and renewal and redecoration plan is required. Each service user has a single bedroom, which is personal to each individual. Some of the rooms have been recently redecorated and the remaining rooms urgently require redecorating including skirting boards, doorframes, windows and radiators. One bedroom has been divided off with a false wall to create a sleeping in room for the staff. The false wall does
Leyland House Version 1.10 Page 18 not reach from floor to ceiling and a gap remains of approximately 6 inches. This does not promote service user privacy and dignity. Service users are offered a key to their room, where a key is not offered a risk assessment must be completed to determine limitations of service users rights within the home. 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 is extremely worn and requires some major works to ensure that the home is well maintained, homely and comfortable and meets service users needs. Shared space is provided within the home. The kitchen has recently been refitted and presents as a homely, hygienic environment. Although the home requires some redecorating it was clean and hygienic. Laundry facilities are domestic in style. Leyland House Version 1.10 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 The home is suitably staffed with well-trained individuals ensuring that at all times service users complex and changing needs can be met. Recruitment policies and personnel records must be held on site and be available at all times in order to establish robust procedures have been followed for the protection and safety of the service users. EVIDENCE: Staff spoken with during the inspection appeared very clear of their individual roles and responsibilities. All staff have been in post between 4 – 10 years, offering a consistent approach for all service users. Staff were seen to support the main aims and values of the home. All staff have received a copy of the General Social Care Council Code of Conduct. The home has clearly defined job descriptions and person specifications in place. All staff have received a series of mandatory training course in order for them to meet the complex needs of the service users. Training includes Protection of Vulnerable Adults, food hygiene, risk assessment, challenging behaviour, first aid, mental health, personality disorder, epilepsy, foot care, loss and bereavement, feeding awareness, relating to people and valuing people. Training records are maintained within the home. All staff within the home have either completed or are working towards their NVQ 2 in care. The manager and the deputy have
Leyland House Version 1.10 Page 20 completed the NVQ 4 in care and are near completion of the Registered Managers Award NVQ 4. Recruitment practices within the home appear well structured. Personnel records could not be accessed on this occasion so a full inspection did not occur. All policies and procedures relevant to the home must be on site at all times. Supervision and appraisal occurs within the home and staff felt that this was a valuable process. The managers are currently implementing a system, which will focus on a continual assessment for all staff. Leyland House Version 1.10 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41, 42 The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is running meeting its aims and objectives. Quality assurance systems are in the process of being implemented to ensure that service users views underpin all self-monitoring, review and development of the home. EVIDENCE: Service users spoken to during the inspection appeared to be extremely happy with the home and appeared to be relaxed in their environment. The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach of the home creates an open, positive and inclusive atmosphere, staff and service users spoken to commented that they feel extremely supported and they feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The service users
Leyland House Version 1.10 Page 22 appeared to benefit from this well structured and well run home. All staff and managers within the home are adequately and suitably trained in order to meet the complex changing needs of the service users. Quality assurance systems are in the process of being developed within the home in order to assure that the service users views underpin all selfmonitoring, review and development of the home. The manager was able to discuss the systems that they are currently working towards. Residents meetings occur within the home and minutes are taken. The service users spoken to felt that their views were listened to and considered. The minutes reflected the involvement of the service user within the home. All records are secure within the home, were up to date and held in accordance with the Data Protection act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. Records regarding staff were not inspected and must be held within the home. Sound generic risk assessments were in place within home, with all external required safety checks occurring. The home does not have thermostatic valves fitted to taps, temperature records must be implemented and a risk assessment completed to ensure safe management of risks within the home. Although a requirement was made in the last report the business and financial plan are still not available for inspection. 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. Where there is no score against a standard it has not been looked at during this inspection. 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
Leyland House Version 1.10 Page 23 CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 3 Standard No 22 23
ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 x 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 2 3 2 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x 2 2 x Leyland House Version 1.10 Page 24 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 43 Regulation 25 Requirement That a business and financial plan is avialable for inspection. (Previous time scale of 31.09.04 not met). The homes Statement of Purpose and complaints procedure must be updated to include the correct address of the Commission and also state that at any time a complainant may refer direct to the Commission. Records for the safe administration of medications must be maintained within the home and correction fluid must not be used. Staff records must be held on site and be available for inspection to assertain that correct procedures are followed for the protection of the service users. An effective quality assurance system must be implemented within the home to ensure the views of the service users are sought. The home must have a maintenace, redecoration and renewal programme in place to ensure that the home is well
Version 1.10 Timescale for action 30th June 2005 30th May 2005 2. 1 22 4 (1) (c) Schedule 1, 22 (6) 3. 20 13 (2) 17 (1) (a) Schedule 3 (3) (i) 17(2) Shedule 4 (6) 15th May 2005 4. 23, 34, 41 15th May 2005 5. 39 24 31st May 2005 6. 24 23 (2) (b) (c) & (d) 31st May 2005 Leyland House Page 25 7. 26, 28 13 (4) maintained, kept in a good state of repair internally and externally, that equipment provided in the bathroom is maintained and in good working order and that all parts of the care home are kept reasonably decorated to promote a homely environment. Service users must have a key to 15th may bedroom unless indicated 2005 through the completion of a risk assessment which defines the risks associated. 8. 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 42 Good Practice Recommendations That all risk assessment should be signed and dated when implemented to ensure good practice and frequent reviewing. Leyland House Version 1.10 Page 26 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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