Inspection on 10/05/05 for Liam House

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Liam House 23/05/07

Liam House 26/02/07

Liam House 23/05/06

Liam House 05/12/05

Liam House 22/11/04

Liam House 02/06/04

Liam House 01/03/04

Liam House 03/11/03

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

CARE HOME ADULTS 18-65 Liam House 13 Spencer Road Bournemouth Dorset BH1 3TE Lead Inspector Stephanie Omosevwerha Unannounced 10 May 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. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Liam House Address 13 Spencer Road Bournemouth Dorset BH1 3TE 01202 294148 01202 789983 liamhouse007@aol.com Mr Marvin Charles Stephens 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) Mr Leslie Robert Loader Care Home Only - CRH (PC) 11 Category(ies) of LD Learning disability (11) registration, with number LD(E) Learning dis - over 65 (11) of places Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 22nd November 2004 Brief Description of the Service: Liam House is a home for adults of both sexes who have a learning disability. It is a large, semi-detached house situated in a central area of Bournemouth close to Boscombe and Bournemouth town centres. The home is conveniently located near shops and facilities and is not far from the sea. It has good access to public transport. Residents accommodation is provided in 7 single and 2 double bedrooms. Seven bedrooms are located on the first floor and two on the ground. The first floor also has 2 bathrooms with WCs and a separate WC. The ground floor has one bathroom with a WC. The communal space is located on the ground floor and consists of a lounge, separate dining room and kitchen. There is a small locked office where all the records are kept. Outside there is a small garden at the rear of the property that has a large storage shed, which contains the laundry facilities and 2 large freezers. The front of the property provides off-road parking. The home is staffed 24 hours a day, with 2 sleeping in staff at nights. Most residents attend day activities organised by different agencies outside the home although this is flexible and residents are also supported to spend time at the home. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place over 5 hours. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI. During the inspection various records and documentation were sampled including health and safety records, staffing records, medication records, and service user contracts. The manager was present for most of the day and three members of care staff and seven service users were spoken to. What the service does well: What has improved since the last inspection? The manager has secured additional funding which has meant an increase in staffing hours giving service users more opportunities for activities and outings. Examples include visits to the cinema, shows, crazy golf, pub lunches, bingo nights in the home and badminton in the garden. Service users have been given opportunities to put forward their views in residents’ meetings, individual keyworker sessions and surveys. This has given them a better sense of ownership of the home and increased their confidence in expressing their views. One obvious change is that service users now come into the kitchen on their return from day centre activities and not the dining room which has led to an increased interaction with staff resulting in better relationships being formed with the staff group. There have been several improvements to the environment since the last inspection including new hall carpet, light fittings, and repainting of some service users rooms. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 6 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. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 standard(s) 5. The manager has made significant improvements to the service users’ contracts, which he is now in the process of implementing in the home. This will mean service users have clear information about each parties responsibilities, their contribution to the fees and the support/services provided. EVIDENCE: The manager has designed a new contract with good use of pictures and clear, simple language to make it more accessible to service users. This clearly sets out each parties responsibilities, the service users’ contribution to the fees and the support/services provided. It was recommended that the room the service user occupied also be included. The manager is now in the process of implementing the new contracts ensuring that appropriate support is available e.g. the service user’s care manager. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 standard(s) 7. An increase in staffing hours and improved practices in the home meant that service users had more choice and opportunities to make decisions about their lives. There is still an outstanding requirement, however, concerning the management of service users finances that needs to be addressed to ensure compliance with legislation. EVIDENCE: There was evidence that service users were encouraged to make decisions about their lives. Since the previous inspection additional staffing hours had been agreed and this was reflected in a better choice of activities and outings for service users, which took into account individual’s likes and preferences. Residents meetings took place to discuss issues such as menus, outings and holidays. One service user was planning a shopping trip to purchase new bedding for her room and others had been to the town centre the previous day to shop for new clothes. Observation during the inspection showed that residents could choose to spend time in the communal areas of the home or in the privacy of their rooms. All residents now have their own bank accounts set up and are supported to use these facilities. Their income support, however, is still going into a collective account and evidence needs to be seen that this has been separated out from any business account to ensure that it complies with the legislation. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 standard(s) 13, 14, 17. Service users are encouraged to access the local community and there have been improvements to the choice and availability of activities and outings. Service users enjoyed the meals, which were varied taking into account individual preferences and offering healthy eating choices. EVIDENCE: Service users spoke about accessing a range of facilities in the local community including shops, post office, banks, leisure centres, pubs, cafes and beaches. The home has good access to public transport and service users confirmed they could catch the bus to the local town centres with staff support. Additional staffing hours had been agreed in the home and this had meant there was more availability to go on outings and recent trips had been to the cinema, shows, crazy golf, and pub lunches. New activities had also been introduced into the home such as a bingo night and playing badminton in the garden. Choices of smaller group holidays were available and 2 groups were going to Weymouth and 3 groups going to Devon at various times over the summer months. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 11 A member of staff had responsibility for catering in the home. She said that service users were consulted about their preferences when drawing up the menus and that service users were involved in shopping and helping to prepare meals in the home. Service users said they enjoyed the food and there was evidence that healthy eating was promoted with lower fat alternatives being available on the menu. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 12 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) 20. The medication at this home is well managed and the manager is currently reviewing the policies and procedures to make further improvements to its administration. EVIDENCE: The medication cupboard was checked as part of the inspection. The home currently uses a NOMAD system to administer medication but is in the process of changing over to a new system on the 18th May 2005. A policy and procedure is in place but this is being up-dated to reflect the changes to the home’s current system. A sample of records was checked and these were found to be up-to-date and accurate. None of the residents have been assessed as able to manage their own medication, although some take responsibility for their medication when they are out at their day-time activities and this is appropriately risk assessed. All staff are given training in the administration of medication. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 13 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) 23. The protection of vulnerable adults is promoted in the home by robust policies and procedures and a thorough staff recruitment procedure. EVIDENCE: The home has robust policies and procedures concerning the protection of vulnerable adults. These included Adult Protection and Prevention of Abuse, Dealing with Aggression and Whistleblowing. Staff records showed that a thorough recruitment procedure was in place and appropriate references and checks to evidence staff suitability were in place. Observation during the inspection showed that staff were effectively able to deal with a disagreement that occurred between 2 residents, which may have led to some aggression. Separating and discussing the incident with both service users diffused the situation. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 14 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. Recent investment has improved the appearance of the home creating a comfortable and safe environment. EVIDENCE: There had been several improvements to the environment since the previous inspection including new hall carpets and light fittings, painting and decorating of some residents’ rooms and a sink had been replaced in one of the bedrooms. The furniture in the dining room is also being gradually replaced. Records relating to all relevant fire, environmental health and health and safety regulations were up-to-date. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 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 and 36. A higher level of staffing and a thorough recruitment procedure has improved the quality of service users’ lives. Staff morale has improved resulting in a more stable workforce providing better consistency of care for service users. This was further achieved by clarification of staff roles ensuring staff were aware of their responsibilities with particular emphasis on keyworking to enable identification of service users’ needs. The staff team have various background experience and are provided with further training opportunities to ensure they have the necessary skills for working with service users in the home. Staff would benefit from a more formal supervision system to give them further opportunities to express their views and gain feedback on their performance. EVIDENCE: Staff spoken with during the inspection were clear about their roles in the home and said they liked working in the home. One member of staff felt they would occasionally like a bit more recognition for the work they did. Observation showed a high level of interaction between staff and service users with good relationships being formed. They were effectively able to deal with a potential incident between 2 service users quickly diffusing the situation by separating the residents. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 16 A sample of staff records was seen and this confirmed a robust recruitment procedure ensuring that all checks and references were in place to protect the safety of service users. A detailed job description was available and all staff received employment terms and conditions including a copy of the grievance and disciplinary procedure. All staff were employed subject to a three month probationary period. Analysis of the staffing rota showed there had been an increase in staffing hours that meant that a third member of staff was now available at peak times i.e. weekends and evenings. This had led to an increase in the activities and outings that the home was now able to offer the residents. The home had experienced a period of some staff turnover but this seems to have stabilised over the past year and the current team provides a mix of genders and age groups with various experience including previous experience of residential care in different settings and home care experience. Records for staff sickness were low. The manager has developed a training matrix and currently 2 members of staff are undertaking NVQ level 3 and one member of staff is undertaking NVQ level 2. All staff carry out an induction that is Learning Disability Award Framework accredited. Other training is provided as necessary e.g. Medication, Basic Food Hygiene, Infection Control and Makaton. In addition the manager has introduced a staff day every two months, which consists of a staff meeting and training issues that includes looking at putting policies into practice, values and fire training. The manager provides an informal system of supervision particularly to discuss keyworking duties in service users care plans but this needs to be formalised to include monitoring of work, support and professional guidance and identification of training and development needs. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 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) 38, 39, 42 and 43. The home benefits from a competent manager who has worked hard to improve the quality of service in the home and introduced strategies to enable service users and staff views to be taken into account. The manager effectively manages health and safety in the home although sharing the responsibility with another member of staff would ensure that checks continue to be undertaken in his absence. EVIDENCE: The manager has a clear sense of direction and has put in place systems/policies and procedures to ensure the effective running of the home. He has introduced strategies for enabling staff to raise issues e.g. 2 monthly training days and staff confirmed they were encouraged to use their own initiative and implement new ideas in the home. They described the manager as “fair” and “very understanding”. Observation during the inspection showed there has been a change of ethos creating a more relaxed atmosphere with greater interaction between staff and service users. Service users spoken with Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 18 had more sense of ownership of the home and were enjoying more choice and say over the care provided. The manager has introduced quality monitoring systems into the home and carries out weekly service checks to ensure the premises complies with regulation e.g. building, fire, water temperatures, fridge temperatures etc. He has introduced a service user survey and a schedule of staff responses and is collating this information to form the basis of an annual development plan. He has worked hard to implement requirements identified in previous inspection reports, which have been significantly reduced since he has been in post. Reports from the Dorset Fire and Rescue Service and the Environmental Health Department confirm the home meets their requirements. Records showed that services and equipment were being inspected at the required intervals. Records of fire drills and safety checks were mostly up-to-date apart from minor slippage when the manager had been on holiday. It was recommended that a second person be nominated to ensure these checks were carried out in the manager’s absence. It was also recommended that the names of service users taking part in fire drills were recorded to facilitate monitoring of this. The manager is aware of the relevant legislation regarding health and safety and policies and procedures reflected this. There was no evidence to suggest the home wasn’t financially viable. On the day of the inspection the home was fully occupied and sufficient staff were on duty, improvements had been made to the living environment that was well maintained. A valid certificate of insurance was seen that provided appropriate cover for business interruption costs. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 1 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Liam House Score x x x x Standard No 37 38 39 40 41 42 43 Score x 3 3 x x 2 3 D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 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 7 Regulation 20 Requirement Timescale for action 31 June 2005 2. 36 18 The registered person should not pay money belonging to any service user into a bank account unless the account is in the name of the service user(s) and is not used in connection with the carrying on or management of the care home. (Previous timescale of 31 January 2005 not met.) The registered person should 1 ensure that persons working in September the home are appropriately 2005 supervised. 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 1 Good Practice Recommendations It is recommended that the service user guide would benefit from being available in a format accessible to service users with learning disabilities. (This was repeated from the previous inspection but not assessed on this occasion.) It is recommended that the service users contract specifies the room that is to be occupied. D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 21 2. 5 Liam House 3. 6 4. 9 5. 21 6. 42 7. 42 It is recommended that the dates of any care plan reviews be recorded to faciliate accurate monitoring of when these are carried out. (This was repeated from the previous inspection but not assessed on this occasion.) It is recommended that staff enable service users to take responsible risks, ensuring that they have good information on which to base decisions within the context of the service users individual plan and of the homes risk assessment and risk management strategies. (This was repeated from the previous inspection but not assessed on this occasion.) It is recommended that service users wishes concerning death and dying are discussed as part of setting up individual care plans and the homes capacity to deal with older residents and illness is addressed in the statement of purpose. (This was repeated from the previous inspection but not assessed on this occasion.) It is recommended that a member of staff is nominated as being responsible for Health and Safety checks in the home as well as the manager to ensure that these are carried out in his absence. It is recommended that the names of service users taking part in fire drills are recorded to facilitate monitoring. Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset BH17 0NF National Enquiry Line: 0845 015 0120 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 Liam House D55 S3956 Liam House V216410 100505 Stage 4.doc Version 1.30 Page 23 - 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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