Inspection on 23/01/07 for Lifestyles Care Home

This inspection was carried out on 23rd January 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lifestyles Care Home 10/07/08

Lifestyles Care Home 20/07/07

Lifestyles Care Home 06/06/06

Lifestyles Care Home 14/12/05

Lifestyles Care Home 25/08/05

Lifestyles Care Home 15/02/05

Lifestyles Care Home 09/08/04

Lifestyles Care Home 30/09/03

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

CARE HOME ADULTS 18-65 Lifestyles Care Centre For Adults With Disabilities Weeland Road Eggborough Goole North Humberside DN14 0RX Lead Inspector Denise Rouse Key Unannounced Inspection 23rd January 2007 08; 15 Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.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 Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.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. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lifestyles Care Centre For Adults With Disabilities Weeland Road Eggborough Goole North Humberside DN14 0RX 01977 661492 F/P 01977 661492 Address 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) Lifestyles Care (Yorkshire) Limited Miss Jean Cronin Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: Lifestyles Care Centre was originally a hotel, which has been converted into a care home with a nursing provision. It offers permanent and respite nursing care for adults with disabilities. The home is situated in Eggborough, a village 7 miles from Selby. Within quarter of a mile are a pub and some small local shops. The building consists of a ground and first floor but service users are currently accommodated on the ground floor only. Fees range from a minimum of £700.00 per week upwards (given on 18 December 2006), then based on assessment such as the level of staff support needed and whether the service user is in receipt of mobility allowance. There are extra costs for hairdressing, therapy sessions (physiotherapy and relaxation), and outdoor activities. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • • • A review of the information held on the homes file since its last inspection. Information submitted by the registered manager in the pre inspection Questionnaire Surveys completed on behalf of six service users, and received from six relatives, and three surveys from health and social care professionals or care managers. An unannounced visit to the home, which lasted eight hours, carried out by two inspectors, which included a full tour of the premises. Evidence gained from the use of an observational tool developed to help inspectors during inspections of services providing care for people with communication difficulties. • • An unannounced site visit was carried out and lasted for eight hours. Service users, management and staff were spoken with. Records relating to the service users, staff and the management activities of the home were inspected. The nature of service users’ illnesses at this home means they are unable to give their written views and in some cases verbal comments. During the visit the Short Observational framework for Inspectors (SOFI) tool was used where the wellbeing, engagement, and interaction of service users was observed and recorded. This helped the inspector to gain an insight of what life is like at Lifestyles for the people that live there. What the service does well: Service users stated that they received care in a way that respected their privacy and dignity. Service users were fully assessed prior to being admitted to the home to ensure their needs could be met. Trail visits were available to allow the service users and their family’s time to reflect and ensure this was the correct placement for all parties. Activities provided were varied and met service users assessed needs. The home had made provision for a “sensory room” to be crated for service users to enjoy. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 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 Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2. Quality in this outcome area is adequate. Service users are assessed prior to admission. However service users do not have access to up to date relevant information about the service and therefore cannot make an informed choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective service users were provided with a statement of purpose, home brochure but the manager stated there was no service user guide produced by the home. The lack of up to date information does not ensure that service users and their family can make an informed choice about the home. From the evidence gained on the site visit and from information faxed to the Commission for Social Care Inspection it remained unclear if all service users, or their relatives were fully aware of the range of services to be provided for the fee that they pay. It was also unclear if all service users and their family had received information relating to the terms and conditions of occupancy. This must be addressed. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 9 The pre admission assessment for a new service user was inspected. The new document required modifying to gain more detailed information. The form was mainly completed by Yes or No responses; detailed comments had not been recorded. However care plans, risk assessments and moving and handling assessments had been completed, with more details about the service user gained from the social services assessment. This ensured that the home could meet the service users needs. Two surveys received indicated that relatives looked around the home and then the service users were invited to try a trial period of respite care before becoming permanent resident within the home. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.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): Standards 6, 7 and 9. Quality in this outcome area is good. Service users were helped and supported to make decisions about their lives and can take risks if they so wish. However one service user required reassessing to ensure the home could still meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users could make decisions about their lives and take risks, with adequate support from staff. Care plans and risk assessments for service users were reviewed regularly and were detailed. Where possible the service user had signed the documentation, when this was not possible the service users family were involved in this process. Documentation examined covered the service users social and health care needs in detail. This ensured staff knew each service users needs in detail and that there needs would be met. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 11 Staff were seen to treat service users with dignity and respect. Service users were able to communicate their wishes in their own unique way, which was understood by staff who delivered personal care relevant to the special needs of each service user. One survey stated “XXX tries to communicate with staff by blinking, most of the staff understand quite well”. Service users were seen making choices about how to spend their day. Two were seen in the “sensory room”, one was laying on a beanbag with the hairdresser cutting their hair, whilst a lava lamps and relaxation music created a tranquil atmosphere. Service users who were not able to make decisions for themselves were represented by their families. There was a brief description of their family history, social likes and dislikes and information about how they used to spend their lives upon the wall by their bedside. This helped to ensure that new and agency staff could converse with each service user about their life. Service users where ever possible handled their own finances; otherwise family members undertook this duty. The manager was not acting as an appointed person for any of the service users. She was not sure if the Responsible Individual for the home was an appointee for any of the three service users who had money sent to head office for their personal allowances and mobility allowances. This requires clarification, to ensure that service users were being protected from financial abuse. On two occasions over the last two years, it was felt that the home could not continue to meet one service users needs due to behavioural and drink related issues. However the service user had been spoken to and at present the home was meeting their needs. It was felt that the situation would continue to remain precarious. In view of this the manager must have this service users needs fully re assessed to ensure that the home are fully aware of all their complex needs, and can be clear if this placement would continue to be relevant for this service user. Support from other professionals must be gained to ensure that the service users needs can still be met. And that other service users and staff were not being placed at risk. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users received a nutritious diet and followed their chosen routines, supported by staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users preferred social activities were known by care staff, Outings were available to all service users. These were to Drax social centre for concerts such as “Beetle Mania” and a Christmas party. Service users were helped and assisted to have a dance, including those service users who were in wheelchairs. This ensured all service users could take part in the activities. Photographs of the service users enjoying themselves during a number of outings and events held in the local community were displayed throughout the home. Staff had assisted service users to gain Christmas presents for their family and had wrote in Christmas cards which were placed under the Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 13 Christmas tree at the homes Christmas party for service users and their relatives. The service users relatives appreciated this. Staff had gained inspiration from a trip to St Catherine’s Hospital, solar centre, where they decided to fund raise to provide a sensory room for the service users. The pub next door had helped host this event and the service users had benefited from acquiring their own sensory stimulation room within the home, which was seen to be well used and enjoyed by service users. Comments received included “the patients enjoy being taken out to different venues, and have entertainment frequently, this year the home has a new sensory room”. Current service users were not able to gain employment and were not undertaking any courses. Management stated that they would be supported to do so it they had the desire and ability to achieve this. Staff were observed knocking on service users doors and waiting to be asked to enter. If service users couldn’t speak, this process still occurred with a short pause before the member of staff entered the room. Staff sang to the service users whilst attending to them if they were known to enjoy music. There was also friendly banter between the staff and service users, which was polite, warm and friendly. This helped to create a friendly relaxed atmosphere within the home. Service users could choose how to spend their day, access to the ground floor of the home was unrestricted and there were two patio areas with some garden furniture for use in better weather, however both of these areas required weeding. The kitchen was inspected; fridge and freezer temperatures were recorded, however hot meat temperatures were not recorded daily for the last two and a half months. The new chef was reminded that this must be completed, and this commenced during the visit. Chopping boards had been replaced and all areas of the kitchen were clean and tidy. There was a hot water boiler in a small kitchenette outside the main kitchen entrance. Service users were prevented from accessing this area by means of a counter and walk through hatch. It was suggested that the hatch should be placed in the closed position to ensure service users could not gain access to the water boiler and therefore maintain their health and safety. Food served was appetizing and service users had a new menu to choose from. Service users were seen to be given time to eat, staff assisted service users in a respectful manor. Service users could choose to eat in their own rooms or have peg feeds in their bedrooms or the living room. Mealtimes were flexible, drinks and supper were available. This ensured that service users nutritional needs were being met. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 14 Surveys indicated staff were knowledgeable about service users requiring tube feeding, and would contact the health professional if they had any concerns regarding feeding. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.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): Standards 18, 19 and 20. Quality in this outcome area is good. Service users receive personal support, however a yearly review of each service users condition must be undertaken, and clarification must be supplied that the medication waste disposal contract is in force. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users stated they were cared for in the way that they preferred. They were seen to be assisted with walking to walk in an unhurried and relaxed manner, if service users were able to mobilize. This ensured that service users mobility was maintained. Service users were washed and dressed by staff that preserved their dignity by ensuring they were not exposed and service users were encouraged to choose what to wear if they could specify this. To ensure that service users individuality was being expressed. Specialist equipment adapted chairs and special beds were available for service users who required this to ensure that they remained comfortable. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 16 One case tracked service user had not received a full medical and psychological assessment within the last year, and there had been some concerns. In view of certain issues, which had occurred this must be undertaken, and any necessary actions to improve the service users life must be implemented. This was discussed with the home manager. Service users did not tend to choose their own general practitioner but received services from the local practice. All were helped and supported to attend appointments at the hospital and dentists. Service users were receiving continence aids, which were suitable and were assessed for their specific needs to ensure their health needs were being met. Service users were also allowed to continue to maintain their own independence for washing. One would not permit their room to be cleaned regularly, just when they wished it to be cleaned. This ensured that service users had a choice and this was respected by staff. Two service users were seen to be having their hair cut by the visiting hairdresser. This was undertaken in the sensory room, with the service users relaxed on beanbags or in their adaptive chairs. Relaxation music was playing and the whole atmosphere was seen to encourage the service user to enjoy this experience. They were well supported by care staff and a very kind and patient hairdresser. Ensuring this experience was enjoyable for the service users. Service users were seen to follow their chosen routines, some stayed in bed in their personalized bedrooms, others chose to get up and go to the television lounge and to the dining room. Others were assisted into their own personalized wheelchairs and then went to the lounge in the afternoon to take part in the bingo session. The medication systems were inspected, and found to be correct. There was a disposal bin in the treatment room for waste medications. Evidence of a signed agreement for waste disposal was provided, however it was not clear if the contract had been agreed to by the provider. Clarification of this must be provided to the Commission for Social Care Inspection. Comments received included “ the standards of care relies greatly upon the manager of the home, and the present manager is doing a really good job”. “the standard of care in the home has always been good”. And “social events have also increased along with regular outings for those that are able”. Also “Staff at lifestyles have always been kind and caring”. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23 . Quality in this outcome area is poor. Service users were protected by the homes complaints procedure, however it was not possible from the evidence available to make a positive judgement relating to the financial protection of some of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had evidence displayed in reception relating to the action, which should be taken if a service user or relative had a complaint. The policy stated that the National Care Standards Commission could be contacted, this was discussed with the manager and this will be changed to reflect the Commission for Social Care Inspection. All complaints had been dealt with within a 28-day time scale. No complaints have been received since the last inspection. A folder containing the details of past complaints and grievances has been completed. This contained all the evidence of the concerns, the investigation and the outcome. Service users and their family could be assured that concerns would be listened to and the relevant action would be taken. Some service users indicated on surveys they would not know how to complain, others indicated that they were aware of what to do if they were not happy. Staff were aware of action, which must be undertaken if an allegation of abuse was ever to be received. Training in regard to this was provided. There was a Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 18 copy of the “No secrets” document in the home. A whistle blowing policy and procedure was in place and this had been utilized by staff. Investigations had been made in relation to concerns, which had been raised, to ensure that the protection of vulnerable adults was maintained within the home. Service users personal allowance accounts were inspected. All but three residents have their own family representatives looking after their interests and handling their own personal allowance. Three service users gain personal allowance monies via lifestyles head office. The home requests personal allowance for these three service users £200 at a time. The balance of these were inspected and found to be correct, receipts were all kept and were numbered. However it was not possible to ascertain if there were more personal allowance monies held for these three service users at head office. It was also not possible to check the invoices for service users receiving mobility allowance; this had been a requirement on the last report that the relevant records be held at the home ready for Inspection. In view of this the inspector phoned head office and spoke to Mr Darren Paul, who indicated that the mobility allowance was part of the fees. Looking at the statement of purpose and a blank contract there was no indication that this was acceptable or had been agreed, for all of the service users. However evidence relating to this for one service user was received by fax. This area requires further clarification to ensure that financial protection of service users can be determined. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 19 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): Standards 24 and 30. Quality in this outcome area is poor. Service users live in a home that required a thorough spring-clean, and further maintenance work to be undertaken to ensure health and safety is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full inspection of the ground and first floor of the home was undertaken. Upon arriving at the home it was noted that the front wall had been repaired which marked the boundary of the car park. The grass in all garden areas was cut and there were items of garden furniture arranged outside. All external paintwork was in varying states of disrepair. Reception was spacious warm and inviting. The main lounge and dining room on the ground floor was well decorated. A small area of corridor outside the laundry had the carpet removed as a burst water pipe on the first floor had recently caused a flood. The laundry was inspected, it was tidy, although the Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 20 ceiling in the dirty side of the laundry was water damaged, the walls required repainting and the sink unit needed to be replaced due to being stained & damaged in the flood. The area behind the dryer was not tiled, and this remained an outstanding requirement from the last inspection. The laundry washing machine had the relevant sluicing cycles being used to ensure infection control was maintained. Hand washing facilities were available throughout the home. All occupied downstairs bedrooms and empty bedrooms were inspected. They were seen to be warm and personalized with the service users possessions. Vacant downstairs bedrooms were warm and presentable, just requiring a spring clean before being ready for occupation. The corridor carpets had no silver sticky tape holding them down to the floor. The loft hatch had been replaced. There were two internal patio areas, both had some dead weeds apparent, one had garden furniture. The smaller of these areas had a small wall built each side of a ramp and a concrete edging on top of one of the walls was misplaced; this should be repaired to prevent any possible injury occurring to a service user or member of staff. The outer door to this area was not secured by means of a lock or bolt. This was discussed with the manager who stated it had been like this for a long time, because it was an internal patio, and persons would have to scale over the roof to this area, it was felt that this was secure enough. In view of the fact that the service users are very highly dependant a lock should be fitted to this door to ensure that these is no possibility that unauthorized access to the home may be gained. The second patio area outer door and surrounding had still not been painted. The water pressure and bathroom temperatures for hot water supplies were all taken by the inspector. It was noted that in service user bedrooms and in the shower and bathrooms water pressure varied and temperatures also varied. All but one was found upon re checking to be within the permissible range, the plumber attended the home the day after the site visit to rectify this. He also confirmed that the water pressure issues were caused by the home being sprawling and the tanks and boilers being far away from certain outlets to gain better pressure. Two shower rooms downstairs had to be completed to be fit to be utilized by service users. One bathroom door had two holes in the inner skin, which were there on the last inspection; this door had not been replaced. This must be addressed. The smokers lounge still had an area of carpet removed which revealed a metal hatch. The manager was not sure if this was a drainage hatch or something to do with the nearby lift. Clarification will be sought from the proprietor. The lift was immobilized by placing blue tac over the lift door sensors. This was to ensure that service users and staff could not use the lift. It was discussed with the manager that this was not an acceptable method of putting Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 21 the lift out of action; evidence of action to be taken to ensure service users could not operate this lift must be supplied to the Commission for Social Care Inspection. The lift engineers report still showed outstanding work had not been undertaken. There was a large notice the door stating that staff and service users were not allowed to travel in the lift. The kitchen flooring in the vegetable area still had silver sticky tape present. This had not been replaced as requested in the last report. The new chef stated that she thought it was because there was a metal drain cover under this. Outside the kitchen there was a counter with a walk through serving hatch. It was not wide enough for a service user in a wheelchair to get through, although there was one independently mobile service user who may have gained access to the water boiler and kitchen area through the hatch. It was suggested that the hatch was kept closed to ensure staff only had access to this area and therefore help to maintain the health and safety of this service user. The first floor was examined there was a number of empty rooms, two were padlocked due to the recent burst pipe as floor boards had been removed and there was plumbers pipe work exposed. There was a staff room, training lounge and a treatment room and store cupboard for pads being used. The deputy manager and manager stated that none of the first floor rooms were used for service users, as they were registered for 20 bedrooms and all these were downstairs. The oxford hoist had been repainted, but this had flaked off; this again should be repainted as an ongoing maintenance, to ensure that it can be adequatly cleaned to prevent cross infection occurring. The home had no only one cleaner 20 hours per week, this was not enough as the home was dusty and a good spring clean was required especially on top and behind radiators as well as service users bedrooms. The manager stated that sometimes she and the care staff get their sleeves rolled up and clean certain areas. Issues with the cleaner’s performance were about to be addressed. Although some improvements to the environment had been made it was clear that there was no ongoing planned maintenance programme for the home. Repairs were made only as required. This does not ensure that the home always looks its best. The proprietors have also stated that financial constraints prevent the outside of the building from being re painted. The poor presentation of some areas of the home deflects from the good care given by the staff to service users, and may well negatively influence potential service users and their families from considering Lifestyles. Comments received included “The overall standard of accommodation has improved greatly over the last 8 years”. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.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): Standards 32, 34 and 35. Quality in this outcome area is adequate. Service users were looked after by adequate numbers of well-trained staff, however there were shortfalls relating to the recruitment process, which had placed service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels upon the day of the site visit were adequate for the nine service users who were resident. Inspection of two new staffs recruitment records indicated that they had commenced employment at the home without being checked against the register of names kept ensuring the protection of vulnerable adults was maintained. Criminal Records Buro results had been gained after the staff had commenced at the home. Staff had received some supervision but the vulnerable service users had not been protected adequatly due to this shortfall. This was discussed with the manager and Protection Of Vulnerable Adults First Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 23 Check must be undertaken and the results known to management prior to new staff commencing supervised practice within the home. New staff completed an induction programme, and gained the relevant staff supervision with a yearly appraisal. Records were inspected and found to be correct. Training at the home was ongoing; staff commented that they received more than enough encouragement and support. The home had a training matrix for healthy and safety to ensure that this was always kept up to date. Service users had stated that they were happy with the help and support they received, this was indicated upon talking with the service users and from the information gained by surveys sent out to service users and relatives. The home did not have a development plan for the business; this was a requirement from the last inspection. The manager stated she could not create this and that the proprietors had not produced this, this must be addressed. Surveys indicated, “the service users were well looked after, and the carers did a marvellous job”. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.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): Standards 37, 39, 42 and 43. Quality in this outcome area is adequate. The home manager continues to develop the quality assurance systems however there were concerns relating the proprietors systems in place to develop the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home manager had just completed surveying the service users and their relatives about the service. The responses were all positive and intimated that on the whole service users and relatives were happy with the services provided. Comments received from surveys stated, “Things have improved greatly since we got this manager”. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 25 The home manager had continued to take and record hot water temperatures and maintain the fire alarm checks etc. This ensured that the health and safety of service users was maintained. However there were issues relating to the lift which required work to be undertaken for it to be safe to carry passengers. The manager undertook health and safety checks to promote the well being of service users and staff, in relation to moving and handling training for staff and fire precautions and maintaining safe hot water temperatures. Regular staff meeting are undertaken and minutes are recorded. Quality assurance systems continue to be developed by the manager, who undertook a regular walk round and informal audit of the service, this was to ensure that medication rounds was being undertaken correctly. This ensured that the dayto-day delivery of service was being monitored. The manager continued to make a positive impact on this service, staff stated that she was fair, supportive and would help staff achieve as much training as they wished to undertake. They also stated that if there were any issues, she dealt with them thoroughly. Surveys received also indicated that service users and relatives felt that the home had improved under the current manager. There was no evidence that the proprietor documented their regulation 26 visits to the home. This must be formalized and a copy sent to the Commission for Social Care Inspection following every visit to the home. To provide evidence that the service delivery was being adequatly monitored by the proprietor. There was also no evidence that the proprietor had produced a business plan, to ensure that the business was evolving in a positive manner. This must also be created and a copy sent to the Commission for Social Care Inspection. Records of each service users contract, complete evidence relating to service users personal allowance and mobility allowance accounts were not held for inspection within the home. It was not clear from brief information faxed to the Commission for Social Care Inspection or evident that these records were full and complete. This area of concern requires further clarification. From the evidence it was not clear that each service user or their relatives had received a written contract and statement of terms and conditions. The manager had no control of this due to this being dealt with from head office by the proprietor. The proprietor must provide further clarification of this to the Commission for Social Care Inspection. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 26 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 1 2 2 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 3 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000027965.V327825.R01.S.doc 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 2 Version 5.2 Page 27 Lifestyles Care Centre For Adults With Disabilities 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 YA1 Regulation 456 Requirement The statement of purpose must be updated to reflect what the home currently provides. The range of fees and what is provided for these fees must be included. A service user guide must be created, and be made available to all service users and their representatives. 2 YA6 2 15 (2) (b) A full reassessment must be undertaken of the one service user who was discussed upon the site visit. To ensure that their needs could continue to be met, and to ensure other service users and staff were not being placed at risk. Records of hot meat temperatures must be taken and recorded daily. The counter hatch must remain closed, in the kitchenette outside the main kitchen. To prevent ambulant service users accessing the water boiler. Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 28 Timescale for action 31/03/07 31/03/07 3 YA17 13 (4) (a) (c) 14/03/07 4 YA22 6 (a) The complaints procedure must be changed from the National Care Standards Commission to state the Commission for Social Care Inspection. All service users full records of personal allowance and mobility allowance accounts transactions must be supplied to the Commission for Social Care Inspection, and be held at the home for full inspection. A copy of the medication waste disposal contract must be supplied to the Commission for Social Care Inspection. 14/03/07 5 YA23 17 & sched 4 9 31/03/07 6 YA20 13 (2) 31/03/07 7 YA24 23 (2)(o) The patio areas must be weeded. 31/03/07 The doors leading to both patios must be able to be locked. The door surrounds must be painted. The loose concrete wall edging, on the small patio must be re cemented to the wall. 8 YA24 23 (2) (b) The outside doors and windows must be repainted. (Previous timescale of 18/08/06 not met) 07/04/07 9 YA24 4 (c) The bathroom door must be replaced which has two holes within its inner skin. The lift must be disabled to service users, by appropriate means, not by placing blue tac over the sensor. 31/03/07 10 YA24 YA42 23 (2) (c) 14/03/07 11 YA24 12 The proprietor must inform the DS0000027965.V327825.R01.S.doc 31/03/07 Page 29 Lifestyles Care Centre For Adults With Disabilities Version 5.2 13 (c) Commission for Social Care Inspection what function the metal hatch has in the smokers lounge. And inform the Commission for Social Care Inspection if there is a hatch in the vegetable preparation area. This flooring must be replaced. 12 YA30 23 (d) All areas of home must be spring-cleaned. And the standard of day-to-day general cleaning undertaken must be elevated, to ensure that care staff do not have to clean the home. The area of exposed breezeblock behind the tumble dryer must be tiled, to enable adequate cleaning to take place. (Previous timescale not met) The laundry must be redecorated, sink and floor covering replaced, following the flood damage. 31/03/07 13 YA30 13 (4) (c) 31/03/07 14 YA34 19 The proprietor must carry out Protection of Vulnerable Adults First check, and receive the result of this before new staff commence supervised practice within the home. The proprietors must produce a business plan and send a copy of this to the Commission for Social Care Inspection for inspection. And undertake a regular visit to the home, which must be documented, and a copy sent to the Commission for Social Care 01/03/07 15 YA43 24 (1) (a) 24 (2) 25 (1) 31/03/07 Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 30 Inspection for inspection after each visit. 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 YA2 Good Practice Recommendations The pre admission assessment document should be redesigned to gain more detailed information about potential service users. Continue to repaint the oxford hoist, as necessary. 2 YA24 Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Lifestyles Care Centre For Adults With Disabilities DS0000027965.V327825.R01.S.doc Version 5.2 Page 32 - 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. 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