Inspection on 27/09/05 for Lilas House.

This inspection was carried out on 27th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lilas House. 03/05/07

Lilas House. 27/04/05

Lilas House. 11/10/04

Lilas House. 12/05/04

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

CARE HOME ADULTS 18-65 Lilas House 5 Cadogan Road Cromer Norfolk NR27 9HT Lead Inspector Lella Andrews Announced 27 September 2005, 10:00 th 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. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lilas House Address 5 Cadogan Road, Cromer, Norfolk. NR27 9HT. 01263 511210 01603 279529 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) Jeesal Residential Care Services Limited Mrs Sam Wiseman Care Home 6 Category(ies) of Learning Disability (6) registration, with number of places Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The Home is registered as a Care Home for up to six adults with a learning disability Date of last inspection 27th April 2005 Brief Description of the Service: Lilas House is a three storey end of terrace property situated in the centre of Cromer. It is registered as a Care Home for up to six adults with a learning disability. Each service user has their own bedroom. There are two bedrooms, with a shared ensuite bathroom, on the ground floor and four bedrooms on the first and second floors. There is a shared lounge and dining room on the ground floor. The Home does not have a garden but there is a small patio area to the side of the Home. The Home is very close to the shops, seafront and other facilities in the town of Cromer. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was announced and took place on Tuesday 27th September 2005. The Manager was present throughout the Inspection and the Inspector also spoke to one of the members of staff on an individual basis. There are four tenants currently living at the Home and three of the tenants spoke to the Inspector at length about their experiences of living at the Home. The Inspector was shown around the communal areas of the Home and inspected some of the records. Not all of the National Minimum Standards were inspected on this occasion. There have recently been some changes to the group of tenants who live at the Home. Three previous tenants have moved to a more independent style of living, one tenant has moved to another Care Home within the organisation due to changing needs and two tenants have moved into the Home from another Home within the organisation. What the service does well: The Home provides a good quality service to the tenants living there which is based on the needs of the individual tenants. The tenants are encouraged to make their own choices and put forward their points of view about all aspects of living at the Home The tenants are supported to take part in a wide range of educational and leisure activities within the local community Staff receive appropriate training and good support to undertake their roles effectively The Home is well managed with the Manager having an open and effective style of management Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 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. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 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 Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 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) 2 and 4 Prospective service users individual aspirations and needs are assessed and they are encouraged to visit the Home prior to making a decision to move in EVIDENCE: The two tenants who have recently moved to the Home described the process of moving. They already knew the tenants and the majority of the staff at the Home as they were living at another Home owned by the organisation. Both of the tenants feel that their wishes and feelings were taken into account during the assessment and planning process. Formal assessments were undertaken and the Manager feels that there was good joint working between the staff at the previous Home and at this Home with regards to handing over information. The tenants said that they visited the Home on many occasions and stayed for longer periods over time. These visits included having meals with the other tenants and then staying overnight. The tenants were invited to a staff meeting at the Home so that they were able to have an opportunity to give the staff team their own views about their individual needs and how they like to live their lives. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 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) 6, 7 and 8 The care plans contain detailed up to date information about the tenants needs and how these should be met The tenants are encouraged to make their own decisions about their lives and are given support to do so The tenants are consulted on and participate in all aspects of life in the Home Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 10 EVIDENCE: Two of the care plans were seen and these contain good detailed information about the individual needs of the tenants and how these should be met. The care plans show evidence of being regularly reviewed and updated. Risk assessments are carried out and are part of the care plans. The Manager has started to complete a new style of format for the care plans. Staff confirmed that these are easier to make reference to and therefore easier to use on a day to day basis. The tenants have an individual meeting each month to review what has taken place in their life in the previous month and to agree on action that might need to be taken in the coming month. These reviews are recorded and, where possible, the tenant signs to confirm their involvement. A tenants meeting is held every evening, except for at weekends. The tenants told the Inspector that they like to take part in these and that they discuss a variety of subjects, such as the menu for the following day, any activities that are planned and which staff are on duty. Minutes of these are kept and the tenants sign, if possible. Tenants said that the minutes are read to the tenant who is unable to read. The majority of the staff have attended training with regard to communication and one of the members of staff is undertaking the Total Communication training provided by the Speech and Language department. The staff are enthusiastic about the improvements that they have been able to make with regard to improving communication. For example, a board is used to show pictures of which staff are on duty each day and objects of reference are used to assist the tenant who does not have speech. Staff were seen to spend a lot of time ensuring that communication is effective. The staff are all aware of the importance of communication and how improvements in this area can enable the tenants to have more control over their life and make their own choices more effectively. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 11 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) 12, 13, 14, 15 and 17 The tenants are supported to take part in a range of leisure and educational activities within the local community Tenants are supported to maintain and develop relationships with their family and friends Tenants are offered a healthy diet and are involved in the process of meal planning and preparation Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 12 EVIDENCE: The care plans contain information about the social and educational interests of the tenants and activities are arranged accordingly. The tenants take part in a range of adult education classes such as literacy and numeracy as well as leisure activities such as swimming, visiting the library, meals out and holidays. Two of the tenants also undertake horticultural work. All of the tenants have recently had a holiday which they said that they enjoyed greatly. The Home is ideally situated for easy walking access to the town and seafront of Cromer and near to the railway station. The Home also has a vehicle for the use of the tenants. The rotas now identify which staff are responsible for supporting each tenant during the shift. The staff said that although this is flexible it does enable more focused support to be provided to each tenant. The tenants told the Inspector about their individual arrangements for maintaining contact with friends and family. The staff support tenants to visit family who do not live in the local area if that is what they wish to do. The comment card completed by relatives states that they are very happy with the care and accommodation provided to their relative. The tenants who have recently moved to the Home have been enabled to visit their previous home to see their friends there. The tenants who have recently moved from the Home have been invited back to visit. The tenants plan the menus at the tenants meetings and all tenants are encouraged to take part in this process. Alternatives are provided for any tenants following a low fat, diabetic or vegetarian diet. A record of menus is kept and a pictorial menu is now on display each day. Tenants described the meals that they most enjoy preparing, with staff assistance. Tenants are able to help themselves to drinks and fruit/snacks if they are able to. A lot of effort is put into offering choice at mealtimes to the tenant who does not use speech. Staff and tenants eat together and mealtimes are a social occasion. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 13 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) 18 and 19 The tenants receive personal support in the way they prefer The tenants physical and emotional health needs are met. The staff have worked very hard over the last few months to ensure that one of the tenants with a particular health care need has received a high standard of care. EVIDENCE: The care plans contain details about how to meet each tenants personal care needs and the ways which they prefer this to be carried out. Only one of the tenants needs full support with personal care whilst the other tenants require very little physical assistance. Staff advised that female staff provide personal care support to the tenant who requires this. The staff have received training with regard to moving and handling which enables them to support the one tenant who requires assistance to move around. The tenants are clearly encouraged to develop their own sense of style with regard to hairstyles, clothes and makeup. The care plans contain detailed guidance about how to meet each tenants physical and emotional health needs. These are clear and regularly updated. The guidance for staff about how to meet the needs of a tenant with epilepsy and diabetes are particularly detailed and provide good information for staff to Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 14 ensure that the tenant receives consistent support to manage these health issues. The new style care plans contain a detailed health care assessment which is clear and easy to understand. The care plans contain records of routine appointments such as dental and optician as well as records of hospital and GP appointments. The care plans show evidence of other health professionals being involved in the clients life where necessary. The District Nurse team provides training to the staff team with regard to diabetes and their completed comment card confirms that the staff communicate well and work in partnership with the nursing team. One of the District Nurses has provided a written statement , kept in the Home, about their involvement and responsibilities with regard to the nursing needs of the tenants. This praises the standard of the in house training provided to the staff. A tenant has recently moved from the Home into another Home owned by the organisation. This tenant had previously spent several months in hospital due to increasing mental health needs. The staff should be commended for their commitment to supporting the tenant whilst in hospital and when he returned to the Home. The Inspector saw a report from one of the other professionals involved in the tenants life which praised the commitment from the staff team with regard to the efforts made to enable the tenant to move back home. As part of understanding the tenants needs it was recognised that they could not be best met at this Home and so the tenant moved but the Manager still maintains regular contact with him. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 15 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 and 23 The tenants feel that their views are listened to and acted on The staff receive training to assist with protecting the tenants from abuse EVIDENCE: Tenants told the Inspector that they are aware of the complaints procedure and that they are confident that the Manager will deal with any problems that they might have. Two of the tenants also said that they know how to contact the General Manager and the Proprietors and would do so if they needed to. As previously mentioned in this report, the tenants are given lots of opportunities to voice their opinions about a range of issues. Tenants have opportunities within a group setting and individually to discuss issues with members of staff. The Home has extensive policies and procedures which aim to protect the tenants from abuse of any kind. The staff have all received training with regard to the protection of vulnerable adults and the staff who spoke to the Inspector are aware of the whistleblowing policy. Staff are confident that the Manager and General Manager will take any concerns seriously and take appropriate action. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 16 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 and 30 The tenants live in a homely, comfortable and safe environment The Home is clean and hygienic EVIDENCE: The Inspector was shown around the communal areas of the Home and also one of the bedrooms. The bedrooms belonging to the two new tenants have recently been decorated and they have clearly been encouraged to personalise them with pictures, photographs and ornaments. The Home has had a new kitchen fitted since the last Inspection. The tenants said that they had all been involved in the choice of the colour and style and that they are all very pleased with the result. The Home has on ongoing programme of redecoration and refurbishment. The organisation employs maintenance staff who are available to undertake work in the Home. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 17 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) 32, 33, 34 and 35 The tenants are supported by competent and qualified staff who receive appropriate training The Home follows appropriate recruitment procedures EVIDENCE: The majority of the staff have worked at the Home for some time now and know the original tenants well and are in the process of getting to know the newer tenants better. Staff are enthusiastic about working with the tenants and are respectful and kind when communicating with them. There are currently three members of staff working at the Home for whom English is not their first language. The Manager is aware of the need to monitor this situation to ensure that the staff are able to communicate effectively with the tenants. The staffing levels are sufficient at present but when additional tenants move into the Home this will need to be reviewed to ensure that tenants are able to be supported to access activities within the community and to have appropriate support within the Home. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 18 Some of the staff team are also currently supporting the three tenants who have moved into a Home two doors away to live more independently. The staffing rota clearly reflects which staff are working at each Home. Staff and tenants advise that this situation is working well and is not detracting from the support provided to the tenants in this Home. The Manager is aware of the need to continually monitor this situation. The majority of the staff team have either completed NVQ Level 2 or are undertaking Level 2 or 3. Training records show that all staff have undertaken mandatory training such as induction, first aid, food hygiene, moving and handling, protection of vulnerable adults, fire safety. Some staff have dates booked to undertake updates for these subjects. Some staff have attended training with regard to additional subjects such as Total Communication, Epilepsy, Care Planning and Behaviour Management. The organisation has recently received accreditation with City and Guilds to provide a range of training to their own staff and others if they wish to. The staff appreciate the training that is available to them and are enthusiastic about taking up these opportunities. The Inspector did not look at any recruitment files on this occasion as they had previously been seen and no new staff have been employed since then. Good recruitment practice is followed and appropriate checks are obtained before the member of staff starts work. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 19 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 and 42 The tenants benefit from living in a well run Home where the Manager has a positive and effective leadership style The views of the tenants underpin all self monitoring and development of the Home The tenants rights and best interests are safeguarded by the Homes record keeping procedures The health, safety and welfare of the tenants are promoted and protected EVIDENCE: The Manager has worked and managed the Home for several years. She has almost completed the Registered Managers Award and has undertaken other relevant training to keep her knowledge and skills up to date. The tenants and staff speak highly of the support provided by the Manager and are confident in Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 20 her style of management. The Manager is aware of the records required by regulation and maintains these to a high standard. Records are stored appropriately. The Manager is currently also managing the Home in the same road which three of the tenants have moved to. This situation seems to be working well at the moment and the Manager is aware of the need to monitor this on a regular basis to ensure that she is able to carry out both roles effectively. The Manager also provides some training with regard to communication for staff throughout the organisation. To continue to undertake all these roles effectively the Manager needs to be able to work supernumerary to the basic staffing rota. The organisation will need to review the staffing levels once new tenants move into the Home to ensure that the Manager is not included on the staffing rota on a regular basis. The Home has several ways of measuring the quality of the service that they provide and the basis of all of these is to gather the views of the tenants about the service that they receive. Some examples of this are the tenants meetings, monthly reviews and annual reviews. The organisation holds a Tenants Forum chaired by one of the Proprietors and one of the tenants attends to represent all the tenants living at the Home. A quality forum group is held at the Home and this group looks at different National Minimum Standards. Several positive developments in the Home have come about as a result of this group. The Home sends out questionnaires to relatives and care/health professionals on an annual basis and these are included in the Annual Development plan. The Inspector saw the most recently returned questionnaires and these contained very positive responses eg. “….guidance and patience is excellent.” The health and safety needs of the tenants and staff are given a high priority. One of the members of staff is responsible for carrying out the monthly health and safety checks. Daily records of fridge and freezer temperatures are kept, as is a record of the cooked meat temperatures. A general risk assessment of the building has been undertaken and the care plans contain detailed risk assessments relevant to each of the tenants. The Manager advised that the hot water temperature is regulated and it was noted that window restrictors are fitted above the ground floor. The records were seen for the fire safety equipment and these are up to date. Fire drills take place regularly but it is recommended that a record is kept of the staff taking part to ensure that all staff take part twice a year. Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 21 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 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lilas House Score 3 4 x x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x 3 3 x I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 22 no 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 Regulation Requirement No requirements are made as a result of this Inspection Timescale for action 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 It is recommended that a record is kept of the staff taking part in fire drills Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 23 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF 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 Lilas House I55 s27466 Lilas House v240910 AN 270905(4).doc Version 1.40 Page 24 - 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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