CARE HOME ADULTS 18-65
Lilena 2 Quintrell Road St Columb Minor Newquay Cornwall TR7 3DZ Lead Inspector
Lynda Kirtland Unannounced Inspection 15th March 2007 09:30 Lilena DS0000009273.V330113.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 Lilena DS0000009273.V330113.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. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lilena Address 2 Quintrell Road St Columb Minor Newquay Cornwall TR7 3DZ 01637 877662 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) Ms Lesley Richardson Mr Neil Harrison Mrs Angela Jeannette Warne Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To include service users who are sixty-five years of age or under on admission to the home 10th January 2006 Date of last inspection Brief Description of the Service: Lilena is a care home registered for up to 14 service users with a Mental Disorder who are admitted to the home under the age of sixty-five. The home is in St Columb Minor on the main road, near Newquay. The home offers accommodation for ten individuals within the main house, there is another part of the home for three people who live more independently and there is an attached bungalow that accommodates one person for greater independence again. There is a small patio area to the rear and a lawn to the front of the home; this is situated next to the main road that goes into Newquay. The Registered Provider owns another home catering for the same client group on the edge of Newquay and care staff work between the two homes. There is car parking to side and rear of the home. Lilena fees range from £358.68 to £369 per week. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection, which was unannounced. It took place on 15 March 2007 and lasted for approximately seven hours. The registered manager was present and the Registered Provider was available for part of the inspection. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the service users living there. The inspection included meeting with a number of service users currently living at Lilena. Members of staff were interviewed and there were opportunities to directly observe aspects of service users’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered manager. The principle method of inspection was “case tracking”. This involves interviews with a select number of service users; staff caring for them and examination of records relating to their care. This provides a useful impression of how the home is working for service users overall. Two service users were case tracked in detail at this inspection. On the day of inspection 14 Service users were resident in the home. What the service does well:
The majority of service users living in the home have been there for several years and are very familiar with the services it provides. They have written information about it, which they are all able to access easily. They generally get on well with each other and the home operates like a shared domestic dwelling with staff support provided where it is needed to assist them to develop and maintain their skills and independence. One service user said, “how can you improve on excellence”, another ‘I get my TLC here, I look forward to the breaks’ (respite) and another “brilliant”. Assessments prior to moving into Lilena are undertaken and based on the individuals health, social and personal care needs, including needs relating to their religious, ethnic and cultural backgrounds, to ensure they can be met in the homes setting. Service users are encouraged and supported to develop their skills and independence in many ways. They are involved in developing their own care plans with assistance and support from staff and attend annual reviews. They
Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 6 have opportunities to make decisions about important aspects of their lives, and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. Service users have clear information on what is expected of them and their rights as residents of a care home. They are aware, for example, that they will be expected to help out with household tasks such as cleaning, so that they can develop their skills and independence and know what to do if they wish to make a formal complaint about something they do not like. Service users views are sought individually and via residents meetings. Service users were complimentary regarding the quality and choice of food available. Service users are appropriately supported with their personal care so that they maintain their dignity. Staff were observed to assist service users with their needs quietly and unobtrusively. Service users have access to appropriate health care. The home’s environment is suitable for the service users living there. It was clean and tidy throughout at the time of the unannounced inspection. The recruitment process is robust and all relevant checks on staff are made prior to them commencing work. The staff team and service users said the home is well managed by an experienced and competent manager. Staff were complimentary about her management style and stated they could approach her with ideas or concerns. The inspector was welcomed to the home in a friendly manner by staff and service users. All were aware of the reason of the inspection. What has improved since the last inspection?
Service users felt that the home provided them with ‘brilliant’ and ‘excellent’ care and ‘good’ accommodation and could not identify any areas for improvement. Staff stated they were satisfied with the management and working arrangements of the home. The registered manager and staff, evidenced by documentation showed that there has been an increase in staff training since the previous inspection. The majority of staff have achieved a minimum of NVQ level 2 plus recent attendance on courses such as medication, infection control, adult protection, first aid, diabetes, fire and food hygiene. The registered manager stated that the medication procedure has been improved thus ensuring a robust medication process in the storage, administration and disposal of medication, which does not place service users at risk. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 7 Lilena has an in/out board so that staff are aware from a health and safety view, as to service users whereabouts. Service users now have individual lockable storage space in their rooms. Some Service users rooms have been redecorated and service users said they were pleased with them. 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. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Admission to the home is based on an assessment of prospective service users so that they can be assured the home will be suitable to meet their needs. EVIDENCE: The care needs and wishes of service users are assessed prior to admission to the home. There is evidence of comprehensive social services assessments, health and specialist assessments with the care home undertaking their own assessment. The initial care plan is based upon the care needs assessment and written in concordance with the service user with a signature obtained, where possible, from the service user to demonstrate this. From observations and talking with service users it was evident that they are settled in the home, and that in the main they get on well with each other and with the staff. Lilena DS0000009273.V330113.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): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are aware of their care plans, which fully address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds (age, religion, culture and ethnicity, abilities, gender and sexual orientation). They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. Service users attend residents meetings where they can express their views on the service the home provides. EVIDENCE: Service users, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. The reviews record service users views so that they are aware of the purpose of their placements in the home and are able to contribute to the ongoing care planning process. The care plan has specific headings to address their health, personal and social care needs, including their individual and diverse needs. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 11 Service users participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. Daily care records provide evidence of the choices service users make in their daily lives. Service users can choose the level of privacy they wish to enjoy in their private accommodation. Service users are able to take managed risks, backed up with written risk assessments and risk management plans. Service users monies were inspected and records tallied. Service users said they were ‘happy’ with the arrangements in supporting them with their money. The policy was not inspected on this occasion. It is advised that the registered managers from both homes audit each other’s accounts to ensure that there is a robust and accountable system in the management of service users monies. Lilena DS0000009273.V330113.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): 12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy. EVIDENCE: Service users’ care plans and daily care records provide evidence that their interests and abilities are fully considered in planning their daily activities, which are planned with them individually. Some activities include assisting them to access voluntary employment opportunities or clubs, for example. The majority of service users said that they are satisfied with the activities provided for them. Records show that planned activities take place on a regular
Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 13 bases. At the time of the inspection service users were engaged in a variety of different and appropriate activities in and out of the home. Service users’ daily care records show that they access a range of community resources. Service users said that they do maintain valued relationships with their families and friends, which their daily care records confirmed. They receive mail unopened and are able to receive and make telephone calls in private if they wish. Service users are supported and encouraged to eat healthily. They participate in the menu planning. Service users commented that the variety and quality of food was ‘good’. In the flat (semi independent) and bungalow (independent units) service users undertake their own shopping and cooking, with assistance where needed. Nutritional needs and preferences are considered as part of the care planning process. All the service users looked healthy and well nourished. The home has an ordinary, domestic kitchen, which they can access freely, to prepare drinks and snacks when they want them. The registered manager acknowledges that the kitchen facilities need to be updated. All equipment in the kitchen works; it was advised that a tile in the kitchen was repaired to promote infection control practices. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 14 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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. There are systems in place to support them with medication. EVIDENCE: Service users’ individual care plans address their personal care needs. Service users confirmed they choose when to get up/ retire to bed and make daily living choices in regards to their appearance and privacy. The home has suitable bathroom facilities so that they can attend to their personal care in private. Service users’ care plans consider their healthcare needs. There are separate healthcare records for each of them, which indicate that they access a range of healthcare services, according to their individual needs. Service users stated there are good relationships with the health professionals. The home has a robust medication system. From inspection this demonstrated that medication is stored, dispensed and disposed off appropriately. A tablet count cross-referenced with documentation. Service users in the home stated they were satisfied with how medication is administered. The written
Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 15 procedures to guide staff on how to safely administer medicines were available. It is recommended that in the event of transcribing medication on the MAR sheets this is witnessed by two staff members. A previous recommendation to ensure that recording by care staff should be full where a difficult, or potentially difficult decision is made and the reasons for this. Daily records evidenced that incidents are recorded in full with actions taken recorded. Therefore this recommendation has been complied with. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. EVIDENCE: All the service users were encouraged to speak to the inspector if they wished so that they could make their views known or raise any concerns. The complaints procedure is available to all service users and they were aware of the process in how to raise any issues of concerns. In addition Service users attend a residents meeting which allows the opportunity to express any concerns or ideas for improving the service. All Service users spoken with expressed satisfaction with the care and services provided to them at the home. The home has received no complaints in the last year. The home has written procedures to guide staff on what to do if they suspect a service user is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. Service users are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. The majority of staff have attended the Multi Disciplinary Adult Protection course and have a copy of this policy. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment provides service users with an ordinary, domestic setting so that they can develop their skills and independence in a noninstitutional setting. It is safe and clean so that service users are protected from risks of cross-infection. EVIDENCE: The home looks like an ordinary, domestic dwelling. It is well decorated and comfortably furnished throughout all three units. All the service users said that the environment and furnishings in the home were ‘great’ and that they enjoyed the facilities the home provides. It is advised that light covering are installed in the kitchen and laundry as these could pose a health and safety risk. The home appeared clean and tidy throughout at the time of the inspection, which was unannounced. All staff have attended basic food hygiene, and infection control courses.
Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 18 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): 32,33,34, 35 . Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have ready access to ongoing training so that service users can have confidence in their knowledge and skills to work with them in a competent manner. Staff are recruited on the basis of fair, safe and effective recruitment and selection policies and practices so that service users can have faith that they are suitable to work in a care setting. Staff attends regular supervision to ensure ongoing care practice and training needs are effectively monitored and managed. EVIDENCE: Staff are working in sufficient numbers at the home with 2 care members of staff on duty plus the registered manager from 8-4, 2 care staff on duty from 4-11pm and 2 night staff as shown on the duty rota. Staff felt there were sufficient staff on duty as did service users. The registered manager explained that when the registered manager is on leave then the registered manager from their other care home covers the management responsibilities of both homes, this process is seen to work well. Staff undertake laundry, cooking and domestic tasks. The registered manager and staff felt there was sufficient staff on duty to complete these tasks and
Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 19 that priority was given to ensuring that service users care needs are met. Service users also stated there were sufficient staff on duty and commented that they would also help out with domestic tasks as part of developing individual living skills. A previous requirement to ensure that 50 of staff has achieved NVQ level 2 has been met. Since the last inspection 3 staff has completed NVQ level 3, 4 completed NVQ level 2 and two members of staff are enrolled for NVQ level2. The registered manager and staff believe that training has increased since the last inspection. Records did show that the majority of staff has recently attended first aid training, medication, food hygiene and moving and handling training. Induction and ongoing training is encouraged. From observations of staff interaction with service users it was evident that they communicate with service users in a competent, fair, patient manner and work with the service users at their pace. Staff recruitment records were inspected which demonstrated that recruitment of staff is robust and all relevant paperwork was in place. Service users are introduced to potential applicants as part of the recruitment process. Staff stated that there is regular formal supervision but no documentation was inspected on this occasion. Staff felt this was more regular and found this to be beneficial. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 20 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): 37,39,40,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is competently managed for the benefit of service users. There are formal and informal systems in place to ensure that service users’ views are taken into account in the ongoing management of the home. The home is maintained to a good standard to ensure that it is safe for all those who live, work and visit the home. EVIDENCE: The and and was Registered Manager is experienced and competent to manage the home has ensured that she receives updated training to expand her knowledge skills. Staff and Service users spoke highly of her skills and felt that she approachable and listened to their ideas or concerns. The registered Providers sent the Commission a quality assurance process, which involves collating views of service users, their relatives, advocates, professionals and staff. Feedback from service users, their representatives and
Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 21 professionals using the service were all positive. This was satisfactory. The registered manager has reviewed the questionnaires since the last audit. The commission was recently sent a letter from a Service user who was complimentary about the service Lilena provides. The home’s environment appeared safe and there are written individual environmental risk assessments in place to minimise risks to service users staff working in the home. Records of fire safety equipment tests evacuations occur regularly. Maintenance of the home and its equipment inspections undertaken by Environmental health are all satisfactory. and and and and A previous requirement to ensure that the registered manager notifies the Commission of any events that affect the well being of Service users has been complied with. All notifications are now sent to the Commission. The crises bed is no longer being used, the registered manager will discuss with the Commission if this service is to be resumed. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement 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 YA20 Good Practice Recommendations When transcribing medication two members of staff should witness this. Lilena DS0000009273.V330113.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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
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