CARE HOME ADULTS 18-65
Lincolnshire House Brumby Wood Lane Scunthorpe North Lincolnshire DN17 1AF Lead Inspector
Christina Bettison Announced Inspection 20th September 2005 09:30 Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lincolnshire House Address Brumby Wood Lane Scunthorpe North Lincolnshire DN17 1AF 01724 844168 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) admin@lincshouse.com Lincolnshire House Association Belinda Samantha Jane Parrington Care Home 31 Category(ies) of Physical disability (31) registration, with number of places Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the home can only accept the specified service user HC with mental health needs. 14th February 2005 Date of last inspection Brief Description of the Service: Lincolnshire House provides accommodation for 31 adults with a physical disability in several individual purpose built bungalows. The most recent being opened in March 2002. All the bungalows are furnished to a high standard and are self contained incorporating appropriately adapted kitchens, dining rooms, lounges, laundry and bathrooms. All bedrooms are for single occupation with 24 of these having en suite facilities. The remaining 7 bedrooms have a wash hand basin in the room. Particular attention has been given to provide adaptations such as overhead tracking, portable hoists, automatic bathroom lighting, automatic key coded entrance doors and extra wide door access all promoting individuals independence. A new building is being erected in the grounds to replace the old education block, it is intended that the building will be used for educational classes and social events. The grounds are well maintained and fully accessible to wheelchair users. CCTV has been installed to monitor the entrances of the premises for security purposes. The home is close to local amenities and the town centre of Scunthorpe. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Tina Bettison carried out the announced inspection of Lincolnshire House on the 20/9/05. The term resident is used throughout this report, as this is the way in which the people who live at Lincolnshire House prefer to be addressed. Staff files and care records were examined. Rotas, staff lists and training records were examined. Managers, staff and residents were spoken to, a tour of the premises was undertaken and care practices and interactions were observed during the inspection. What the service does well: What has improved since the last inspection?
The home has improved the ways in which they employ new staff. When new staff apply for a job at the home, the company now get references and check with the police that they are safe to work with service users thereby ensuring that service users are protected. Each resident living at the home now has a plan, which guides staff on how their needs could be managed and includes important information, which would help staff to provide quality care.
Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 6 Staff are now receiving training in specific disabilities, this will help them to do their jobs properly and be able to meet residents needs. 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. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 the following standard(s): 2 Residents needs and individual aspirations are thoroughly assessed ensuring that staff are given enough background information in which to develop detailed care plans and therefore meet the residents needs. EVIDENCE: There had been no new admissions, in the last 4 years. All residents currently living at the home had been admitted through social services. In the care files examined by the inspector all contained a copy of the social services assessment and care plan. However the manager informed the inspector that they had not been received for all residents although requested, however the home and staff team are well aware of residents needs. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 the following standard(s): 6,7,9 Residents are involved in the preparation of their care plan and therefore know that their specific needs and goals are included. Residents that display behaviours that pose a risk either to themselves or others do not have behaviour management guidelines to evidence that they or their representatives have agreed to any limitations on facilities, choice or human rights. Residents are supported to take risks as part of an independent lifestyle; any areas of risk were clearly documented. EVIDENCE: Three care files were examined as part of the inspection process and had been developed to cover all aspects of the residents needs. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 10 Risk assessments were in place for any areas that posed a risk and measures put in place to minimise the risks, i.e. personal safety, road safety and leisure activities. Residents are encouraged to be involved in the development and review of risk assessments. Some of the residents are on occasions difficult to manage and may at times pose a risk to themselves and others. Where residents exhibit behaviours that are difficult to manage those risks must be assessed, guidance from appropriate professionals obtained and behaviour management guidelines drawn up to ensure a consistent approach. Key workers were allocated if the residents wanted one. Some of the residents spoken to did not want a specified key worker, those who had a key worker knew who that person was. Details of a local self-advocacy group was available to service users’. All residents were enabled to be as independent as possible this was confirmed by taking to staff and residents. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: None of these standards were assessed at this inspection. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Resident’s physical and emotional needs are met, by the provision of a wide range of healthcare professionals and outside agencies. Residents are encouraged to manage their own medication where possible and supported with this when required, however the staff still need to undertake training. EVIDENCE: Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 13 The philosophy of the home was observed to be very relaxed and informal and staff appeared to be sensitive to the residents needs and responsive to requests. Care files examined demonstrated that residents had their health needs monitored and recorded and if problems were identified appropriate referrals were made. All residents were registered with a GP of their choice. Residents were supported to have regular check-ups with their GP, dentist, optician and chiropodist. They could get support to access community services or have visits take place at the home. Care files showed that support from health professionals was obtained on behalf of the resident where required, for example speech therapist and dietician. Residents informed the inspector that they could choose their own clothing, hairstyle etc. Choice on getting up and going to bed was down to the individual’s preference. The inspector saw that technical aids were provided to ensure that residents had maximum independence such as electric wheelchairs, automatic door opening and closing, and movement sensitive lights in their own rooms. A key worker system was in place unless a resident had requested not to have a key worker Some of the staff have received training in the administration of medication however not all, therefore this remains an outstanding requirement. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 22,23 Residents are listened to and their views acted on by a wide range of methods. Lincolnshire House has a robust complaints procedure that all residents were aware of. Strategies are in place to ensure that Residents are protected from abuse, neglect and harm EVIDENCE: Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 15 The home’s complaints policy was displayed and it gave details of how to refer a complaint to the CSCI and included timescales for response. The home’s record of complaints was inspected. The home had not received any complaints since the previous inspection. Regular residents meetings gave residents the opportunity to raise any concerns or complaints. The home had a copy of the multi agency guidelines for the Protection of Vulnerable Adults (POVA) and an in house policy/procedure. Since the previous inspection the in house policy/procedure on the prevention/detection of abuse had been reviewed and amended in respect of alerting, referral and investigation so that it links in with the multi agency guidelines and the majority of staff had attended the Protection of Vulnerable Adults (POVA) training provided in house. New staff were told about POVA during induction and foundation training and staff completing NVQ 2 and 3 in care also covered POVA. The home had a whistle blowing policy that referenced the Public Disclosure Act 1998. The home had policies and procedures in place regarding the managing of residents’ finances. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 the following standard(s): 24,30 Residents live in safe and well-maintained individual bungalows that are of a very high standard. Residents are provided with ample individual and communal space. All residents have a single room and the majority have en suite facilities. EVIDENCE: The home was located close to local amenities including shops, college and leisure facilities. It was in keeping with the surrounding area as the street had many different styles of residential properties. The bungalows offered enough space to accommodate domestic style furniture and leave ample space for wheelchair users to move around freely. The premises were accessible to all residents with corridors and doorways being widened to provide easy access for wheelchairs. Planned maintenance and renewal was on a four year cycle and as a need was identified. The home employed a gardener/handyman. The home was clean and free from offensive odours throughout. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 17 The home employed domestic staff, however the residents themselves could choose to keep their own bungalows clean with assistance if required. Laundry facilities were provided in each bungalow, again giving residents the option of doing their own laundry should they choose. The washing machines and tumble driers were of a domestic nature. The washing machines had a 95°C wash programme. A policy was in place regarding infection control and dealing with spillages and all staff had recently completed training in infection control. A sluice was provided in one bungalow. CCTV in the grounds and security lighting were in place in order to ensure the security of the premises. Since the previous inspection work had commenced on building the education block in the grounds. Attention to Health and Safety was paramount and residents explained to the inspector of how their access around the grounds had been restricted and why. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 The staff team at Lincolnshire House is on the whole a long standing, well established team, thereby leading to stability and consistency in the provision of care and support to meet residents needs. EVIDENCE: From examination of records, discussion with staff and observation it was evident that staff work to support the written aims and objectives of the home. It was also evident from discussion with staff that they knew how to meet the needs of residents and there was good evidence in care files of the involvement of other agencies with specific expertise. There had been 5 new staff appointments since the previous inspection, from examination of staff files it was evident that recuitment practices had improved, all staff had a satisfactory CRB disclosure and copies of application forms and references were all evident on files. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 19 Training records evidenced that staff received all mandatory training including fire safety; moving and handling; food hygiene, first aid, health and safety and infection control, the majority were up to date. In addition the home provided training specific to the needs of the service users living at the home such as epilepsy; diabetes; peg feeding, use of hoists and slings and foot care, knowledge of disabilities and specific conditions of residents and dealing with difficult behaviours/conflict. Out of 40 staff, 18 staff had achieved NVQ level 2. The home is working towards the requirement of 50 of care staff holding NVQ 2 or above by December 2005. Staff were observed to respect residents and were approachable and motivated. The manager informed the inspector that new staff were completing the home’s own induction which meets the LDAF standards. Regular supervision and annual appraisal gave staff the opportunity to identify any training needs and was provided as appropriate. Staff received at least five paid training days (pro-rata) a year. The home did not employ any staff under the age of 18. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, Lincolnshire House is an organisation that is well run and managed from the board of trustees to the staff team, with a wide range of policies and procedures that are regularly reviewed and monitored which promote residents rights and best interests. EVIDENCE: The home has a new responsible individual and registered manager who has been registered with the CSCI. The new manager has nearly completed her NVQ level 4 in care and has a wealth of management experience. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 21 The manager had started the development of a formal quality assurance/ monitoring system. Residents surveys had been undertaken, however it needs to evidence that the views of families, friends, advocates and stakeholders in the community have been sought on how the home was achieving goals for residents’. The home had an annual development plan. Requirements for further development of the formal quality assurance system remain an outstanding requirement. Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 4 x x x x x 4 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 2 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Lincolnshire House Score 4 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x x x DS0000002909.V251459.R01.S.doc Version 5.0 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement The registered person must ensure that individual plans are reviewed at least 6 monthly and amended in light of changing needs. The registered person must ensure that where residents display behaviours that are likely to cause harm to themselves and/or others, that a behaviour management plan is put in place that all staff understand and follow. The registered person must ensure that all staff who deal with residents’ medication undertake accredited medication training. (Timescale of 1/6/05 not met, timescale extended) 4 YA39 24 The registered manager must further develop the quality monitoring system seeking the views of residents’ and seeking the views of family, friends, advocates and stakeholders in the community on how the home is achieving goals for residents’.
DS0000002909.V251459.R01.S.doc Timescale for action 20/09/05 2 YA6 13(6) 31/12/05 3 YA20 18 (ac) 31/03/06 31/03/06 Lincolnshire House Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lincolnshire House DS0000002909.V251459.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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