Inspection on 01/05/08 for Lindisfarne

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindisfarne 16/11/07

Lindisfarne 02/06/06

Lindisfarne 01/12/05

Lindisfarne 15/07/05

Lindisfarne 03/12/04

Lindisfarne 22/09/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Lindisfarne Greenvale Court Frizington Cumbria CA26 3SZ Lead Inspector Liz Kelley Unannounced Inspection 1st May 2008 10:00 Lindisfarne DS0000022679.V365243.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 Lindisfarne DS0000022679.V365243.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. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindisfarne Address Greenvale Court Frizington Cumbria CA26 3SZ 01946 813402 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) griffinclse@walsingham.com www.walsingham.com Walsingham Miss Pamela Brannon Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of LD (Learning disabilities) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 16 November 2007 Date of last inspection Brief Description of the Service: Walsingham are the Registered Company for Lindisfarne. They have similarly registered homes in Cumbria and throughout the Country. Lindisfarne is located in the village of Frizington on the West Coast of Cumbria. There is a large enclosed garden and patio area. Car parking is available and there is level access into the home. Lindisfarne is on a lower level to the nearby residential court of flats and houses and the incline to the home is graduated. Accommodation is on one level and the corridor and door entrances are designed for people who may use wheelchairs. There is a kitchen, dining room, lounge, office and utility room, with private bedrooms situated off the two corridors leading from the entrance hall. Toilets and bathrooms are specially equipped and designed. The current scale for charging is £563.32 per week. A Handbook is available for prospective residents, and the latest Commission for Social Care Inspection report is made available on request. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an inspection where all the key areas of the National Minimum Standards were assessed, after the last inspection of the 18th November 2008 where concerns were raised about the quality service. Residents, and their families, and members of staff had given their opinions regarding the home to Commission for Social Care Inspection (CSCI). These comments, and the observations made by the inspectors, Liz Kelley and Nancy Saich, have informed the judgements made in this report. We also: • Received questionnaires from professionals and other people working with the home • Interviewed the manager and spoke with staff • Visited the home, which included examining files and paperwork • Received a self-assessment report/questionnaire from the manager. At this inspection it was judged that the manager and staff had made progress in meeting the shortfalls identified at the last inspection. Three relatives replied to our surveys and all were complimentary on the care their relative received, only one referred to the problems of staff shortages. What the service does well: For over ten years the staff team had provided a stable home and a good quality of life to people who had previously encountered a much more institutional style of care. Last year saw changes which has put the service under strain, and the staff team are working hard to meet these challenges and ensure they offer care that is safe and meets individuals needs. One relative said “ We visit every week and should we have any concerns regarding the care they are quickly dispelled. During the 10 years that Lindisfarne has been open we have found that the staff have been most helpful and caring” The staff team provide a comfortable home and have established good links with the local community, which is benefiting the lives of people living here. Another relative said “ The staff treat the residents with respect at all times and provide an excellent service to enable them to have a good quality of life”. Relatives reported that they are always kept informed of important matters. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 6 The home is good at seeking guidance from other professionals in the best ways to support people. What has improved since the last inspection? What they could do better: At the last inspection it was recommended that the manager and senior staff would benefit from training in carrying out pre-admissions assessments to determine whether people’s needs can be met by the home. This has yet to be arranged, and we further recommended on this inspection, that paperwork be devised to help managers ask the right questions and ensure they have all relevant information from all sources before admitting people to the home. Good practice would also recommend that this includes nutritional assessments, and that these are on-going as the need arises. This is important which for this home where a number of people have complex nutritional support needs. The manager would need training in this area to ensure peoples dietary needs are being met. Care plans give more detail to staff on how to care for individuals with more complex needs, particularly about strategies of how to manage challenging behaviours. The whole staff team need training on complex behaviours and Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 7 how to keep people safe when their behaviour is challenging. This must be done following good practice guidelines using a fully accredited trainer. This should be in addition to any training and strategies worked out for individuals in the home for crisis management. In this home there should be significant investment in this type of training, which currently is not happening. The service must ensure that all staff who administer medicines are trained and assessed as competent in the safe handling of medications. Again this is in addition to any training on the dispensing system used in the home, and is usually an accredited training course. The manager needs to use quality checking measures to keep on top of important areas in the home such as reviewing care plans to ensure they are meeting changing needs. Currently no quality audit system is in place and this leads to important areas being over looked, for example not all staff have had the required number of fire instruction up dates and training, and as all staff take it in turns to sleep over this could potentially put people at risk. Managers of Walsingham run care homes do not have additional hours to carry out managerial and administration tasks and this could be a contributing factor to why these areas where judged as poor at the last inspection. We advised the manager to use CSCI website for links to good practice to help her improve the home. The home would benefit from the manager producing a Development plan to help with the direction and care to be offered in future, this should link into a Business Plan that sets out how this will happened and be funded. Walsingham does not have a dedicated Training Officer, which many organisations of a similar size do, and this could be the reason for so many gaps in training being identified and many managers having to source their own training, which is time consuming and not effective use of their time. 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. Lindisfarne DS0000022679.V365243.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 Lindisfarne DS0000022679.V365243.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 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff have not received training or guidance on pre admission assessments and therefore, new people referred to the home are not properly assessed and the home may have difficulty meeting their needs as a consequence. EVIDENCE: At the last inspection we judged that new people referred to the home had not had a full assessment that was carried out and recorded by the manager or home’s staff. At this time one person was referred to the home when it was seriously understaffed, and the need for a high level of supervision had been stressed by a number of professionals to the home in order to keep this person safe. Staff also reported that they did not have the training to be able to meet the needs of the new people and consequently the staff team are struggling to do so. They had also failed to properly consider the compatibility issues with other people already living in the home. The home previously had a group of people who were middle to old age who had lived together for over 10 years. They had been judged by CSCI on previous inspections to be meeting their needs Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 10 well. The age range now is from very young adult to old age and the ability of staff to meet the range of needs is severely compromised. The practice for admitting the latest people into the home, as judged at the last inspection, was putting people at risk. As the home has had no new admissions since the last inspection it is difficult to gain a clear picture on how they would do this now. However, it was recommended at the last inspection that the manager should develop an assessment process and receive training in carrying out assessments. This has yet to be arranged, and we further recommended on this inspection that a set of tools and paperwork be devised to help managers ask the right questions and ensure they have relevant information from all sources before admitting people to the home. Good practice would also recommended that this includes nutritional assessments that are on-going as the need arises, which is essential for this home where a number of people have complex nutritional support needs. The manager would need training in this area to ensure peoples dietary needs are being assessed and met. In future the manager must carry out a full needs assessment which takes into account the specialist care the person requires and the skills, knowledge and training of the staff team in order to ensure the well-being of all people living in the home. The homes Statement of Purpose was examined and found to be out of date, as it contained staff who had left the home sometime ago while not containing details of new staff members. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s care plans have improved and are being developed in a more person centred way to make sure they are more individualised and give clearer instructions to staff on how best to support people. EVIDENCE: Care plans have benefited from a review, and clearer instruction are now written down for staff on daily routines, personal care for each person and how to keep people safe. As well as this care plans, health care plans and general residents paperwork has been up-dated and they are now stored in a more orderly manner with important instructions for staff such as risk assessments being given a higher profile and more readily accessible. The staff team are now on track to develop all plans in a more person-centred way. This was demonstrated by care plans now being written in the first Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 12 person, which is good practice, and a large volume of written material was examined on flip charts developed by a whole team event to write up one persons new plan with input from professionals and other relevant people. One professional reported at the last inspection that they felt the quality of life for residents could be greatly improved “through a more enabling, more structured and individual day programme”. While the person centred plans will help to provide a framework the home needs to be fully staffed to allow this to happen. There was now evidence to show that the manager was having a greater input into care planning, and that these are being reviewed much more frequently. This now needs to be developed and added into a quality audit check for the home’s running as a whole to measure and ensure the quality of the service. In light of the Mental Capacity Act the home needs to review the people living in the home with regard to their capacity to make decisions and set up support for those requiring an advocate to represent their best interests. The manager has recently conducted a very good piece of work following a recommendation from a CSCI Pharmacy Inspection which involved multidisciplinary decision-making with regards to the administration of medication. This now needs to be carried out for other areas of decision-making and detailed in each person’s care plan. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 13 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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s lifestyle choices are improving as staffing levels gradually increase and as people’s plans are made more personalised. However until these levels are resolved choice is still limited. EVIDENCE: Staff are working hard to cover shifts and to care for people living at the home as best they can and the problem of long-term staffing shortages and high use of agency staff is being addressed. Two new members of staff have been employed since November 2007 and another is due to start in the next couple of weeks. We saw records that describe the weekly activities in the home. People each have a different weekly programme of activities; most of these are based around attending a day service. There was an activities chart for all residents on the noticeboard and in files. Activities stated were - Pub, walk, MIND, inLindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 14 house pub night, swimming, art, craft. One person had no activities written in for three days of the week. Staff said they tried to go out for impromptu walks when staffing levels allowed. Staff are doing their best to be flexible and make the most of the opportunities they have to take people out on their own. This is summed up by a relative who said “I feel that under the circumstances the care home do a great job in making their lives as comfortable and varied and enjoyable as possible”. The following are examples where staff have helped people to make choices and promote more positive lifestyles: Two residents had just returned from their first holiday abroad accompanied by the manager and assistant manager. Another resident had been supported to maintain contact with his family who lived some distance away. Staff had helped with transport and provided hospitality during their visit to the home. Staff shortages and use of agency staff coupled with the dependency levels of residents mean that suitable activities are not always available. While people are offered a good basic diet that meets the general nutritional requirements of most people, some people in the home have more specialist dietary needs. Specialist advice is sought from dieticians, however the staff team should have knowledge of this area and receive training in how to carry out nutritional assessments and ongoing monitoring. Lindisfarne DS0000022679.V365243.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): 18,19, 20 and 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The monitoring and recording of healthcare has improved and is better coordinated. However, the management of more complex health and behavioural issues requires more in-depth training for staff to respond appropriately. EVIDENCE: Each person has a Health care plan, with the latest guidance from health care professionals. Based on information received from professionals, relatives, and observations of the staff, and also from the written records, people receive appropriate support to access the health services they require. Residents are registered with a GP of their choice and have access to other members of the Primary Health Care team. Other checks such as opticians and dental checks are also recorded on Healthcare files. Any personal care is delivered in resident’s own bedrooms and staff demonstrated that they are aware of issues of dignity and privacy. Interactions were observed between staff and residents and this was carried out in a sensitive and respectful manner. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 16 Management strategies for people have greatly improved, and one person’s plan detailed a step-by-step approach on how to defuse situations. Staff were observed working with this person in a measured way and in line with the guidance they had been given. Staff had also received advice from the Challenging Behaviour team on how to best to support people. Discussions with staff however, demonstrated that they were not up-to-date with the latest thinking in this area. Staff have not received accredited training in the use of physical intervention, and the organisation does not commission this type of training. They rely on crisis management input from the NHS Challenging behaviour team. This area of training requires significant investment by the organisation to meet good practice guidelines. The manager has identified that staff require training on dementia but further consideration is required on training needs and the general approach of the staff team to the needs of older people. This training need on dementia was identified several months ago and is yet to be actioned, and one person has lived in the home for this length of time with staff not yet being trained in this area. The Pharmacy Inspector, Angela Branch, carried out an inspection on the 2nd November 2007 - four requirements and three recommendations were made. She judged that quality in this area was poor. The full Pharmacist report is available on request from CSCI. Improvements made following this visit have included: ensuring that the administration of medicines in food or fluids is done only as appropriate, safely and in residents’ best interests; and a series of best interest meetings have been held with a team of professionals who have followed good practice guidance set out by the Mental Capacity Act. While staff have received training in the pharmacy system used in the home, staff also require training in the Safe Handling of Medications which usually entails an accredited training course. Once trained the staff who dispense medications need to have their competency checked from time to time. The senior on duty had not had this training and up until recently she had been given responsibility to carry out the ordering. On the whole the handling of medications was found to be satisfactory, a few minor errors where found in the handling of liquid medicines. The system could be strengthened by the introduction of quality checking or an audit. Lindisfarne DS0000022679.V365243.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): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. How people are kept safe is being handled in a more professional manner and increasing the likelihood that residents are protected and their well being promoted. EVIDENCE: Evidence indicates that referrals are now made to social services in a timely and appropriate manner. The manager and staff now have a better understanding of how to safeguard people from harm or abuse, and the majority of staff have undergone training in this area. The policies and procedures for safe guarding people have also been revised and updated and staff have had these explained to them in team meetings and supervisions. The organisation, Walsingham, have responded to criticisms of mismanagement in safe guarding people with an action plan to address these failings. A large part of this action plan was to ensure staff have training in safe guarding vulnerable adults. The training programme for the organisation was examined and this detailed dates of forthcoming Safeguarding training. The senior on duty had not yet received this training but when questioned was knowledable on the procedures she would follow following an allegation of abuse. She said that the staff team had been given instructions from her manager and senior managers of the organisation, and this had also been discussed in recent team meetings. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 18 Staff in the home are having to deal with more challenging behaviours and have been under pressure to protect other more vulnerable people in the home. Consequently, it is recommended that the current level of training in physical intervention is reviewed to assess what level of training staff now require in order to protect people in the home. Surveys returned by relatives all say they know how to make a complaint. One relative said “ We visit every week and should we have any concerns regarding the care they are quickly dispelled. During the 10 years that Lindisfarne has been open we have found that the staff have been most helpful and caring” Lindisfarne DS0000022679.V365243.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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, safely maintained home that meets their individual needs. EVIDENCE: The home has a good location in the heart of the community which leads to ready access to local amenities such as health centre, shops and pubs all within walking distance. The home is a purpose built bungalow and is well equipped for peoples needs, having specialist bathing aids and hoisting equipment. People’s individual rooms are well furnished and decorated to their own preferences. On the day of inspection the home was orderly and clean, and a cleaner was busy attending to individuals rooms and one resident was helping to put laundry away. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 20 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 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s staffing shortage has improved which should lead to more quality time being spent with people living in the home. EVIDENCE: The home has a core group of experienced staff, and health care and social services staff report that they listen to advice and provide good care to residents. This staff team has provided care to all but 2 new residents, for over ten years and a strong bond and relationships have been formed. This was recently highlighted by the death of two long-standing residents and this was reported as an upsetting time for staff. Although the staff team were judged to be hardworking and did their best to provide a good level of care to people this has been seriously affected by staffing shortages and the high use of agency staff. The high reliance on agency staff is now around 35 hours per week and not 80-100 as at the last Inspection. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 21 The organisation is looking to develop its own bank staff team to eliminate the use of agency staff altogether in the longer term. A number of professionals reported that they recognised that the home was under staffed. “Given the available resources I think the staff do a tremendous job under difficult conditions” “poor staffing levels mean that, unfortunately they cannot fully meet clients needs” and another said “ I believe a higher staff/client ratio would make a vast difference to the clients quality of life by possible enabling a more structured individual day programme for service users”. The home has been running for the past year with 3.5 members of the staff team down, this has now improved to the position that only one more staff member is required for full staffing levels. A barrier for recruiting new staff was identified as the processes employed by the central Walsingham HR office based in London and co-ordination between the regional office and the home. This has been rectified by a series of measures, including a recruitment drive that has included open days and radio programmes. Managers in Walsingham services now reported a turn around of 4 to 6 weeks from application to start date, this had previously been up to several months. Walsingham have introduced these measures without compromising the thoroughness and careful vetting procedures required, which was tested out by checking staff files and interviewing new members of staff. While staff report that they feel supported by the manager formal staff supervision sessions are not consistent or regular, and do not always focus on practice and development issues for each staff member. The manager needs to ensure these take place regularly, focus on quality and care issues and are stored in a more orderly fashion. The same applies to individual training plans, which need to be more orderly and the home needs an overall training profile and plan for the home. This will assist in identifying gaps in training and when courses need renewing. Staff reported that they had been provided with a range of training courses to assist them in working with people with learning disabilities. One newer member of staff reported never having had so much training before, while another more established team member had crucial areas of training missing. Training in meeting more specialised care needs is gradually being provided, for example the staff team all reported a need for training in dementia care and autism at the last inspection. Since then a number of staff reported attending autism training that had helped them in their work. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 22 The manager should be given support and resources to provide this training to the staff team. The staff team have received training in person-centred planning and are trying their best to put his into practice. The expectation from the DfES and DH guidance regarding interventions with people who have learning disabilities or autistic spectrum disorders is that training should normally be ‘provided by trainers who are accredited under the British Institute for Learning Disabilities (BILD) Code of Practice on ‘Training Staff in the use of Physical Interventions’. And as mentioned earlier in the report this area of training requires significant investment by the organisation to meet these good practice guidelines. Many areas for improvement highlighted in this report are around training gaps e.g. safe handling of medications, nutritional assessments, admission assessments, physical intervention training, and dementia care. The organisation needs to have a training plan that meets the needs of staff and the changing needs of service users, in a planned and targeted way. A dedicated training budget, and designated person with responsibility for the training and development programme should control this area, as recommended by the NMS. This should lead to a training needs assessment carried out for the staff team as a whole, and an impact assessment of all staff development is undertaken to identify the benefits for service users and to inform future planning. Consideration should be given to providing a more co-ordinated approach to training, and as with many other providers of this size, thought given to a training officer role to ease pressure off managers arranging and sourcing their own training. Staff reported that they had received good support from the manager and examination of supervision records demonstrated a good format for discussions and the required regularity of these sessions. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 23 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has improved recently but more checks and audits are required to ensure that a quality service is being offered to people living at the home. EVIDENCE: The manager is qualified in care and in a managers award, as set out in the national minimum standards (NMS) to run the Home; she is aware of and works to the basic processes set out in the NMS. However more in-depth knowledge would be beneficial on good practice guidance issued by CSCI and other professional bodies, for example Key Lines of Regulatory Assessment and Guidance logs. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 24 The manager is aware of the need to keep up to date with practice and to continuously develop management skills, but often finds it difficult to either attend courses or to source relevant courses to up-date her skills. This is highlighted by the need to have training in assessments and nutritional assessments and to find appropriate training for her staff, e.g. in safe handling of medicines course. This is not helped by the manager having no set supernumerary hours to carry out any managerial or administration tasks. The organisation should review this situation to assist in the effective and safe running of services. The manager is starting to develop measures that monitor practice and compliance with the homes plans, policies and procedures. For example her input and checking of care planning was more in evidence on this visit. More work is needed in this area. As mentioned at the last inspection, Quality Assurance monitoring is not effectively implemented as a core management tool. For example this would help to identify gaps noted by Inspectors in fire training and Practice drills. As not all staff had received up-to-date training a requirement is made to ensure this happens especially as all staff at some point sleep over in the house, and are in charge in the event of a fire. Individual risk assessments had been carried out in good detail for each person in the home and how they were to be supported in the event of a fire. The home does not provide a qualified first aider for each shift. They need to carry out an assessment to determine if this is necessary or not and make this assessment available to CSCI. Many of the home’s policies and procedures also require up-dating, and certain key policies should be kept under constant review depending on the changing needs of people living at the home. For example three of these key policy’s Physical Intervention, Dealing with Violence and aggression and Safeguarding Adults were last reviewed on the 8.2.04. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 25 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 2 2 2 3 2 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 2 2 X 2 X X 2 x Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 YA33 Regulation 18 Requirement Timescale for action 30/07/08 2. YA20 18(1)(2) 3. 4. YA42 YA35 23 18 The registered person must ensure that at all times suitably qualified, competent and experienced staff are working in the home in sufficient numbers to meet the needs of residents (Carried over from 31/12/07) Staff that handle medication 30/07/08 must be suitably trained in the services medication policy and must receive training in safe handling of medication with assessment of competence in order to protect residents’ health. (Carried over from 01/04/08) All staff must receive fire training 30/05/08 and instructions on a regular basis to keep people safe Staff must be trained in physical 31/08/08 intervention and challenging behaviour strategies by an accredited trainer in line with British Institute of Learning Disabilities guidelines. Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 27 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 manager should use a needs assessment tool to record and analyse if they can meet the needs of new service users, in addition to any other assessment received from other sources. Each person should be assessed by a multi-disciplinary team to determine capacity to make decisions under guidance from Mental Capacity Act 2005, and if appropriate an advocate found to represent people. Specialist professional advice for healthcare or behaviour management should be documented and clearly laid out in care plans and risk assessments for each individual. An assessment should be carried out by a qualified trainer to determine the level of physical intervention training required to keep people living at the home safe. Staff require specific training on autism and dementia to meet the needs of residents. The manager should undertake an assessment to determine the level of qualified first aiders required in the home, as described in the CSCI Guidance Logs. 2. YA7 3. YA19 4. YA23 5. 6. YA35 YA42 Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Lindisfarne DS0000022679.V365243.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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