Inspection on 11/07/06 for Lingwell Approach

This inspection was carried out on 11th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lingwell Approach 06/07/07

Lingwell Approach 09/02/06

Lingwell Approach 22/07/05

Lingwell Approach 08/12/04

Lingwell Approach 18/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Lingwell Approach 14 Lingwell Approach Middleton Leeds West Yorkshire LS10 4TJ Lead Inspector Stevie Allerton Key Unannounced Inspection 11th July 2006 10:30 Lingwell Approach DS0000001475.V301355.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 Lingwell Approach DS0000001475.V301355.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. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lingwell Approach Address 14 Lingwell Approach Middleton Leeds West Yorkshire LS10 4TJ 0113 277 8517 0113 2778517 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) None United Response Mrs Jackie Campbell Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Lingwell Approach is a four bedroomed bungalow, purpose built to accommodate service users with multiple disabilities. It is situated in a fairly new development of mixed housing in the Middleton area on the southern outskirts of Leeds, with nothing to distinguish it from the other properties as a care home. The area is well served by local shopping centres, sports and leisure facilities, with good access via public transport from Leeds and Wakefield. The home accommodates up to four young women with learning disabilities and some physical disabilities, who may be wheelchair users. The property is managed by a housing association but the care service is provided by United Response, a national charity specialising in the field of learning disabilities. There is a new Manager in post, who has not yet gone through the registration process, and there is good line management support from the regional office in York. Current fees are £1,293.94 per week. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out without prior notification and was conducted by one inspector, accompanied by Sue Van Daatselaar from the CSCI Regional office in Leeds, as an observer. The inspection took place over one day, starting at 10.30am and finishing at 5.00pm. The Manager, Paulette Hamilton, was on duty and assisted the inspector throughout, along with other staff team members. The inspector would like to thank everyone who took the time to talk and express their views. Survey forms were sent out to a selection of health and social care professionals and two were returned. Parents of one of the service users was also spoken to by telephone. Before the visit, accumulated information about the home was reviewed. This included looking at any notified incidents or accidents and other information passed to CSCI since the last inspection, including reports from other agencies, such as the Fire Officer. This information was used to plan this inspection visit. The inspector case tracked two service users. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, the inspector assessed all twenty-one key standards from the Care Homes for Younger Adults National Minimum Standards, plus other standards relevant to the visit. The inspector spent time with identified service users and spoke to relevant members of the staff team who provide support to them. Documentation relating to these service users was looked at. Where possible, contact was also made with relatives and external professionals, to obtain their opinions about the quality of services provided at the home. What the service does well: The philosophy of the home places the service user at the centre of everything that happens and staff were seen to actively support individuals so that they are included in all aspects of daily life. The written plans of care are extremely detailed, outlining how the support will be delivered, which enables staff consistency. The system of induction training, shadowing established staff followed by observed practice, ensures that all staff know how to deliver appropriate support. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 6 New and existing staff have the benefit of a wide-ranging training plan, to equip them with the skills needed for the work they do, supported by a structured programme of supervision. The staff work well with other health and social care professionals to ensure that service users’ physical, social and emotional needs are met. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. The provider produces information for service users in a simple format and places are only offered following extensive assessment. EVIDENCE: Care files show thorough multi-disciplinary assessment process. Service user guide present in file, also contract. Service user information is provided in a format that can be more easily shared with individuals, including the use of pictorial symbols to illustrate points. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 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, 8 & 9 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. The staff team have a healthy approach to risk, demonstrating good awareness of the balance to be achieved between the duty of care to service users and supporting them to enjoy stimulating activities. Service users are supported to achieve their personal goals and to take an active part in all aspects of daily life. EVIDENCE: Two of the service users were selected for case-tracking, with a third person’s care notes also looked at, to test out specific areas such as the admissions process. Files were well organised, information being held in two files for each person (one for the care plans and one for risk assessments) and crossreferenced between them. Information is very detailed. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 10 Reviews are held regularly, although some planned 3 monthly reviews were overdue. Support workers have a role as key worker for named service users and it could be seen that they prepare material for reviews and are part of the planning process. There was evidence of multi-disciplinary discussion about restraint issues, surrounding people who go through periods of self-harming. The inspector was able to observe staff interacting with service users, offering choices and giving time for preferences to be indicated, by whatever method of communication was appropriate for that individual. Service users are actively involved in everything going on in their home, not just observing from the periphery whilst staff carry out tasks. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 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): 12, 13, 14, 15, 16 & 17 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. The philosophy of care promotes and reinforces rights and respect. Service users are supported to have a healthy and varied diet. Staff support service users to maintain whatever family contacts they have and to have an active presence within the community. EVIDENCE: Weekly activity sheets were seen in the service users’ care plan files. These show the activities that individuals are involved in on particular days, with staff assigned to support each activity. There are a wide range of activities, either around the house or in the community, including colleges of further education shopping, preparing lunch, doing laundry tasks, tidying & hoovering the bedroom, going for walks, listening to music, hand massage, foot spa, dance & self-expression, swimming and art. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 12 There have been concerns about weight loss, for one of the service users who was case tracked. Support had been received from a dietician, with advice about increasing calories. Suitable food-stuffs were seen in the fridge to support this regime. One service user has a PEG feed fitted. Two of the senior staff have had training in enteral feeding and can train staff in the correct procedures. Support plans are written in the first person, which reinforces each individual’s rights, encouraging them to make choices by the use of picture cards or objects of reference. Each service user has their own front door key, which their support worker takes with them when going out together. Parents contacted by phone confirmed that staff make efforts to maintain good communication between them and their daughter, keeping them informed by weekly telephone calls, for example. They were happier with the day-time activities their daughter currently has, feeling that she is much better with a one to one support worker than attending a large day centre. On the day of inspection she was out shopping during the morning with her support worker and was going away the coming weekend for a short break with 2 staff. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. Service users receive a high degree of personal support, which ensures their physical and emotional health needs are met. The staff team have a good depth of knowledge about how each person communicates, which enables them to continuously respond to changes in well-being. There are appropriate systems in place for the safe management and administration of medicines. EVIDENCE: Records show that personal support is tailored to each individual, with detailed support plans outlining how personal care interventions should be given. Information is passed on through the staff handovers at each change of shift, where changes in physical or emotional well-being are highlighted. One of the Senior Support Staff went through the medication procedure: ordering, storage, administration and recording were all carried out according to the home’s written policies and no deficiencies were observed. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 14 There was evidence in care plan files of referral to other health care professionals, such as Occupational Therapists for assessment for mobility equipment, or behavioural psychology support. There were good records of telephone contact with parents and others, which demonstrated the staff’s involvement of all relevant people in each individual’s care. Comments from one of the GP practices were positive, referring to a good working relationship with the staff regarding health care matters. There were detailed communication plans in place for those who were case tracked, along with a good Health Action Plan assessment tool. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. Information on complaints and adult protection is available in a form that can be used more readily with service users. Behaviour management plans and risk assessments take account of protection issues. EVIDENCE: Parents contacted by phone confirmed that they felt they could (and do) approach the staff if there are any problems. This had clearly been tested out, as one spoke of meetings that had taken place to talk things through and resolve issues before they became complaints. The Manager felt that it was important to take a pro-active approach with parents and other services, keeping an open dialogue so that concerns can be addressed at an early opportunity. Care records showed good levels of awareness of protection and restraint issues, with regard to self-harming behaviour. In discussion with staff, they were aware of whistle-blowing procedures and were to receive core training in September on POVA policies & procedures. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 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 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. Service users live in a safe, comfortable and well-equipped environment that meets their needs. EVIDENCE: The house has been re-carpeted and re-decorated over the past few months, providing a comfortable and well-furnished environment to live in. The house was clean & tidy; day and night staff do domestic tasks daily as part of their normal duties. All bedrooms are individually personalised to suit each service user. All mobility and pressure-relieving equipment was seen to be in place where needed. Some extra paving has been laid in the garden, providing a bigger area for service users to sit out in fine weather. Service and maintenance records were seen, demonstrating that mechanical equipment and systems are safe. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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, 33, 34 & 35 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. Staffing levels meet the needs of current service users. The staff team are supported by good training opportunities and structured supervision arrangements, which ensure they maintain good care practice. EVIDENCE: The inspector discussed the induction of new support staff with the Manager & Senior Support Worker. The induction process is comprehensive; checklists provide records of what has been demonstrated, observed practice and competence assessed. The checklist for competence is gone through for all four service users, so that everyone knows how to support each service user. LDAF (Learning Disability Award Framework) training has been completed. One of the Leeds colleges provides NVQ (National Vocational Qualifications) level 2 free of charge; three of the support staff have nearly completed this and hope to then go on to level 3. New starters go on to the next available course, held at the regional office training unit, for the mandatory training, such as moving & handling. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 18 Unfortunately this will not be due to take place until September so the Manager is trying to find free courses from other providers in Leeds. Staff rotas show that support is provided appropriately, both day and night. Supervision is set up to take place every 4 weeks. Staff records for new starters were seen on site – the majority of personnel information is held centrally, but the CRB disclosure number was present, as were copies of two written references. One support worker was spoken to, who had been in post for 8 weeks. She described the induction training, the shadowing of other support staff initially, to get to know each service user and how they need to be supported. She had already had training in Medication, Makaton, First Aid and Fire Safety. The staff team are a diverse group in terms of age, background and origin, but all are female to reflect the client group they support. Staff can access training in Equality and Diversity through the organisation, which runs a two-day course. The Senior SW on duty described the provider organisation’s Personal Development Plans: she has an annual plan which identifies what training needs she requires, for example she has identified IT skills as a need. In conjunction with her Manager, she will look for a suitable course, either provided by the organisation or externally. She has undergone a good range of management training to support her in her role as a Senior, including: Health & Safety Management, NVQ Level 2 in Team Leading, Supervision & Appraisal, Managing Resources & Conflict Resolution. The Manager feels that the staff team are good; they support each other and she can rely on the Senior Support Workers to promote consistency in her absence. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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, 38, 39, 40, 41, 42 & 43 Quality in this area is good. This judgement has been made using available evidence, including a visit to the home. Health and Safety is given a high profile and staff are trained in this area. There are good lines of accountability, which protect service users who have difficulty in getting involved directly themselves. The home uses a range of written policies and detailed procedures, in order to ensure that service users’ best interests are protected. The registration of the Manager would provide the consistency required for staff, outside professionals, service users and their relatives to have confidence that the home will continue to operate at a high level. EVIDENCE: The Health & Safety records contain all of the maintenance and repair information regarding hoists, the vehicle, pieces of equipment, etc. The Fire records show weekly tests taking place, as well as a monthly evacuation. The Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 20 Fire Officer’s report of Sept 2005 stated that all requirements were being complied with. There are extensive policies and procedures, held in files in the office, but made easier to use by the “route map” index, showing where to find policies on particular issues. Those that were sampled demonstrated the providers’ philosophy regarding inclusion, ensuring that all service users are supported so that they have equal opportunities in their everyday lives. The home’s Line Manager carries out quarterly audits in all areas of the service; basic audits also take place monthly, the home managers in the area auditing each other’s services. Service Managers meet every 3 months to discuss “The Way We Work” (the provider’s service standards manual), in order to promote consistency. Financial records were seen for service users; these appear to provide a clear audit trail of personal income and expenditure. Staff from the Human Resources and Finance Departments in York also do spot visits to ensure compliance with procedures. Service users’ parents made comment about the regular turnover of staff and how this continuous change can have an effect on individuals, having to frequently get used to new carers. There was a philosophical attitude towards this, the only area of criticism about the service, with a recognition that staff may seek advancement in their careers and move on. The current Manager has been in post now for 6 months and needs to apply for registration. Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 3 3 3 3 Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 22 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 YA37 Regulation 8 Requirement The appointed Manager must apply for registration with CSCI. Timescale for action 01/11/06 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 Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lingwell Approach DS0000001475.V301355.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!