Inspection on 10/01/06 for Lisburne

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lisburne 17/10/08

Lisburne 23/10/07

Lisburne 16/05/06

Lisburne 15/08/05

Lisburne 02/03/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Lisburne 36-38 Church Hill Honiton Devon EX14 8DB Lead Inspector Susan Lyons Unannounced Inspection 10th January 2006 10:20 Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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 Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lisburne Address 36-38 Church Hill Honiton Devon EX14 8DB 01404 42364 01404 42364 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) Devon Partnership NHS Trust Paula May Allen Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users must be in the age range 21-50 years This variation allows one named person aged over 50 to remain in the home The maximum number of placements including that of the named person will remain at 6 That on the termination of the placement of the named person the registered person will notify the Commission and the particulars and conditions of this registration will revert to those held on the 8th November 2002 The manager must complete the NVQ level 4 in management and care by April 1st 2006. 15th August 2005 5. Date of last inspection Brief Description of the Service: Lisburne was originally two semi-detached modern bungalows, now converted into one large property. The home is situated in a residential area, near to the railway station and within walking distance of the centre of Honiton. The home cares for younger adults who have a learning disability, autistic spectrum disorders, are highly dependent, and with challenging behaviours. Accommodation for residents is provided in six single bedrooms. There are two lounges. There is a separate dining room. There is a garden at the rear of the property and some parking on site. It has nothing to distinguish it as a residential home. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspectors arrived at the home at to do this unannounced inspection at 10.30am. Two residents were away from the home but the inspectors were able to meet the other four residents. It is not possible to obtain verbal information from the residents therefore the inspectors looked at written records spoke to staff and watched what was happening in the home. There was a relaxed atmosphere within the home. Two inspectors undertook the inspection at this home, Susan Lyons and Rachel Doyle. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that sufficient detail is included in the care plans to enable all staff to work in the same way. Staff need to be conscious of the fact that residents need to be offered choice and to be aware of the ways in which this can be done. There still remains a lack of stimulating activities offered to all residents. Although staff are able to give acceptable answers in relation to the Protection of Vulnrable Adults not all of them have received training or seen the ‘No Secrets’ video. There is an unpleasant odour in one of the bathrooms despite it being redecorated and the floor being sealed. During most of the time the inspectors were in the home it felt cold and as the heater was on a timer heat was not available all the time. Some staff require training in the administration of medication and/or the administration of invasive Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 6 medical procedures. It was noted that a designated fire door was held open by a stool and the fire alarms have not been tested weekly. There is one bedroom radiator which is uncovered. 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. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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 Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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): This core standard was assessed on 15th August 2005 EVIDENCE: Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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 Lack of detail in care plans means that staff are not adequately provided with information to consistently meet residents’ needs. Residents are not able to consistently exercise choice. EVIDENCE: Care plans were looked at for all residents. Some of the care plans require more detailed information in particular this relates to how personal care is to be provided and communication. It was noted that on one care plan a sensory integration programme is detailed which says it needs to be undertaken twice a day. There was no evidence of this happening and when questioned, one member of staff said they understood this had been discontinued. There were also speech and language assessments on some files which indicated that residents should have specific communication systems set up for them, staff were unaware of this and there was no evidence to say that anything had been done. Some long and short term goals are not dated. In some cases a need has been identified but there is no detail of how this is to be met. It was felt that there needed to be a care plan in relation to tissue viability for one resident but there was not one in place. Care plans are well presented with photographs of staff included but it was established that of the four staff photographs on one care plan three of the staff had left. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 10 Whilst it is acknowledged that it is difficult to establish what choice many of the residents are making there it is little evidence to suggest that staff are trying to do this. Two of the staff who spoke to the inspectors did not appear to have given much thought as to how they may achieve this. However one member of staff was able to describe how he offered choice to his key client and seemed very aware of the residents specific needs as an individual. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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 & 16 Residents lack stimulation and variety due to the lack of activities within the home. Privacy and dignity of residents is understood and respected. EVIDENCE: It was noted from the daily recording that for many of the residents there is a lack of stimulating and meaningful activities provided. Some residents go out for a drive on a regular basis but this often seems to be the only activity on offer. On the day of the inspection two residents were away from the home, one resident was at a day centre and one resident went food shopping with two members of staff. The remaining two residents who are unable to mobilise independently were left in the home with a member of staff. One resident was in the same chair with nothing to occupy them for the whole morning a second resident was in the bedroom all morning listening to music. The inspectors noted that for approximately two hours nobody checked to see if this resident needed anything. Eventually the resident was taken to sit in the doorway of the kitchen to watch the meal being prepared. Staff told the inspectors that they had been informed at induction of how to maintain residents privacy and dignity and they were able to give examples of Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 12 how this would be achieved. Details were seen in a care plan of the preferred name by which a resident wishes to be known. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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): 19 Residents are protected by systems which monitor their medical needs. EVIDENCE: Evidence was seen that residents health care is being monitored on a daily basis and where areas of concern have been noted action has been taken in a health care appointment. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 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): 23 Service users are protected by the adult protection procedure but lack of staff awareness of adult protection may compromise this. EVIDENCE: Not all staff have received training in the Protection of Vulnrable Adults or watched the ‘No Secrets’ video. This was a recommendation following the last inspection.However all staff were able to answer appropriately in relation to reporting incidents of concern. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 15 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, 25 & 30 Residents live in a well decorated home however attention is needed to ensure that heating is consistent throughout the home and standards of hygeine are maintained. EVIDENCE: Throughout the morning the inspectors felt that the home was cold. They checked the boiler and it appeared that the heating was turned off. The majority of the residents within the home are unable to say whether they are cold and some of them are unable to move around unaided. The staff said they thought the heating was on a timer and when it was on, it was very hot. An immediate requirement was issued in respect of this. On the day of the inspection the home was in the process of being cleaned. It was noted that there was an unpleasant odour from one of the bathrooms. This room has recently been redecorated to seal the walls and floor to try and elliminate this problem. Staff said that they understood that the room was to be changed into a ‘wet’ room which was felt would meet the needs of residents more. The home does suffer quite a lot of damage to the interior furnishings and decorations due to the needs of residents. However staff have made an effort to decorate individual rooms in a way which will capture the imagination of the individual resident by using stencils posters etc. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 16 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 & 35 There is a commitment within the home to staff training but residents are potentially at risk due to lack of training in specific areas EVIDENCE: It was not possible to establish how many staff overall have gained NVQ level 2 or above but one of the staff who spoke to the inspector said that she was over half way to completing NVQ level 3. In relation to other training it was noted that staff who administer medication have not all received training in this, one member of staff who spoke to the inspector also needed to update her training in relation to invasive medical procedures. A recommendation was made in relation to this following the last inspection. Records indicate that other core training is being kept up to date. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 17 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, 41 & 42 The health, safety and welfare of residents is not protected by the systems currently in place. EVIDENCE: The registered manager is currently undertaking NVQ level 4 and the registered managers award. It is a condition of registration that these are completed by April 2006. A requirement has been made on the last four inspections that the quality of care is monitored and an annual development plan produced, a copy of which is sent to the commission. This remains outstanding. Records, which need to be maintained in the home were not assessed on this occasion. However it was noted that the rota indicated that the manager was on duty, whilst in fact she is currently supporting a resident away from the home. Another manager is spending three days a week at the home but apart from the deputy manager the other staff did not know when he would be there as it was not marked on the rota. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 18 It was noted that the fire alarms are not being tested on a weekly basis. This was a requirement following the last inspection. An immediate requirement was issued in relation to this. It was also noted that a designated fire door was held open by an inappropriate means. An immediate requirement notice was issued in relation to this. It was noted that the cleaning materials are stored in the laundry which although it had a lock on the door the key was in it and was therefore accessible. An immediate requirement was issued in relation to this. It was noted that all the radiators are covered apart from a second one in a bedroom which is against a bed. This needs to be covered if it is to be used. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 19 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 X 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 X 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X 3 X 1 X 1 1 X Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 20 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 2 Standard YA24 YA24 Regulation 16 (2) (k) 23 (2) (p) Requirement You are required to ensure that the home is free from unpleasant odours You are required to ensure that a comfortable temperature for all residents is maintained within the home at all times You are required to establish and maintain a system for reviewing and improving the quality of care and introduce an annual development plan. A copy of which be sent to the commission. (Timescale of 3110-04, 30-6-05 & 31/10/05 not met) You must ensure that the rota reflects who is actually working. You are required to ensure that the fire alarms are tested weekly. (Timescale of 16-9-05 not met) You are required to ensure that fire doors are only held open by appropriate means You are required to cover the radiator in the identified bedroom. You are required to ensure that all cleaning materials are kept DS0000021967.V276289.R01.S.doc Timescale for action 13/01/06 13/01/06 3 YA39 24 (1) (a) (b) 10/02/06 4 5 YA41 YA42 17 (1) (2) 23 (4) (c) 10/02/06 13/01/06 6 7 8 YA42 YA42 YA42 23 (4) (c) 13 (4) (c) 13 (4) (c) 13/01/06 10/02/06 10/02/06 Lisburne Version 5.1 Page 21 locked away when not in use. 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 2 3 4 5 Refer to Standard YA6 YA7 YA12 YA23 YA35 Good Practice Recommendations It is recommended that more detail is included in care plans. It is recommended that residents are offered more choice. It is recommended that residents are offered a wide range of activities both inside and outside of the home. It is recommended that staff through either training or other means receive input in relation to Adult Protection It is recommended that staff who administer medication are trained to do so and that staff who administer invasive medication receive training in how to administer. Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Lisburne DS0000021967.V276289.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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