Inspection on 16/05/06 for Lisburne

This inspection was carried out on 16th May 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 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 10/01/06

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 Key Inspection 16th May 2006 09:15 Lisburne DS0000021967.V288917.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.V288917.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.V288917.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.V288917.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. 10th January 2006 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. The fees for the home range from £500 to £998 per week. The manager of the home said that he makes the Commission reports available to staff by telling them that they are in the home and by discussing them with them. In the future he intends to send a copy of the report to all relatives of residents. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the past year the Commission has worked closely with the Adult Protection Team and Social Services in assessing whether the needs of the residents at this home were being safely met. Changes have taken place as a result. Additional funding has been put into place to enable one to one work with residents to take place and the previous registered manager of the home has returned to take over the management. At this inspection it was good to see that the staff were displaying a positive outlook to their work and were enthusiastic about the way in which the extra staffing has allowed them to work effectively with residents. This unannounced inspection took place at 9.15am and lasted until 4.20pm. Prior to the inspection surveys were sent to fourteen members of staff and seven were returned. A survey was sent to the GP surgery, which covers the home. A positive response was received. Telephone contact was made with an occupational therapist and psychologist. Positive responses were received from them. The speech and language therapist was also contacted but has not visited the home recently and is going to contact the inspector at a later time. Relatives who were visiting on the day of the inspection told the inspector that the home was perfect. There is limited verbal communication with residents therefore much of the inspection consisted of observation. What the service does well: The home is good at providing information about residents to maintain their safety and meet needs. The care plans are in the process of being updated and the home is being helped with this by other professionals. Residents are encouraged and supported to make individual decisions about their own lives in relation to what they wear and what they want to do. Residents access the local community in distances and places which individually meet their needs and the home is excellent in ensuring that residents maintain contact with relatives. Food is nutritious and varied and residents are involved in the choice and preparation of them. Support and healthcare needs are met in a way which meets the individual needs of residents and they are protected by the homes complaints and protection procedures which staff are aware of. Although the environment needs constant repair and attention there has been considerable effort put into meeting individual needs, which reflect residents’ interests. New developments taking place within the home will ensure that the maintenance of infection control and general hygiene of the home is good. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 6 Staffing levels are now good and there is a much more positive approach amongst the staff who recognise and celebrate achievements made by residents. They are committed to enhancing their training by attaining a recognised qualification and are able to put into practice what they have gained from other training courses. Recruitment procedures are good and the staff report that the manager and assistant manager are approachable. 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. Lisburne DS0000021967.V288917.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.V288917.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information received ensures that residents’ needs can be met at the time of admission. EVIDENCE: There have been no recent referrals or new admissions to the home. As the current residents have been at the home for some time they may not have had a copy of the shared assessment from health and social services at the time of admission. However the home is clear that for any new referral is made via social services they must obtain a copy of the shared assessment. This will ensure that the home has the information they need to meet any new residents’ needs. Lisburne DS0000021967.V288917.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good care planning and resident involvement in daily living ensure that resident’s needs are met in a consistent way. With minor additions risk management will be well maintained. EVIDENCE: Care plans were looked at as well as the daily records for each resident. They are in the process of being reviewed and currently one remains to be completed. New guidelines are also being developed with external professionals especially in relation to behavioural guidelines. Care plans detail the way in which staff should be working with individual residents and contain specific guidelines for behaviour etc. This ensures that staff are all supporting residents in the same way. Relatives who were contacted felt that residents’ needs are being met and care managers feel that there has been an improvement in the home. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 10 It is difficult to involve some of the residents in decision due to lack of verbal communication. Staff do try to involve residents in making choices which affect their everyday life. A member of staff was seen to show a choice of top to a resident, which he was to wear. Where residents have limited verbal communication staff have an awareness of when they are upset and happy and are able to tell when they do not wish to do something. Individual risk assessments are included in care plans and are also in the process of being reviewed. Action should be taken to minimise risk to residents regarding the bathroom doors which have recently had self-closures fitted to them. Staff are concerned that residents may catch their fingers in the doors. Lisburne DS0000021967.V288917.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): 12,13,15.16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good activities and community access enrich residents’ lives. Excellent support maintains relative relationships. Residents benefit from nutritious meals. EVIDENCE: Currently none of the residents are undertaking further education or employment opportunities. However, for four of the residents, Occupational Therapists have been involved in developing activity programmes to meet the individual needs of the residents. The inspector watched two sensory programmes taking place, one in relation to sound and one for touch. Residents were seen to smile and interact with staff who spoke to them in a calm and clear way. Staff feel that the work they have undertaken with residents within these structured activity programmes have also had a positive outcome on residents lives. They said they are more relaxed in each other’s company and enjoy going out. Evidence was seen that activities are being undertaken on a daily basis. The inspector spoke to one of the occupational therapists who has been involved in working with staff. She felt that there had Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 12 been positive progress since extra staffing hours have been made available and staff have time to undertake the activities. Residents use the local community according to their individual wishes and how comfortable they feel. On the day of the inspection one resident went out to assist with the food shopping and helped to push the trolley around the supermarket. Later the same resident went out again with another resident and staff. The home has its own transport available. One resident said that they had been to a local nursery and bought a plant and had a drink. The staff support residents to maintain links with their families and if needed will take residents to see relatives. On the day of the inspection one resident went to spend the day with his family and another resident received a visit from their parents. The inspector was told that residents’mail is given to them and staff offer support as required. Although keys are fitted to most of the bedroom doors only one resident is able to manage having their own key. The name by which residents wish to be called is recorded on care plans. The staff have made efforts to ensure that residents’ privacy and dignity have been maintained. For example curtains which get pulled down have special fittings and some windows have special covering on windows to maintain privacy. However it was noted that a lock was missing from one of the bathroom doors and this may mean that residents’privacy and dignity will not be maintained while they are using this room. One resident told the inspector that they are given a sheet to choose what they have for meals. These are menu sheets with pictures which have been developed with the speech and language therapist. Records indicate that varied and nutritional meals are provided. Residents also undertake some cooking. Lisburne DS0000021967.V288917.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): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health needs are met. With more attention to detail medication procedures within the home will protect residents. EVIDENCE: The home works with the physiotherapist in relation to how they support residents’ mobility and staff were able to describe some specific needs and how they had been addressed. Equipment such as hoists, wheelchairs and walkers are available for residents to help them move from place to place and a bell is situated outside the front doors at a height which can be reached from a wheelchair. Additional support is provided to residents from occupational therapists and speech and language therapists. Residents are supported by the home to access healthcare facilities within the community this includes visits to the GP, dental and optical appointments. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 14 The home uses a monitored dosage system of medication from a local pharmacy. Staff have received training and medication was stored correctly. It was noted that on two occasions medication had not been signed to say it had been administered. It was felt this was because the person administering the medication had forgotten to sign. There is a risk of medication being given twice if it is not signed for at the time it is administered. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 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 outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the complaints and adult protection procedures. EVIDENCE: The home has a complaints procedure which has been sent to relatives and a format in which to record any complaints made. None have been received since the last inspection. All staff see the ‘No Secrets’ video as part of their induction and are able to say what they would do if they felt that a resident was being ill treated. Residents will be protected by staff having this knowledge. One new member of staff has, as yet not seen the video as she has not yet completed her induction. On this occasion residents’ finances were not looked at. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 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 outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an individualised and clear environment. EVIDENCE: The internal fabric of the home needs on-going decoration and repair due to the damage it receives from residents. Staff have tried various ways of meeting residents individual interests whilst at the same time providing a comfortable place in which people can live and their needs are met. They have made use of stencils and murals to reflect individuality in bedrooms as well as sensory equipment. Furniture around the home is domestic in nature unless specialist equipment is needed. One of the bathrooms which has been difficult to keep clean and free from odour is to be stripped out and made into a wet room. Additional cupboards are being put into the corridor so that cleaning materials and protective clothing are more readily available in the areas where they are most needed therefore ensuring that risk of infection is minimised. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 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 and 35 Quality in this outcome area is good . This judgement has been made using available evidence including a visit to this service. Residents benefit from trained and qualified staff in sufficient numbers to enable individual work to be completed. Recruitment procedures protect residents. EVIDENCE: Currently the home has one member of staff undertaking NVQ level 4, one undertaking level 2 and two staff undertaking level 3. Two other members of staff are to start NVQ training soon. Staff said that the training was making them question the way in which they do things. Since the last inspection all the residents at the home have been reassessed by Social Services and extra funding has been agreed for two of the residents for part of each day. This funding is currently on a temporary basis but it means that staff are able to offer one to one support to all the residents at certain times of the day. Residents have benefited from this in the activities which are being undertaken with them and this has decreased some of the difficult behaviour. Staff report that residents are much happier and are more Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 18 comfortable in each others presence. Staff are concerned that the extra funding will be withdrawn. Recruitment paperwork was seen for five members of staff and the correct checks were seen to have been completed ensuring that residents are protected. Staff have a short induction within the home and a longer more detailed corporate induction. The induction is accredited with the Learning Disability Award Framework which means that it is specific to the residents needs. Staff who spoke to the inspector were also up to date with statutory training such as Food Hygiene and Safe Moving and Handling. They also undertake specialist training to meet the needs of the client group. There was an enthusiasm amongst the staff group and they were pleased that they now have time to put into practice the things they have learnt on courses or from work with other professionals. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 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, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good management. The home needs to improve the way in which residents and relatives are consulted about the quality of care. EVIDENCE: The previous manager of the home has now returned to the home and staff reported that he and the assistant manager are both approachable and ready to listen if they have concerns. The manager has a clear understanding of the residents’ needs and staff said that he helps out with care when needed. He has many years of experience within the residential care setting. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 20 The home has not yet undertaken a quality assurance programme although the assistant manager has sent out some questionnaires. This needs to be completed to ensure that residents and their relatives views are sought. Records within the home indicate that fire checks have been completed and although all staff have received fire safety training some have not received any since last August 2005. Additional training is booked for June 5th 2006. Additional records supplied by the home indicate that the estates department maintain a check on most of the other safety checks. In the shed which is used for art work there is a free standing heater. The inspector was informed that the use of it has been agreed by the fire officer. The home needs to ensure that measures are taken to minimise the risk to residents, taking into account the behavioural needs of the residents. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 1 X X 3 X Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13 (4) (C) Requirement The registered person shall ensure that – Unnecessary risk to the health or safety of service users are identified and so far as possible elimininated, Timescale for action 18/06/06 2 YA16 12 4 (a) This refers to risk assessments being in place for the self-closing doors and the heater in the shed. The registered person shall make 18/06/06 suitable arrangements to ensure that the care home is conducted – In a manner which respects the privacy and dignity of service users; This refers to ensuring that a lock is fitted to the bathroom door. Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 23 3 YA20 13 (2) The registered person shall make 17/06/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This refers to ensuring that medication is signed for at the time it is administered. The registered person shall establish and maintain a system for – Reviewing at appropriate intervals; and Improving The quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. This refers to establishing and maintaining 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, 10/02/06 & 30/4/06 not met) 4. YA39 24 (1) (a) (b) 30/06/06 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 Lisburne DS0000021967.V288917.R01.S.doc Version 5.1 Page 24 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.V288917.R01.S.doc Version 5.1 Page 25 - 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. 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