Inspection on 17/10/08 for Lisburne

This inspection was carried out on 17th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lisburne 23/10/07

Lisburne 16/05/06

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lisburne 36-38 Church Hill Honiton Devon EX14 2DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Delacroix     Date: 1 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Lisburne 36-38 Church Hill Honiton Devon EX14 2DB 0140442364 0140442364 colin.mcdill@devonptnrs.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Premier Living (Devon Partnership NHS Trust) Name of registered manager (if applicable) Mr Colin George John McDill Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6. The registred person may provide the following category of service only: Care home providing personal care- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD and who are aged 21 years or over on admission Date of last inspection Brief description of the care home Lisburne was originally two semi-detached modern bungalows, but has now been converted into one property. The home is situated in a residential area, near to the railway station and within walking distance to the centre of Honiton. Four adults who have a learning disability and have complex care needs live at the home. The home is registered for six people but the service has chosen to provide a home for only four people. There are two lounges with a separate dining room. There is a garden at the 6 Over 65 0 care home 6 Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home rear of the home and there is some parking on site. The weekly cost is 740 pounds 797 pounds, with extra charges for hairdressing, toiletries, holidays and presents. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place over one day and lasted approximately six hours. At the time of the inspection, four people were living at the home with three members of care staff on duty, plus initially two staff members from the management team. Later in the day, a manager from another home in the group joined us to support the deputy manager. Members of staff contributed to the inspection, as did one person living at the home. Another person was unwell and unable to contribute at the time of the inspection. However, they had completed a survey with the support of staff prior to our visit. Two other people were unable to vocally express their views on the service so we spent time in communal areas observing their care. Care Homes for Adults (18-65 years) Page 6 of 27 Prior to the inspection, we sent out surveys to help us gather information about the service. This report includes comments from these surveys, and we spoke briefly with a visiting health professional during the inspection. We have also included comments from three care managers who completed surveys. As part of the inspection, two people were case tracked; this means that we spoke with staff about their care needs, observed their care, visited their bedrooms and looked at records relating to their care. During the inspection, we looked around the home, and at written records for training, care plans, medication and how peoples individual money was managed. We also used information from the homes Annual Quality Assurance Assessment (AQAA) to help us judge the services performance. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Care Homes for Adults (18-65 years) Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is aware of their need to assess people before they move to the home. Evidence: There have been no recent referrals or new admissions to the home so these standards were not fully inspected. However, the manager is aware of their responsibility to assess peoples needs before they move to the home. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been significant improvements to how care is planned for and recorded, which helps promote individual care and consistency in the way staff work with people. Evidence: We looked at two plans of care and spoke with staff about the progress of person centred planning which helps build a comprehensive plan of care in an accessible format to them. This work is on-going work. However, work has also taken place to demonstrate who has been involved in the current plans of care. Staff told us they were given up to date information about the needs of the people they care for. One staff member felt that the service did well in following care plans which are regularly reviewed to best suit service users giving the most suitable care to them. Throughout the inspection, we saw staff adopting the guidance recorded in peoples care plans i.e. by picking up on verbal cues or changing their approach to suit the persons mood. A person living at the home told us that most days they could make their own Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: decisions about daily life. We also saw a member of staff supporting a person to make plans to visit local shops at the weekend to buy their favourite magazine. Three care managers were asked if individuals are supported to live the life they choose, one said this was usually the case but depends on clients frame of mind and two indicated this was sometimes the case. (See Lifestyle section) There are noticeable improvements to the guidance surrounding risk for each individual, which are colour coded to rate the degree of concern. They provide advice to staff i.e. how to respond and where possible minimise the risk. Risks are put in context and assessments detail possible triggers to peoples behaviour. Risk assessments are individualised recognising peoples changing moods and the approach needed by staff. Discussion with staff confirmed an understanding of when to adapt their approach. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from access to the local community and holidays, are well supported with meals and maintain strong links with people who are important to them. Evidence: Currently, none of the people living at the home are undertaking further education or employment opportunities. However, we could see from records and from hearing conversations between staff and people living at the home that people are supported to have access to the local community, such as through horse riding or hydrotherapy. Staff did comment that peoples access linked to peoples moods and staffing levels, this is particularly relevant for one person who requires two staff to go out with them. One staff member said we require more staff at times so that service users can go out Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: and do more and meet other people and make friends. In the homes AQAA there is recognition that there could be further improvement in the range of activities available. We saw from records that people have had access to individual holidays to suit their different interests and needs. We also saw how people are encouraged to participate in daily tasks i.e. someone was supported to make their own breakfast. Staff told us that they had built good relationships with peoples families and that this positive contact was supported by two annual social events put on by the home. care records evidence contact from families and their involvement with the home. During the inspection, we saw people making decisions about their daily lives, such as where they spent their time and what time they got up. Records also reflected how people made choices in their daily lives and staff could give examples of how this is promoted. We saw that meals are provided in a relaxed and friendly atmosphere, with staff joking and chatting with people living at the home. Staff made sure that people knew what was being served and supported people at their own pace. We were told how people living at the home are involved in choosing meals, and we could see this from records. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from being well supported with their health needs. Evidence: We saw from records and through staff approach that people are given support with their personal care needs in a flexible way. We saw how peoples personal needs are met in an individual way. For example, one person living at the home gains pleasure from their appearance and choosing clothes. We saw how this enjoyment was supported by staff, and saw how their approach promoted their dignity. We saw how staff explained their actions when helping people with moving around the home. A care manager commented that the home used specialist equipment well. We saw from records that the home maintains contact with health and social care professionals, for example meetings with the dentist and optician. We also met with a health professional during our inspection who was positive about the service. Staff were able to tell us how they measured peoples well-being, and records showed how staff are aware of peoples changing moods and emotional needs. We saw staff picking Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: up on non-verbal communication and adapting their approach in line with peoples moods. We saw that care plans provide information about peoples history to help explain their behaviour, which can be challenging to the service. Medication is well managed and records were up to date, with no unexplained gaps. The medication was being reviewed on the day of the inspection. We saw staff explaining to a person what their medication was for, which is good practice. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from a staff group who recognise if they are unhappy and take appropriate action. Evidence: No complaints have been received by CSCI, and staff told us in their surveys that they knew what to do if someone wished to make a complaint. A person living at the home told us they knew what to do if they had a problem and that staff listened to them. Since the last inspection, there has been improved recording of incidents at the home to help gain an understanding of what might have caused the incident. Recording in care plans and the homes AQAA shows that staff recognise the importance of identifying peoples changing moods to help them assess if people are satisfied with the support they are receiving, and whether this needs to be reviewed. One care manager said that the home were quick to phone if difficulties arise and that the service had always responded appropriately if they had raised concerns. Two other care managers said that the service usually responded appropriately. We saw from staff records that staff have had training to carry out their safeguarding role and that some staff have received training in the Mental Capacity Act. We spot checked the management of peoples personal allowances and saw that they Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: were well managed and that the system could be audited through clear records. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements to the homes appearance, and people benefit from a home that is kept clean and where infection control measures are in place. Evidence: Since the last inspection, there has been improvements to the maintenance of the home, which makes it appear more homely and less institutional. Broken items have either been removed or mended. However, the homes AQAA states that it is a struggle to keep up the homes appearance because the home lacks a decorating maintenance programme. The home was clean and odour free, and someone living at the home said this was always the case. We saw that staff have clear instructions to manage infection control issues, and provided with appropriate equipment. Staff were able to explain their role in maintaining good infection control procedures, and we saw them supporting people living at the home to wash their hands and keep clean. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from skilled and well trained staff. Evidence: We looked to see how staff are supported to carry out their roles. We saw from records and the homes AQAA that since the last inspection more staff are being provided with access to NVQ training and/or specialist training to meet the needs of people living at the home. The home was staffed at an appropriate level on the day of the inspection. Three staff told us in their surveys that there are usually enough staff to meet the individuals needs of people living at the home, one said this was always the case and one said this was sometimes the case. We were told that that no new staff had been recruited since the last inspection. We saw from three staff members training files that mandatory training was generally up to date, and is supplemented by training to promote good practice such as diversity awareness. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Care managers told us that staff usually have the right skills and experience to support peoples social and health care needs, and staff confirmed in their surveys that their training kept them up to date and was relevant to their role. A care manager told us that the staff were very caring, very respectful ...very patient. We saw examples of staff treating people in an individual way, which shows their person centred approach. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well run home. Evidence: We looked at how the home is run. Records are up to date, and stored appropriately. One staff member told us that there is good continuity in the running of the home... Another person told us that the continuity of staff...helps promote security and stability. Three staff members told us that they always felt supported, and had the right experience and knowledge to meet the different needs of people living at the home, while another staff member said they usually felt supported. We looked at how the service monitored their performance. We were told by staff that the twice yearly annual events, which families are invited to, enabled people to give feedback informally, and were well attended. Care plans now give guidance for staff to help measure the satisfaction of people living at the home. Staff are clear about feeding back concerns and visiting professionals said the home had responded Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: appropriately to concerns. Health professionals told us that staff from the home attend regular multi-disciplinary meetings to promote best practice, in order to review the service given to people living at the home. Staff also told us that the manager met with them regularly to give support and discuss how they were working. On this inspection, there were notable improvements to the management of health and safety issues. For example, chemicals were stored safely, infection control measures have improved and there is better maintenance of the environment. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 13 Staffing levels should be monitored and reviewed to ensure that all people living at the home have regular access to the community. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - 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!