Inspection on 23/10/07 for Lisburne

This inspection was carried out on 23rd October 2007.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lisburne 17/10/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Lisburne 36-38 Church Hill Honiton Devon EX14 2DB Lead Inspector Louise Delacroix Unannounced Inspection 23rd October 2007 11:00 Lisburne DS0000021967.V349439.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 Lisburne DS0000021967.V349439.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. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lisburne Address 36-38 Church Hill Honiton Devon EX14 2DB 01404 42364 01404 42364 colin.mcdill@devonptnrs.nhs.uk 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) Premier Living (Devon Partnership NHS Trust) Mr Colin George John McDill Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered 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 The maximum number of service users who can be accommodated is 6. 2. Date of last inspection 16th May 2006 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 four adults who have a learning disability, autistic spectrum disorders, are highly dependent, and with challenging behaviours. The home is registered for six people but the service has chosen to provide a home for only four people. Accommodation for people is provided in four 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.V349439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day and lasted seven hours and thirty minutes. At the time of inspection, four people were living at the home with three members of staff on duty. However, one person was spending the day with their family. The manager was also present. Three members of staff and the manager contributed to the inspection, as did one of the people living at the home. This report also includes feedback from surveys received from health and social care professionals. Surveys were also received from three of the staff group, four relatives and two people living at the home. As part of the inspection, two people were case tracked; this means that where possible we asked people about their experience of living at the home, we visited their rooms and looked at the records linked to their care and stay. One person we case tracked we were unable to communicate with. We spent time in communal areas of the home to observe care practice but sometimes people living at the home were asleep or chose to go to their own rooms. During the inspection, we looked around the home, and at records including training, care plans, medication, we checked how people’s individual money was managed. We also used information from the home’s Annual Quality Assurance Assessment (AQAA) to help us judge the service’s performance. What the service does well: The service is committed to ensuring that they can meet people’s needs before they move to the home. There are individual plans of care for each person living at the home, which detail likes and dislikes. People living at the home are able to make day-to-day decisions about their lives and have access to community resources. The service recognises the importance of maintaining people’s relationships, including visits to their families. People living at the home were seen making choices about how they spent their day. Generally, people are supported in a way, which maintains their dignity. The home works in partnership with other agencies, such as health and social care professionals, to the benefit of people living there and in most instances medication is managed well. The home has not received any complaints since the last inspection and people in contact with the service know how to make a complaint and feel concerns are dealt with appropriately. People living at the home are protected by staff who know their duty to report poor care practice. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 6 People living at the home take pride in their bedroom, which they are able to personalise and be involved decorating decisions. Mandatory staff training is well managed and people visiting the home feel that staff generally have the right skills and that staffing levels are appropriate. Staff recruitment is managed well and NVQ training is promoted. Staff benefit from regular supervision and felt well supported. The manager is experienced and is approachable. What has improved since the last inspection? What they could do better: We make requirements when improvements must be carried out within a set timescale. During this inspection, we made five requirements, one of which has been carried over from the last inspection in October 2006. This relates to better record keeping when medication is administered, which will help improve the safety of people living at the home. The second requirement is linked to reporting adverse events to CSCI so we can monitor how the home keeps people safe. The third is improving the maintenance and cleanliness of the home, the fourth is to ensure care practices prevent cross infection and the fifth concerns ensuring chemicals are stored safely. Action in these areas will help make the home a more attractive and safer place to live. We also made twelve recommendations to improve care practice in the home. These are made to promote best practice. Care plans should be person centred showing the involvement of the person and their representatives, with clear guidance on identified risks and consistent recording. To help promote peoples’ dignity staff should always interact with people as they care for them. People living at the home would benefit from improvements to the layout, decoration, cleanliness and furnishings. An annual development plan would help the service focus on areas of improvement and all confidential records should be kept appropriately to ensure people feel confident that their privacy is respected. People living at the home would benefit from staff trained to meet their complex needs and from improved communication, which would help improve consistent approach. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standard 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 peoples’ 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 individuals have lived 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 manager was clear on the last inspection that for any new referral 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 person’s needs. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to plans of care and recording will help ensure that they reflect the views of each individual living at the home, and provide clearer guidance to staff to ensure a consistent approach. EVIDENCE: We looked at two plans of care, which showed recognition of the individual needs of each person, including communication and dietary needs. However, it was unclear how much people had been consulted about the content of these plans. The manager has recognised that this is an area for development through the completion of the home’s AQAA and discussion during the inspection. He told us that an independent organisation had been asked to look at person centred planning to build a comprehensive plan of care for each person, which would incorporate the views of people living at the home and in a format accessible to them. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 11 Two people living at the home told us through their surveys that they were able to make decisions about what they did each day. One person said this was always the case and another person said this was sometimes the case. However, they both said they could usually do what they wanted to do in the day and in the evening, including at the weekend. Relatives said in their surveys that the care service either always met or usually met the different needs of people living at the home and always supported people to live the life they chose. Health and social care staff said that usually the care service support individuals to live the life they choose, with one person commenting that this could be difficult due to their client’s complex needs, which result in rapid mood changes. We saw from daily records, from observation and discussion with staff that the behaviour of a person living at the home could prove a challenge to staff. Risks were identified but records did not clearly show the context of some of this behaviour, which made recognising any patterns or triggers difficult to recognise and therefore manage appropriately. Discussion with staff and the language in records showed a lack of understanding around the approach to care for this person. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 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. People living at the home benefit from access to the local community, are generally 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. The local Community Learning Disability Team told us that they work regularly with two of the people living at the home. One person attends a weekly hydrotherapy session and another takes part in horse riding once a week. We looked at activity/occupation records for two people; we saw for one person that there were sometime gaps in the records and that the person regularly ‘refused all activities’. However, it was unclear exactly which activities were being offered so it was difficult to see Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 13 if these linked with the activities that the person had identified as enjoying such as cooking, arts and crafts and games/puzzles. For another person we saw in their recent activity records entries about sensory experiences relating to sound and noise, a trip to the shops and to hydrotherapy. The manager said in the home’s AQAA that there had been an improvement in the amount of social activity available but explained during the inspection that sometimes repairs on the home’s minibus prevented them happening. On the day of the inspection, one person was spending the day with their family. We received four surveys from people who visit the home, and three said that the home always helped them keep in touch with their friend/relative and one said this usually happened. They all said they were kept up to date with important issues and the manager told us that one of the strengths of the home was the strong links with peoples’ families. During the inspection, we saw that one person was making decisions about their daily lives, such as where they spent their time, and we heard staff respecting people’s privacy. One person had chosen to get up mid morning and they told us this was their choice. We saw from their records that their morning routine was variable and they chose when to get up. We saw from another person’s records that they made choices about when they ate their main meal, which according to the records was respected by staff. A staff member wrote in their that the service encourages people to be as independent as possible, giving them choice and encouraging social interactions. We observed a meal and saw staff sitting beside people to assist them, which helps maintain their dignity. Some staff took time to engage with the person about the meal and helped in a way that supported them with their independence, although this was not always the case with one staff member who had little interaction with the person they were supporting. Staff were able to tell us about the food likes and dislikes of people living at the home, which were also detailed on care plans, although on the day of the inspection one person was given water with their meal which was listed as a dislike. Staff told us that people living at the home choose their meal each day and that an alternative is offered. We saw that after the main meal no pudding or fruit was offered to people, the manager agreed to look at the menu to ensure that this was an option. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 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. People living at the home have their health needs met but improvement to administering medication will help reduce risk to individuals. EVIDENCE: The local Community Learning Disability team told us that they worked closely with the home and that they are appropriately contacted to discuss changing needs, equipment and for staff training and the use of equipment. They felt that the staff had a positive approach towards the introduction of newly introduced equipment, and think about individual peoples’ needs and contact the team to discuss ideas. We spoke to a staff member who could tell us how they provided support for one person living at the home, which respected their dignity and supported their independence. One person living at the home takes pride in their appearance, and gains pleasure from their clothes. We saw this enjoyment being supported by staff during the inspection, and an entry in their records promoting their dignity. We saw from records and surveys that the home is in regular contact with health and social care professionals, including six monthly meeting, which is Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 15 attended by a range of professionals and promotes best practice. One person who responded to our survey said that there had been clear progress for two of the people living at the home, and that recommendations made by them had been followed by the home. We heard how the service had been creative to ensure that a person living at the home was not frightened by a medical procedure by being supported by staff to provide reassurance and comfort. Records also confirmed the success of this approach. Staff were able to tell us how they measured the well-being of the people living at the home, particularly for those people who have communication difficulties. Care plans show that staff record the emotions of the people living there and are aware of their changing needs and moods. Two social and health professionals told us that medication was always managed well and one person said this element of care was monitored closely and reviewed regularly. We checked how medication was stored and looked at the medication records, generally these were completed correctly, although there were gaps in the medication administration records, which the manager said they would discuss with the staff member. This was identified as a problem on the last inspection. When there are gaps it means that the home cannot evidence that medication was given and there is a risk that it may be given twice. Medication reviews are due for three people living at the home and the manager said the consultant was due to visit the home to complete these. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 24 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the complaints policy, the reporting and recording of incidents would help provide more robust protection for people living at the home. EVIDENCE: The manager has confirmed in their AQAA that the home has not received any complaints since the last inspection. None have been received by CSCI. Two social and health care professionals said that the home always responded appropriately if they have raised concerns, and one person said that sometimes the home responded appropriately. Two staff members knew what to do if a person living at the home or a visitor had a concern, a third person did not. Two visitors said they knew how to make a complaint, one said the situation had never arisen and one said they did not know how to make a complaint. Two people living at the home said they knew how to make a complaint, one person felt they would share concerns with their parents or doctor while the other person said they would talk to staff. The manager explained that the service had tried to put the complaint information into an accessible format but this had been unsuccessful. We looked at the complaint policy for the home and saw that it did not contain up to date contact information about CSCI. The manager said he would rectify this and send out to all staff and visitors, and explain this change to the people living at the home. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 17 We talked to staff about what they would do if they saw poor practice. They were clear on what constituted abuse, their duty to report, and knew how this could be done within the organisation but were less clear about external organisations who they could also contact with concerns. We saw staff records, which showed that staff had undergone safeguarding training and staff also told us that this had taken place. We spot checked the management of people’s personal allowances and saw that they balanced and could be audited through good records and a clear system. Since the last inspection, there was an incident of misconduct (not relating to people living at the home) concerning a staff member. This matter has now been resolved. However, the matter was not reported to CSCI as it should have been Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 24, 25 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is poorly maintained which prevents the building looking like a home for the people that live there, while current infection control practices have the potential to put staff and people living at the home at risk. EVIDENCE: Internally, the home has an institutional appearance, mainly due to the fact that only one room used by people living at the home is carpeted. Other rooms have lino for flooring, we were told that in two bedrooms this was due to the needs of previous people who had lived at the home but did not necessarily reflect the needs of the current people living at the home. One bedroom had obscured glass despite there being no overlooking houses, which meant the person could not look out onto the garden. The dining room is an unattractive room, which has two doors either side making it more like a corridor. This room joins the two bungalows. It also contains a large freezer, a chest of drawers, which has a high pile of chair Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 19 cushions stacked on top and a sofa, which faces one of the doors. A visiting professional commented that ‘a better building would improve things for the people living there’ and staff also commented that the layout could be problematic to manage due to the number of doors, narrow corridors and maintaining contact with people at different ends of the building. Some areas of the flooring were marked and some corner areas had not been cleaned thoroughly. Staff said that the equipment they had at the home was not adequate to maintain a high standard of cleanliness. Care staff as part of their rostered care hours carry out cleaning. The home is poorly maintained, and staff told us that they carried out decorating during their rostered care hours whilst also caring for the people living there. The quality of this work is variable. Around the home, paintwork is marked and painted radiator covers are peeling and rusty, which makes them hard to keep clean. Doors are scratched and battered. Grouting in the bathroom and kitchen is marked/stained, walls are stained in the kitchen, kitchen cupboard doors and handles are sticky too touch. The fridge in the kitchen had two broken vegetable compartments, one of which was still in use. A drawer was broken in the kitchen. Furniture in one of the lounges was ingrained with dust and in another lounge there were a pile of boxes containing office information. In one of the bathrooms, there is an industrial metal storage cupboard with messages written on it, while the bath seat is rusty at the back, which again affects the ability to clean it. We visited two of the bedrooms and saw that steps had been taken to personalise them, and one person living at the home told us that they had chosen the colours for the walls and were happy with their room. We visited the laundry room and talked to staff about how they managed soiled laundry in the home. Despite the incontinence needs of people living at the home, the home does not have a sluicing system within the washing machine. Staff told us that they sluice items in the laundry sink or a bowl if they can find one; the laundry sink is also used for hand washing. Staff told us that they use protective clothing when dealing with soiled laundry, which they carry through the home to the laundry. There are no instructions in the laundry room as to what temperatures soiled clothes should be washed on, and no system to wash the laundry baskets in this room where soiled laundry is placed until it is washed. These practices make cross infection a risk although the manager has pointed out that in his ten years of work at Lisburne there has never been an outbreak of bacterial or viral gastric infection which has affected more than one service user. There was no odour on the day of inspection and we also saw that the efficiency of staff hand washing was being monitored, with steps taken to Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 20 address concerns. People living at the home were also heard being encouraged to wash their hands when using the kitchen. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 32,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the staff team meet the needs of people living at the home , although some staff would benefit further from training related to the specialist needs of the people they care for. EVIDENCE: One health and social care professional said that staff always had the right skills and experience to support people’s social and health needs, two others said that staff usually had this ability. Two visitors to the home said staff always had the right skills and experience, while one person said they usually did and another that they sometimes did. Training records are well kept and showed us that the manager had worked hard to ensure that mandatory training was up to date, such as food hygiene and moving handling. The home’s AQAA states that under half of the staff team had an NVQ Level 2 but that a further four people were working towards this qualification. On the day of the inspection, there were three staff members on duty in the morning, which increased by one later in the day, and by 6.30pm two members of staff are on duty until the night staff arrive. Staff and the manager Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 22 confirmed this was the normal staffing level. A social and health care professional commented in their survey that the service has improved threefold since the number of people living at the home has been reduced. One staff member felt that there was usually enough staff on duty and two people felt this was sometimes the case. Three visitors to the home said they always felt the home met the needs of their relative and another person said they usually met their relatives needs. We looked at two staff files, which showed us that staff recruitment ensures that references, a full employment history and police checks are in place before people start working at the home. On the day of inspection, several people were attending training around equality and diversity. Three staff members told us in their CSCI surveys that they felt were provided with training relevant to their role, which kept them up to date with their new ways of working and helped them understand the individual needs of people living at the home. Staff also confirmed this on the day of the inspection, although the manager told us that there have been delays in some training areas, which prevented some people moving forward in their practice. We saw that these delays had been logged when we looked at two staff files. We also saw that some of the staff team were on waiting lists to access specialist training linked to the care of people with a learning disability and their communication needs. We saw on two staff files that people receive induction into the service, which was confirmed by staff in their surveys. We also saw that staff benefit from supervision sessions with the management team and that these contain action points and aims for personal development. Staff also said that their practice was observed, i.e. ‘my manager and assistant manager work most day with me so there is constant support’ and ‘supervision is given regularly’. The manager gave us examples of action being taken to address poor practice by following the organisation’s policies in this area. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 37,39,41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to voice their views on the service but the management of confidential information is inconsistent and the management of health and safety issues could potentially put people living at the home at risk. EVIDENCE: The manager has a clear understanding of the needs and the personalities of people living at the home, and the staff rota showed us said that he spends time providing ‘hands on ‘ care. He has many years of experience within the residential care setting and was clear with us about his expectations of staff to perform their job in an appropriate manner. A staff member said that a strength of the service was that there was a constant aim for ways to improve care, while another staff member felt that the service made the people living at the home the priority. A third staff member said they felt well supported by the Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 24 manager and a fourth said there was an ‘open door’ policy, which meant the manager was approachable. Feedback from health and social care professionals raised concern that they are provided with inconsistent information by the staff at the home, and that sometimes staff were not aware of the professionals involvement. Two staff members said that sometimes communication needed to be improved between staff, although another person said that they benefited from good handovers. Staff identified that the person beginning the shift midway through the day sometimes missed out on information. The manager told us that the home had sent out questionnaires about the service to relatives but had received a low response. He felt that the family events, which take place twice yearly enabled people to meet up and gain support and share concerns, and said these were well attended. He said that he kept in regular contact with families. The manager explained that it was difficult to gain the views of half of the people living at the home because of their complex communication needs but felt that the remaining people living at the home were able to voice their opinions. We saw minutes from staff meetings and staff told us that they could make suggestions to improve the service and felt listened to. The home has regular multi disciplinary meetings with other social and health care professionals, and the manager said this enabled others to influence the service. The home also has visits from people outside of the service but part of the organisation to monitor the quality of the service. However, currently the home does not have a written annual development, which would help the service monitor its aims and areas for improvement. The home’s AQAA shows that a number of the polices issued by the organisation that runs the home are overdue for reviewing, and this was confirmed by looking at the policy file. Currently, some archive files from the office are stored in boxes in one of the lounges, which does not promote confidentiality or a homely appearance. However, on the day of the inspection, the manager ensured that other confidential documents were locked away. We looked at health and safety issues while we inspected the home, and saw from the staff files that we looked at that staff were up to date with their fire training, and that fire safety checks were carried out regularly. Fridge temperatures are recorded regularly, although staff seemed unsure about the accuracy of some of the recordings, which the manager said he would address. However, during a tour of the building we found in the kitchen and the hall unlocked cupboards containing cleaning materials, which is unsafe practice. Staff took steps to store the cleaning items safely during the inspection. Some cupboards had locks attached to them but the key had been left in. This was the case in the laundry, which could be accessed by an open back door despite Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 25 the corridor door being kept locked. Staff said the back door was often left open. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 26 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 2 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 x 27 x 28 x 29 x 30 1 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x 2 2 x Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes. 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 YA20 Regulation 13 (2) Requirement Medication must be administered and recorded in a way, which protects people living at the home. This means people must sign for medication given or record why this has not happened to help keep people living in the home safe. (This is a repeated requirement with the previous timescale of 17/06/06 unmet). CSCI must be informed of adverse events in the home to ensure that they are managed appropriately and people are kept safe. All parts of the home must be kept clean. Rusty items must be treated and repainted or replaced. Broken furniture must be mended or replaced. These steps will help make a more homely and cared for atmosphere for the people living there. The manager, after consultation with environmental health, must ensure that there are suitable arrangements in place to stop the spread of infection and keep DS0000021967.V349439.R01.S.doc Timescale for action 20/11/07 2. YA23 37 (1) (g) 20/11/07 3. YA24 16 (2) (j) 31/01/08 4. YA30 13 (3) 17/12/07 Lisburne Version 5.2 Page 28 5. YA42 13 (4) people safe from harm. This must include an individualised infection control procedure for the home, an appropriate method to carry soiled items through the home and store them, and a safe system for sluicing. All chemicals must be stored securely to help keep people living in the home safe. 20/11/07 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 Refer to Standard YA6 YA9 Good Practice Recommendations Care plans should demonstrate the involvement of the individual living at the home together with family, friends and/or advocate as appropriate, and relevant agencies. Incidents related to identified risks should be recorded in a consistent manner and the manager should ensure that all staff have up to date guidance on how to respond in these situations. Records should evidence what activities are offered to ensure that these are ones identified by the individual as things that they enjoy. The manager should ensure that all staff interact with the person they are supporting whether assisting with a meal or supporting them to move around the home The home should up date the complaints policy to ensure that it has current CSCI contact details and ensure this update is provided to people in contact with the home. The home should consider replacing the lino with carpets to provide a more homely appearance and removing obscured glass where it is not needed. The manager should ensure that there is suitable equipment to keep the home clean. The home should consider relocating the dining room to one of the spare bedrooms in consultation with people living at the home therefore making it a more attractive and relaxing place to eat. Decorating should not be carried out during rostered care DS0000021967.V349439.R01.S.doc Version 5.2 Page 29 3 4 5 6 YA12 YA17 YA22 YA24 7 YA24 8 Lisburne YA24 9 YA35 10 11 12 YA37 YA39 YA41 hours and be carried out to a more professional standard. Waiting lists for training should be reviewed and acted upon to ensure that all staff have access to training on the complex needs of the people living at the home, which includes communication needs. Communication between staff groups and external agencies should be improved with a review put in place to ensure that staff are working in a consistent manner. The home should have an annual development plan to help identify areas for improvement, the action taken and the outcomes for people living at the home. Records should be stored in an appropriate manner, which maintains confidentiality and policies reviewed. Lisburne DS0000021967.V349439.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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