Inspection on 07/09/06 for Lombardy Park

This inspection was carried out on 7th September 2006.

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

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

Other inspections for this house

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

CARE HOME ADULTS 18-65 Lombardy Park 5 Monmouth Close Ipswich Suffolk IP2 8RS Lead Inspector Claire Hutton Unannounced Inspection 7th September 2006 10:50 Lombardy Park DS0000063430.V309470.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 Lombardy Park DS0000063430.V309470.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. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lombardy Park Address 5 Monmouth Close Ipswich Suffolk IP2 8RS 01473 686445 01473 686446 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) Active Care Partnerships Ltd Jessie Elizabeth Leggett Care Home 28 Category(ies) of Learning disability (28), Learning disability over registration, with number 65 years of age (2) of places Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th December 2005 Brief Description of the Service: Lombardy Park is registered to provide accommodation and person care to 28 adults with learning disabilities. Two service users may be over 65 years of age. The home is situated in the Maidenhall area of Ipswich. It is approached through a largely residential estate with some communal facilities, including a park, sports facilities including a small supermarket, fish and chip shop and pub. The home is within sight of the Orwell Bridge from the rear of the property. Accommodation at the home is all single storey and had a linked bungalow designed. There are four five-bedded lodges, one four-bedded lodge and two, two-bedded units. All the residents had single en-suite bedrooms and each lodge had its own communal spaces. There is a central office and administration area. Fees for this home range from £492 to £982 per week. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that focused upon the core standards relating to Adults (18 – 65). It took place on a week day. The process included a tour of Pines, Ash, Yew and Elm Lodges, discussions with residents and staff, observations of staff and service user interaction, and the examination of a number of documents including residents care plans, medication records, the staff rota, recruitment, training records and records relating to health and safety. The report has been written using accumulated evidence gathered before and during the inspection. Six completed comment cards were received back from relatives/visitors, all of which were generally complimentary. Two comment cards questioned if there were sufficient staff on duty. Fifteen completed surveys were received back on behalf of the residents. All of which were positive in their responses. Throughout the afternoon the inspector met several of the residents, three of whom were spoken with privately and were able to express themselves and talk about what it was like to live at Lombardy Park. What the service does well: What has improved since the last inspection? The primary achievement at Lombardy Park is that the quality of care and support given to residents has been maintained. The care planning development and implementation is now complete. The one requirement from the last inspection to ensure documents are kept secure and confidential has been demonstrably actioned. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 6 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. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 Quality in this outcome area is good. People who use this service can expect to have their needs and aspirations assessed, be able to ‘test drive’ the home, be provided with current information, also a contract and terms and conditions will be supplied. EVIDENCE: The Statement of Purpose and Service Users Guide were available to examine. Care records for three residents were examined in detail. contracts in place including terms and conditions of stay. assessments for three residents were examined and were read if required. These had gone on to be developed into All three seen had Full needs available for staff to care plans. One resident was relatively new to the home and before they moved in they had visited and spent time at the home with relatives before a decision was made to move in. Close review and monitoring in the initial period was taking place to ensure everyone was satisfied with the placement made. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is excellent. Residents, and their representatives can be confident that the plans of care maintained at the home reflect and address the individual and changing needs and aspirations of the person concerned. Individual support and choices are positively promoted from staff. EVIDENCE: Care plans at Lombardy are based upon a model from Roper, Logan and Tierney’s activities of daily living and on John O’Briens 5 Accomplishments. This was explained at the front of each care plan. There was a care plan in place for all residents and these were regularly reviewed. The care plans were of sufficient detail to give staff adequate information about the levels of support individuals needed. The care plans had been developed from the assessments made on individuals. This included risk assessments that were both generic and had individual elements that promoted independence and freedom where possible. Examples were finances and ironing. The daily statements made by staff were of good quality and stated what support had been given to enable the residents to maintain as much independence as was possible. The statements also demonstrated how individual choices had been respected throughout their day. Staff were observed to interact with residents in a respectful way encouraging them to participate in tasks around their own Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 10 home. This included one individual cleaning their room and others participating in meal preparation. Information about residents is handled in confidence and in a sensitive manner. Staff spoke with residents and encouraged them to speak for himself or herself and in private. Staff spoken to demonstrated a good knowledge of assessments and care needs. Residents spoken with were aware of their care plans and what they stated and how these were developed. One resident was able to guide the inspector through their individual plan. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is excellent. Residents, and their representatives can be confident that the home enables residents to maintain appropriate lifestyle with individual opportunities and support. Decisions around personal, family and sexual relationships are respected. EVIDENCE: Evidence from care plans, daily statements and from talking to staff and residents confirmed that the opportunities to socialise and participate within the local community were many and quite individual. Each resident had an individual plan of day services, college, clubs and groups that had been created from differing contacts. Advocates were encouraged. Care plans and staff demonstrated that residents were able to see family and friends of their own choosing, in private if desired. The home has a knock and wait policy instructing staff to respect the privacy of residents at all times. This was observed on the day. Each of the care plans examined by the inspector contained a section dedicated to expressing sexuality and developing relationships. Staff spoken to were aware of individuals preferences regarding this aspect. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 12 The menus that have been created are with the involvement of the residents as is the shopping that is done from local stores. Residents were seen to be participating in the meal preparation and making choices around food that they liked. Mealtime in each Lodge was different. In one Lodge residents had chosen to have scrambled eggs on toast with tomatoes sauce. Residents in the surveys had all praised the quality and quantity of food. On the day one resident said ‘food good’. Another resident said ‘I like everything about Lombardy’. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is excellent. Residents, and their representatives can be confident that the home offers appropriate personal and health care support. Trained staff appropriately administer medication and they are supported by good policies and procedures. EVIDENCE: Care plans set out the support the residents required. One resident spoken to was quite happy with the support offered and had a good understanding of why things happened in the way they did. Another resident without verbal communication was able to summon staff to administer personal care swiftly and staff were observed to do this well having regard to privacy, dignity and respect for the individual concerned. All fifteen questionnaires were positive about the support offered and residents felt staff listened to them. Care plans recorded all health care and professional visits made. Entries were seen for GP appointments, occupational therapy, chiropody, opticians, district nurses and dieticians. There was a specific form available to be completed upon any resident being admitted to hospital. This form ensured that the appropriate level of information would be sent to enable them to be cared for more effectively. Staff were aware of specialist referrals through Walker Close and clinical psychologists. Staff were aware of the differing prescribing protocols of primary and secondary dispensing of medication and how the GP Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 14 plays a vital role. Medication was on the whole well managed with the home. All staff were adequately trained. Training is delivered from varied sources, but also from one very experienced member of staff at the home and this was said to be endorsed by the dispensing chemist. The home has a monitored dosage system in place provided by a local chemist. Medication administration records were seen to have been consistently completed, with the initials of the person administering the medicine recorded on each occasion. Medication for one resident was audited and found to be correct. The manager as a quality checking method completes monthly auditing of medication. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Residents, and their representatives can be confident that the home has appropriate procedures in place to deal with complaints and residents are protected from abuse and neglect as far as is possible. EVIDENCE: Neither the Commission nor the home has received any complaints in the last year. The home has a complaints procedure in place and this is displayed for visitors to see. Residents surveyed stated that they knew who to speak to if they were unhappy and knew how to make a complaint. In relation to protection of residents both the manager and staff have received appropriate training. In June this year 21 staff attended training. The manager was aware of national guidance on protection of vulnerable adults and had a copy of the local procedure, however the local procedure had been updated. The manager was unaware and stated that she would obtain the revised local policy. With regard to staff recruitment there was evidence that enhanced criminal record bureau checks were in place and POVA first checks were made before staff started work at the home. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is excellent. Residents, and their representatives can be confident that the home is comfortable, well maintained and meets the needs of the existing resident group. EVIDENCE: This home was purpose built and at the time of registration it conformed to all national minimum standards. This is still the case and the home is well maintained and decoration is good throughout the home. There is a rolling program of decoration and a shower unit in Ash was due for refurbishment. Areas of the complex visited included Pines, Ash, Yew and Elm Lodges. All communal areas were visited, as were three bedrooms once the permission of each resident was given. All communal areas are comfortable and clean and have personal touches that make it homely. Each bedroom seen was truly a reflection of the person who resided there. Feedback from residents is that they are happy with their accommodation. One resident had disco equipment, sky TV CD player and a karaoke. The laundry areas were well equipped and able to be used by the residents. The grounds are well maintained by a gardener and there was ample parking for visitors and the homes transportation. For residents with a physical disability there were overhead tracking devices to enable comfortable transfers Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 17 to wheelchairs from bed and in bathrooms for bathing. Specialist equipment for physical disabilities were seen in place including wheelchairs with moulds and beds. The bed of one resident was not ideal for their needs or for ease of use by staff. The Inspector was aware that this piece of furniture came with the individual and belonged to them however this situation must be reviewed and involve the appropriate professionals to advise. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 18 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): 31, 32, 34 and 35 Quality in this outcome area is excellent. Residents, and their representatives can be confident that the home employs suitable numbers of staff that are well recruited and adequately trained to meet the needs of the residents. EVIDENCE: The staffing rosters for the home were examined and discussed with the manager. Several previous weeks worth of rosters were examined and confirmed that staffing levels were consistent. These were examined in detail as two comment cards from relatives/visitors questioned if there were sufficient staff on duty. The home currently had 27 residents accommodated in the five Lodges and two Cottages. Each Lodge had a separate staff team with a Team Leader in place. As the residents in one Lodge and the cottages were more able and independent staffing levels were not as high as the Lodges. On the day of inspection approximately twenty residents were out of the home at various placements and day services. The home do not use agency and have no done so for a number of months. Therefore the comments from relatives/visitors were explored and cannot be substantiated. The roster is very complex, but is said by the manager to be based upon resident needs. The home is fully staffed and has planned well for one staff member leaving and had recruitment for replacement staff well underway. In addition to the registered manager there is a deputy manager and the home also have two driver/handymen employed. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 19 The home employs a total of forty five care staff. Fourteen staff have NVQ 2 and One staff member has NVQ3. Fourteen staff are currently doing NVQ 2 and three staff are currently doing NVQ 3. Induction training for new staff was in place. Staff training is on a computerised plan for all staff. There was evidence of training in manual handling, fire safety, health and safety, first aid, basic food hygiene, infection control, medication and POVA. Planning of refresher training was also seen. Recruitment records for three staff were examined and this showed all the required checks were in place and that a through recruitment process was followed. There was evidence of regular staff supervision that was recorded. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 20 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, and 42 Quality in this outcome area is excellent. Residents, and their representatives can be confident that the home is appropriately managed. EVIDENCE: The registered manager is suitably qualified with NVQ 4 in care and the Registered Managers Award. She has several years relevant experience in working with people who have a learning disability. She is friendly and approachable. One member of staff said ‘Liz is fair, very resident focused, supportive of staff and sorts things out’. One resident said ‘I like her - she needs to be able to keep staff in line and can do that’. In relation to self-monitoring the home has a quality auditing system in place that has already been running. This is based upon questionnaires residents. The last audit sparked action with in the homes garden. The home had sent out questionnaires to relatives in July and these were being collated by head office. Other monitoring systems in place include monthly auditing of care plans and monthly auditing of medication systems. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 21 The local fire service had inspected this service on 4th July 2006. A recommendation around fire door closures was being actioned to comply with the recommendation. The home has a fire risk assessment in place. COSHH (Control of substances hazardous to health) assessment was in place. In relation to water safety the home has regular testing for Legionella (last done in January 2006) and does restrict hot water temperatures to prevent risk of scalding. There was evidence of regular recording of hot water temperatures. Evidence was seen in relation to servicing of ceiling hoists and the mobile hoist – work was being done on the mobile hoist to bring it back up to standard. There was also evidence of a gas safety certificate and public liability insurance. Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 X 4 4 5 3 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 4 25 4 26 4 27 4 28 4 29 2 30 4 STAFFING Standard No Score 31 3 32 4 33 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 3 3 LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X X 4 X Lombardy Park DS0000063430.V309470.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA29.6 Regulation 13 (5) 16(2) (c) 23 (2)(n) Requirement The provision of disability equipment necessary to meet the individually assessed needs of service users and to keep staff safe must be in place. Therefore the bed of one resident must be reviewed and involve the appropriate professionals to advise. Timescale for action 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA23 Good Practice Recommendations The home should access the revised local procedure for referrals of protection of vulnerable adults. 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