Inspection on 11/07/05 for Lonsdale House

This inspection was carried out on 11th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Lonsdale House 28/01/09

Lonsdale House 15/01/07

Lonsdale House 15/12/05

Lonsdale House 17/11/04

Lonsdale House 10/06/04

Lonsdale House 14/10/03

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

CARE HOME ADULTS 18-65 Lonsdale 8 Lichfield Road Walsall West Midlands WS4 2DH Lead Inspector Mike Kirton Unannounced 11th July 2005 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 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 Stationary 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. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lonsdale House Address 8 Lichfield Street, Walsall, West Midlands, WS4 2DH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01922 721566 01992 722767 Caldmore Area Housing Association Limited Angela Crisp (Acting Manager) Care Home 15 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia (15) of places Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17th November 2004 Brief Description of the Service: Lonsdale House is registered to provide residential care for 15 adults aged between 18 and 65 who are experiencing mental ill health. The home aims to provide a rehabilitation service to enable service users to develop skills required for independent living. They are closely supported by the Walsall Community Rehabilitation Team. The property is a large detached house, which is situated close to Walsall Town Centre and local amenities including shops, a market, pubs, Arboretum park and good access to local public transport. There are ample car parking facilities for visitors and a ramp for easy access at the front of the property whilst at the rear are landscaped gardens. Accommodation is provided over three floors with a summerhouse and 2 selfcontained houses situated separately at the rear. There are 10 single bedrooms and 3 self-contained bed-sits within the main building. Additionally there is a large kitchen, dining room, 3 lounges, office and separate staff sleeping in room. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours and included a tour of the buildings, and informal interviews with the acting manager, service manager 8 service users and 5 staff members. Records were also examined for 2 service users. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 7 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 standard(s) 1,2,3,4&5 Lonsdale has very good admission procedures, which ensure service users views make up a large part of their assessment. They appear to have been provided with sufficient information to enable them to make an informed choice before moving in. Close links are maintained with their community team to ensure a continuity of service is provided. EVIDENCE: All new referrals for Lonsdale House come through Walsall’s Community Rehabilitation Support Team who continues to be involved during their stay and subsequent move onto independent living. Once an application has been made a representative from the home attends a referral meeting and then weekly reviews with the team. The files for two service users who had recently moved in were examined. These contained a basic information sheet, placement enquiry form and a referral form completed by them. Copies of the Care Programme Approach (CPA) assessment and care plan were also obtained before the home carries out their own assessment. The needs assessment contained detailed and comprehensive information covering personal history, daily living skills, risk assessments, physical and mental health, early warning signs and relapse prevention plans. The CPA review summary and contact details for the care co-ordinator is also included. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 8 The summary of identified needs is then used to develop the individuals support plan once they move in. Visits to Lonsdale are arranged before any decision to move in on a trial basis is made. New service users receive an induction to the home, which is recorded and kept on their file. This covers areas such as finding their way around, health and safety issues, policies and procedures, and local community information. Licence agreements are signed by service users and include a list of the homes rules, their room to be occupied and a list of furniture and fitting provided. All areas required by the regulations are covered in this contract. Confirmation in writing that the home can meet the individual’s needs is provided at the review meetings by the whole team. Discussions with service users confirmed the admission procedures and that they had visited other homes before deciding to accept Lonsdale’s offer of accommodation. One comment received was that the home ‘was beautiful by miles’. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 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 standard(s) 6 Care plans accurately reflected the good work undertaken during the assessment period to ensure that actions are taken to meet individual needs and develop independence. EVIDENCE: All care plans are in the process of being updated with the key worker and service user. Two individual files were examined. These contained a support plan with specific areas such as medication and housework tasks broken down into daily planners. Needs reflected those identified in their assessment and plans were geared towards meeting their specific goals. This was supported further through discussions undertaken during the inspection. Risk assessments in relation to potential violence and aggression had been clearly identified in the CPA care plan with actions in place to reduce potential incident occurring. Similarly early warning signs of deterioration in mental health and relapse prevention plans had been recorded. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 11,12,13,14,15&16 The home provides excellent opportunities to enable service users to develop their skills in preparation for living independently. They are encouraged to make and take responsibility for their own decisions within a supportive environment. EVIDENCE: As previously mentioned Lonsdale is well supported by the Community Rehabilitation Team. This includes monthly planned visits and reviews by the consultant psychiatrist and input by the occupational therapist, social workers and community psychiatric nurse. The home operates a key worker system to ensure further continuity of care and hold residents meetings every six weeks. They chair these themselves with staff invited to attend as required. Service users are encouraged to attend activities and organisations outside the home. These include colleges, day centres, links to work and growing links (a gardening group). There are also events planned at the home including holidays to Blackpool, trips out to Drayton Manor and BBQ’s in the garden. Some staff members are undertaking their mini bus training to enable more Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 11 activities outside to take place. A range of community information including advocacy advice is displayed on the notice board. All service users have their own keys and can receive visitors up until 10:00 PM or later with prior agreement. They can be seen either in their own room or one of the lounge areas around the home. Unless alternative arrangements are made all users are expected to return by 11:30 PM. Staff were observed to engage with service users and actively sought their involvement in the daily routines of the home including going to the shops and completing housework responsibilities. These are detailed in their daily planners. Service users spoken to during the inspection said the home was ‘very nice’, ‘facilities were good’ ‘you are allowed to get on and do your own thing’ and ‘staff treat you well’. They reported that the home did enable them to become more independent and many had plans to return to living independently. There was also evidence that users were pursuing their own interests and developing their skills and knowledge through further education. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 20 There have been poor practices in the past with regards the correct handling of medication. This is now in the process of being improved and new safety procedures have been implemented. EVIDENCE: The medication records and procedures for the ordering and returns were examined. Prescriptions can either be made by the GP or Consultant Psychiatrist, which can sometimes cause an discrepancy in the repeat prescriptions and record sheet. At was agreed that the home will record all consultations with the doctors and amend the administration sheet as required. Copies of prescriptions must also be made and used to check against all stock received from the pharmacist. New procedures have been introduced including a list of individual’s medication and descriptions of why and when they are required and the manager undertakes a weekly audit. PRN medication (given as required) is monitored by the Consultant Psychiatrist who works in consultation with the home. All drugs returned to the chemist are signed for in the returns book. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 13 The homes policy and procedure needs to be updated in line with current practices. A copy of all staff signatures must be obtained to easily identify who has signed for the medication. A system must also be introduced to track when medication not supplied in blister packs has been started. Service users who are not on a staged self-medication programme have agreed for staff to administer on their behalf. Those that do self medicate only undertake this following a risk assessment with subsequent checks made by the staff. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards were not fully assessed on this occasion. EVIDENCE: Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29&30 The home was generally found to be clean and tidy and well maintained. The layout and design benefits the process of rehabilitation by enabling service users to develop their independence through several levels of accommodation. The right balance between encouraging individual responsibilities and maintaining health and safety has been made. EVIDENCE: A tour of all communal living areas, bathrooms, toilets, summerhouse, kitchens and laundry room took place. Two single rooms, two bed-sits, and one of the coach houses were also inspected. The home was in the process of having new carpets laid and refurbishing the laundry/training kitchen. All communal areas were found to be clean and tidy, decorated to a high standard and well maintained. The bathrooms and toilets required some modernisation and this should be included with the homes maintenance and renewal plan. Service users are responsible for cleaning their own rooms with assistance as required. Health and safety checks are however still carried out by the manager to ensure a standard is maintained. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 16 All service users wash their clothes separately however once the laundry/training kitchen is completed and strict procedure must be implemented to avoid any cross contamination. Service users will have their own food cupboard and fridge in this area. An intercom system is linked from the office and staff sleeping in room to all the individual rooms. All service users are issued with a electronic key for the front doors and a key to their room. Bathrooms, toilets and showers also have appropriate locks fitted. Staff will only use override devices in an emergency or if action is needed to ensure health and safety procedures are being followed. Monthly checks are made of the building and audits of individual rooms have been completed. The kitchen was found to be clean and tidy and food was being stored correctly. Appropriate health and safety checks were being made including fridge, freezer and cooked meat temperatures. On the day of the inspection however there was a problem with a freezer resulting in some cross contamination. As a result a lot of food was disposed of. Prompt immediate action was taken to resolve this problem. Both the grounds at the front and rear of the home were maintained and landscaped to ensure easy access. The gardens are well used, especially in the summer for BBQ’s. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 There was sufficient staff on duty during the day to ensure service users needs were being met. Staff were seen to interact well and had time to engage in 1:1 activities. EVIDENCE: The staffing rotas for the home was examined however it did not clearly or accurately show the numbers of staff actually working in the home. The manager is however in the process of updating this. The minimum number on duty excluding the manager include a 1 team leader and at least 1 support worker however this is increased as required and for 1:1 activities. At the time of this unannounced inspection there were 3 support workers on duty. During the night the home provides only 1 staff who sleeps in. This situation must be reviewed taking into account health and safety issues and the assessed needs of service users. The findings must be forwarded to the Commission and continually reviewed. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 The new acting manager demonstrated commitment to improving the current practices at Lonsdale and had a good knowledge and understanding of her role and responsibilities. EVIDENCE: Angela Crisp has been appointed as the new acting manager and has only been in post for a few weeks. She has already obtained the Registered Managers Award, NVQ Level 4 in Care, and City & Guilds Level 3 in Community Mental Health Care and has previously worker at Lonsdale as a support worker and for nearly 4 years as a Team Leader at Oak House. An application will be made to the Commission for registration. Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 4 3 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lonsdale Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x x x E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 6 Timescale for action The homes Statement of Purpose 01/10/05 and Service Users Guide requires updating with a copy sent to the Commission. 18/07/05 Copies of prescriptions must be made and used to check against all stock received from the pharmacist. The homes policy and procedure must be updated in line with current practices. A copy of all staff signatures must be obtained to easily identify who has signed for the medication. A system must be introduced to track when medication not supplied in blister packs has been started. Implement a maintenance and renewal plan for the decoration and furnishing of the home. A procedure for the new laundry/training kitchen must be implemented. Ensure an accurate and clear staff duty rota is maintained at all times. E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Requirement 2. 20 13 3. 4. 5. 24 30 33 23 16 17 01/11/05 01/10/05 18/07/05 Lonsdale Version 1.40 Page 21 6. 7. 37 39 8 24 8. 9. 41 42 17 19 10. 42 13&16 Review the current practice of having only 1 night staff on duty who sleeps in taking into account health and safety issues and the assessed needs of service users. The findings must be forwarded to the Commission and continually reviewed. The acting manager must apply to the Commission for registration. The quality assurance system must be formalised and based on a systematic cycle of planning, action and review and cover all aspects of Standard 39 of the National Minimum Standards This is an outstanding requirement from the last inspection. Daily records must be maintained for all service users. All staff must attend two fire training sessions a year This is an outstanding requirement from the last inspection. Risk assessments must be completed for the building and all activities carried out by staff, service users, and visitors. 01/08/05 01/11/05 11/07/05 01/09/05 01/10/05 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 Good Practice Recommendations Lonsdale E55 X00023 S20830 Unannounced Lonsdale House V237893 110705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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