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Inspection on 08/04/09 for Loppington House

Also see our care home review for Loppington House for more information

This inspection was carried out on 8th April 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Key inspection report CARE HOME ADULTS 18-65 Loppington House Wem Shrewsbury Shropshire SY4 5NF Lead Inspector Sue Woods Unannounced Inspection 8th April 2009 11:20 Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Loppington House Address Wem Shrewsbury Shropshire SY4 5NF 01939 233926 01939 235255 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) www.loppingtonhouse.co.ukE mail office@loppingtonhouse.co.uk Loppington House Ltd Hilary Evans Care Home 36 Category(ies) of Learning disability (36) registration, with number of places Loppington House DS0000020698.V374968.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 Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 36 The maximum number of service users who can be accommodated is: 36 Date of last inspection Brief Description of the Service: Loppington House is a further education unit and adult centre established in 1983.The establishment is situated in the rural North Shropshire countryside close to the small market town of Wem and just 14 miles away from the historic town of Shrewsbury. Loppington House is registered with the Care Quality Commission (CQC) to provide accommodation and care for a maximum of thirty six people with a learning disability. The accommodation comprises of a main house, which provides the education resources on the ground floor and residential accommodation on the first floor, two detached houses in the grounds and two bungalows. In addition there is a small swimming pool, an office and a separate flat that accommodates up to six visitors. In October 2007 Loppington House was purchased by Active Care Partnerships (Holdings) Limited. Hilary Evans is the registered manager and Angela Forster is now the responsible individual. Information is shared with people who live at the home in the Service User Guide and regular in house meetings take place with everyone invited to attend. Advocacy support is promoted and a quality assurance system is in place in the form of questionnaires and regular audits. Inspection reports about this service can be obtained direct from the provider or are available on our website at www.csci.org.uk Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. The unannounced key inspection of Loppington House took place on 8th April 2009. The inspection started at 11.20 am and lasted just over six hours. The inspection reviewed all twenty two of the key standards for care homes for younger adults and information to produce this report was gathered from the findings on the day and also by review of information received by CQC prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the inspection we, the commission, met and spent time with a number of people who live at Loppington House. Some people said that they did not want to speak with us. Two people preferred to complete an on site survey to give us their views of the service they receive. We also spoke with staff on duty at the time of the visit and spent time with one of the two registered managers of the home. Given that staff on duty were busy supporting people to prepare their evening meal we also left on site surveys for staff to complete when they had the opportunity. This meant that staff could contribute their views to the inspection without taking time away from the people they support. We looked at three care files and extracts were seen from others. We also looked at a number of other records referred to within this report. We looked at three staff files, including recruitment, supervision and training records. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection that took place on 22nd April 2008. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment. (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? People are being supported to become more independent and take a more active part in their everyday lives in a number of ways. One house now manages its own food budget and this means that people plan and shop for the foods they like to eat and also take part in preparing and cooking their meals. The organisation plans that the other houses at Loppington will soon do this also. People are also becoming more active in their local community both with leisure activities and in work based projects. The manager said ‘We have established links with local shops and businesses, volunteer groups and local businesses. As a result people are receiving more opportunities to develop and learn new skills’. People told us that they are enjoying this. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 7 We previously found that the admissions procedure for Loppington House was very thorough and the manager reported to us that this system is now even more robust. This will mean that the home will be better able to admit people whose needs have been assessed. Updated information, now available, about the service offered at Loppington will provide people with sufficient information to help them make the decision that Loppington House is right for them Some houses have started the process of redecoration and people told us that they like the improvements to their homes. Staff told us that people living at Loppington had helped chose the colours for the walls and the soft furnishings. The new induction programme for staff will mean that people coming to work at Loppington, especially those with no previous care work experience can receive information about all aspects of the job they have been appointed to do including the value base that will underpin their practice. This will mean that people living at Loppington will be supported by staff who are competent and who treat them well. What they could do better: As a result of this inspection we identified areas where improvement is needed to keep people living at Loppington House safe and free from abuse. We found that care plans did not reflect some people’s needs and behavioural support guidelines were not always appropriate or followed. Staff are not being appropriately trained to meet the needs of the people they support and as a result people, including staff members, are getting hurt. Given that the home states that they can support people who have ‘challenging or unpredictable behaviours’ the lack of training and guidance is putting people at risk. The manager acknowledged in the AQAA ‘We do not provide suitable access to mandatory training’. Although plans are in place to start this process the home should have assessed the risks to people living at the home and to the staff team of them not receiving at least the mandatory training when they started work initially. Training required includes training in relation to health and safety and safe working practices. The manager also stated ‘We have not sourced enough activities for those less able service users’ although she did say that an activities coordinator is going to be looking to address this issue. Staff thought that communication between themselves and the manager could improve and staff also felt that staffing levels could improve to provide people Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 8 with better one to one activities. The manager supported this finding too. Some concerns were noted in relation to responding to information and investigating complaints and the responsible individual is now reviewing complaints received in order to develop a more robust procedure that protects people living at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 9 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 Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who stay at Loppington House are supported by appropriate assessments of their care and support needs to ensure as far as is possible their successful admission to the home. EVIDENCE: The manager told us that there have been no new admissions to Loppington House since the time of our last visit and that the admission referred to in the homes self-assessment related to the college facility only. We previously found that the admissions procedure for Loppington House was very thorough and since that time the manager has reported (in the AQAA) that the home has a ‘More robust admissions procedure and a new brochure has been published and is freely available’. The service User Guide was seen to be ‘freely’ available in the reception area where visitors and people living at the home regularly visit and the document now contains pictures of each house and of the two registered managers of the site. The judgement in this outcome area remains unchanged. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples changing support needs are not always recorded in their plan of care making them vulnerable if staff do not know how to meet and respond to their needs safely. People are enabled to take responsible risks however formal assessments are not being reviewed or completed appropriately on all occasions making people vulnerable. EVIDENCE: We looked at three peoples care plans in detail and found that although the majority of required information is available there are some areas where individual needs, as explained by staff at the time of our visit, have not been included in the plan of care and as a result people may not have their needs Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 12 met appropriately or safely. For example one person was unwell and this was affecting her behaviours. Staff did not have up to date guidelines of how to support this persons behaviours and so were reacting to situations, as they felt appropriate. This could place the person at risk of harm by a well-meaning staff member. Likewise some people living at Loppington House have behaviours that challenge or that are unpredictable. Behavioural guidelines seen for one person did not reflect safe or appropriate practice and there is evidence that people are at risk of injury from this person as a result. We saw staff involving people living at Loppington House in decisions about what activities they would like to take part in that evening and also involved people in preparing the dining room for the evening meal. People, in one house, told us that they are involved in menu planning and have been able to choose their favourite meals to eat. Risk assessments seen had been updated over recent months although the home can still not demonstrate that risk assessments are carried out when peoples needs change. This suggests that they may not understand the importance of risk assessments in helping to reduce or eliminate the risks of daily living and just complete them because they are required. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: We looked at standards 12,13,15,16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Loppington House enjoy a variety of structured educational and leisure opportunities that reflect individual choice and enable people to become a valued part of the local community. People benefit from supported family contact and involvement meaning that they are able to stay close to the people that matter to them. EVIDENCE: When we visited Loppington House a number of people who normally live there were spending the Easter holidays with their families. One person told us that he was seeing his mum the next day and was looking forward to this. Staff said that family contact is important to people and is encouraged and Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 14 supported. Plans are written into the care plan for one person to enable him to visit his family without causing him undue stress. The manager gave examples of how people are getting more opportunities to access community resources than ever before and gave examples to support this. For example some people attend a business venture in the nearby town of Ellesmere and share facilities with locals who are also employed in their own businesses. Another group of people are involved in a project to look at making places accessible to all. One person told us that he had enjoyed his day working in the local town. Other people had enjoyed local leisure facilities. Over recent months people living in two of the houses on site have begun menu planning, shopping and preparing their own meals within their own homes. This is a positive development that is enabling people to become more independent and people told us they are enjoying it. One person told us ‘I am happy’. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people who live at Loppington House are generally well met enabling them to have a good quality of life. People are safeguarded by the home’s system for handling, storing and administering medication EVIDENCE: Care plans showed that people attend regular health care appointments and on the day we visited a group of people had all been to the local GP surgery for blood tests to ensure they remain well while taking their prescribed medication. A very person centred booklet has been produced for everyone that details people’s health care needs and preferences that has been designed to be taken to health care appointments or in health care emergencies when hospital admission is required. The book enables health care professionals to know how Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 16 people prefer their needs to be met and identifies any important information that will enable them to meet that persons needs safely while in their care. These booklets were seen on all files reviewed. Arrangements in place for the recording and storage of medication were satisfactory with protocols available to ensure consistency when administering medications as and when required. Staff who showed us medication records were all clear as to when identified medication should be given and records supported their use. The home ensures that medication arrangements are followed by carrying out regular monthly audits. The last audit carried out found that staff were following procedures to ensure safe administration with only one action point identified in relation to compiling a signature sheet to identify which staff have signed the administration sheets. People are safeguarded by these arrangements and effective monitoring means that any errors can be picked up quickly and actions can be taken to improve processes when required. One person told us that the home does well ‘Looking after people’ One person commented that the home ‘Looks after me and makes sure I am ok’ Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Loppington House are at risk of harm or abuse because not everyone who is employed to look after them is appropriately trained or qualified to manage their challenging or unpredictable behaviours and care plans do not support staff to follow clear protocols that would protect them EVIDENCE: The homes self assessment form states that in the last 12 months there have been 52 referrals and 44 investigations under the safeguarding adults procedures. This is a significantly high number and the majority of these investigations have been substantiated. As a result local placing authorities have been requested to review peoples care and support packages to ensure that the home continues to meet peoples needs. It was reported by the manager that this process has now been completed and the home continues to support everyone assessed, suggesting placing authorities are satisfied with care provided. Over recent months referrals have decreased however in recent weeks three referrals have been made and are currently under investigation. It is of concern that there has been a delay in training staff to support people with challenging behaviours because people are getting hurt as a result of staff not having the skills to protect both themselves and people living at the home. Behavioural support plans are not clear meaning staff do not have consistent Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 18 guidance about how to keep people safe. Likewise it appears that action plans are not being followed or referred to. For example one action plan states that the plan should be reviewed weekly. This has not happened. The same plan states all staff must be trained and they are not. The manager reported that in house training in relation to managing violence and aggression is being started in June this year however there has been a delay in staff receiving this training and this has left people receiving a service and the staff team supporting them vulnerable and at risk of harm. Given the home advertises itself as supporting people with ‘medium to high dependence’ ‘who may display unpredictable or challenging behaviour’ this is unacceptable. The AQAA states that the home has received seven complaints within the last twelve months although paperwork was not clear as to what they all were. The home investigates complaints within its own policy and procedures although some investigations are outstanding suggesting timescales are not always adhered to. Since the inspection the responsible individual for the organisation has agreed to look back at all of these investigations to ensure that they have been responded to appropriately and that actions have been taken to improve practice as a result. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Loppington House are provided with a safe place to live however redecoration and new furnishings will make the houses more homely and improvements to the laundry room in one of the houses will make the environment more hygienic. EVIDENCE: We visited four of the five residential ‘units’ as part of this inspection. The college accommodation was closed due to it being the Easter Holiday. Although each house was seen to be clean they were all in need of refurbishment. The organisation had started this process when we visited last year however further progress has been very slow. Décor looks tired and kitchens and laundry rooms need to be brought up to an acceptable standard Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 20 to enable people to use them to develop their independent living skills (as is the stated ethos of the service). One house was in the process of being decorated and the manager said that people have chosen colours for their bedrooms and bedding. Some people had also had new curtains to match their chosen colour schemes. Two people told us that they liked their new rooms. The manager was aware of what is still required to bring the houses up to a good standard. Furniture for communal areas is being purchased and the manager stated that items would be more homely in appearance. When we asked people who live at Loppington and staff who work there what the home could do better, decoration of the houses was a common response. When asked what had improved one person commented ‘nothing we are still waiting for it to happen’. The manager shared this frustration. Where laundry facilities were in place in one house the room was inaccessible making it difficult to promote independence and the walls were brick and thus not easy to clean. Loppington House DS0000020698.V374968.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Loppington House cannot be sure that they are supported by a qualified or competent staff team and as a result they may be at risk of harm if staff cannot keep them safe or carry out personal care tasks safely. EVIDENCE: People living at Loppington feel well looked after by the staff who support them. Staff work flexibly and say that they like their work. Staff said that they receive regular support and supervision however when asked how the home could improve the majority stated that communication could be improved between the managers and themselves. The manager could not demonstrate that staff working at the home are qualified and competent to carry out their roles safely and effectively. Training records seen for new staff were blank and the manager stated that staff have not received mandatory training in order to equip them to carry out their jobs. For example staff have not received manual handling training, health and Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 22 safety training or first aid training. Plans are in place for staff to attend such courses in the near future but staff are working in the houses without this level of training currently. The biggest concern we had was is in relation to the training in managing violence and aggression. New staff have not received such training and accident and incident records show that named staff have been injured as a result. This lack of training also means that they cannot effectively protect vulnerable people who receive a service and so people may be hurt as a result. The staff files of the last three care staff to join the team were reviewed and found to contain the essential information required for the home to demonstrate that people are recruited safely to ensure the protection of vulnerable people. All checks are carried out before people work with the people living at the home. Records were well maintained and readily available for inspection. Staffing levels on the day of the inspection reflected the rota although staff felt more staff available to offer one to one support would improve the service at Loppington and the manager reflected this in the AQAA. Loppington House DS0000020698.V374968.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Previous management arrangements have enabled people to have a good quality of life however the current lack of appropriate training and poor management of challenging behaviours along with out of date or inappropriate care plans for some individuals have all put people at risk of harm over the last twelve months. EVIDENCE: The manager of Loppington House is experienced and competent to carry out her roles and responsibilities however she is currently also having to oversee the management of the college and of a small care home also in Wem without the support of the second registered manager who is currently overseeing the management of a further care home operated by the organisation. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 24 This arrangement was discussed with the responsible individual following the inspection who felt that there were adequate support mechanisms in place to enable the manager to carry out her role effectively. She also outlined future plans to ensure effective management. As a result of this inspection we found that certain issues relating to Loppington House continue to cause concern and people are being put at risk as a result. For example one persons care plan was not followed as agreed at a multi disciplinary meeting and as a result the person is now considered to be vulnerable. Likewise when peoples care needs change, plans are not being updated. The manager is also typing up new care plans that have been developed by the senior staff team and this is very time consuming and as a result is not happening as quickly as it should. The organisation has a senior management team that have a regular presence at Loppington House however the delay in accessing suitable training to support staff to manage behaviours that challenge the service have placed people at risk of harm and this is unacceptable. The manager has developed and implemented a quality assurance questionnaire that has been sent out to people who receive a service and she has just produced a graph to show overall satisfaction. However the action plan has yet to be produced. The manager and two staff who spoke with us still believe that policies and procedures are still more suitable for older peoples services and paperwork that we saw would suggest that documents need to be adapted further to reflect the needs of the people supported at Loppington House. For example pressure sore risk assessments are in place and challenging behaviour risk assessments are not. Generally health and safety issues are addressed within the homes with regular audits taking place and people who live at Loppington being involved in meetings however the lack of health and safety training currently on offer does pose a risk to the health and wellbeing of people. The manager reported in the AQAA that the home uses products that are hazardous to health but there are currently no risk assessments to support their safe use and this again may place people at risk of harm. The home has developed a fire risk assessment and action points identified as a result of this assessment are currently being addressed. Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 25 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 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 1 36 X 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 3 X X 2 X Version 5.2 Page 26 Loppington House DS0000020698.V374968.R01.S.doc NO 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 YA6 Regulation 12 Requirement People must be provided with the care, support and supervision they need in order to be kept safe and well. Care plans must contain the necessary guidance for staff in order to do this Care and support plans must be kept under review to demonstrate that peoples changing needs are being recognised and plans are developed to meet them. Care plans must identify how the staff team can safely and effectively meet peoples challenging and unpredictable behaviours. Risks associated with people’s behaviors must be identified and minimised through the effective use of risk assessments. This is to ensure that as far as is possible people remain safe. Complaints must be thoroughly and promptly investigated and records be available to demonstrate this process. This is so that the home can show that DS0000020698.V374968.R01.S.doc Timescale for action 01/07/09 2 YA6 15 (2) (b) 01/07/09 3 YA6 13 (6) 29/06/09 4 YA9 13 (4) (C) 29/06/09 5 YA22 22 (3) 29/06/09 Loppington House Version 5.2 Page 27 6 YA23 13 (6) 7 YA32 18 (1) (a) 8 YA35 18 (1) (c) 9 YA42 13 (4) (C) they listen to peoples concerns and ensure that appropriate action is taken in a timely manner to keep people safe and improve the service provided. The home must have training in place to recognise and manage challenging behaviours to keep people safe and protect them from abuse. The home must ensure that staff have the skills and experience necessary for the tasks that they are expected to do. This is to ensure that they can carry out their roles safely and effectively Staff must receive training (including induction training) to ensure that they can carry out their roles safely and effectively. This must include all mandatory training and any specialist training identified to meet the assessed needs of the people they are to support. The home should identify these training needs and develop a training plan to show how these needs are to be met. This is to ensure that staff have the knowledge and understanding of the roles they are to carry out in order to meet peoples assessed needs. The manager must ensure safeworking practices within the home at all times. To include training and direction in all aspects of health and safety. This is to keep staff safe from harm or injury that could be avoided. 01/06/09 01/06/09 29/06/09 25/05/09 Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 28 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 3 4 Refer to Standard YA30 YA24 YA33 YA38 Good Practice Recommendations The laundry room walls at Park House should be washable to ensure the room is hygienic and the risk of spreading infection from soiled laundry is reduced. It is recommended that the individual houses that make up Loppington House are refurbished to make them more homely and comfortable. Staffing levels should be continually reviewed to ensure that there are sufficient staff on duty at all times to respond to peoples individual needs The manager should ensure effective communication between herself and the staff team Loppington House DS0000020698.V374968.R01.S.doc Version 5.2 Page 29 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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