Inspection on 19/06/06 for Lorne House

This inspection was carried out on 19th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lorne House 12/08/08

Lorne House 14/08/07

Lorne House 05/01/06

Lorne House 08/08/05

Lorne House 25/10/04

Lorne House 31/08/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Lorne House 66 Yarm Road Stockton-on-Tees TS18 3PQ Lead Inspector Julia Connor Key Unannounced Inspection 19th June 2006 11:45 Lorne House DS0000000011.V295902.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 Lorne House DS0000000011.V295902.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. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lorne House Address 66 Yarm Road Stockton-on-Tees TS18 3PQ 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) 01642 617070 01642 641006 Lorne House Residential Home Trust Limited Mr James Dunbar Leslie Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons shall not exceed 14 adults with learning disabilities inc 3 with mental and physical disability 5th January 2006 Date of last inspection Brief Description of the Service: Lorne House is a 14 bedded home which provides residential care for adults with learning disabilities, including 3 adults who also have physical disabilities. The home has an extension added to the original building, car parking to the front of the home, a conservatory and a very large enclosed private garden to the rear that contains a lawned area, flower beds and garden furniture. There are ample bathrooms, shower rooms and shared living areas, to meet the needs of the people living at the home, which is situated on a busy road that runs into Stockton Town Centre. There are shops and churches nearby. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over two visits. The first visit on the 19th June commenced at 11.45 a.m. and concluded at 3.40 p.m. The second visit was on the 28th June and commenced at 1.25 p.m. and concluded at 4.20 p.m. Three Residents’ and two members of staff were spoken to during the inspection. Eight relatives’ returned comment cards. The current fees structure is £314.00 to £1.446.00 a week depending on the level of care the Resident requires. It is of concern that there are requirements from previous inspection reports that have not been addressed. What the service does well: What has improved since the last inspection? Three bathrooms and the dining room have been decorated and the crack on the upper hall staircase has been repaired. The first floor corridor has also been decorated. Two of the Residents’ bedrooms have been decorated, two bedrooms’ have had a new carpet laid and three bedrooms’ have had new furniture. Lorne House DS0000000011.V295902.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. Lorne House DS0000000011.V295902.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 Lorne House DS0000000011.V295902.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): 2 and 5 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Residents’ are admitted to the home once their individual needs have been assessed but there was no evidence that they had been involved in their assessment. Written contracts do not contain sufficient information to fully reflect what the Residents’ can expect for their money. EVIDENCE: Residents’ contracts did not clarify what services were/were not included in the cost of the placement, nor did the contract reflect the full cost of the placement. The Manager informed the Inspector that the Registered Person is currently discussing fees with Stockton Borough Council and the contracts will be finalised once these discussions are completed. Three Residents’ care files were audited and all contained assessment documents; however there was no evidence that the Resident had been involved in his/her assessment. Lorne House DS0000000011.V295902.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 and 9 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Care documentation is in place but due to it not being dated there is the possibility that the information does not reflect the current needs of the Residents’. Residents are encouraged to make decisions about their lives, which includes taking risks. EVIDENCE: Three Residents’ care files were audited and then the Inspector spoke with these Residents’. All contained an adequate amount of information; however, as the documentation was not dated it was difficult to establish whether the information was up to date and reflected the changing needs of the Resident. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 10 Neither the Resident nor a member of staff had signed the care documentation. One relative/visitor had recorded on their comment card that they were mostly kept informed of important matters, when they were not they put it down to staff failing to communicate. Three of the Relative/Visitor comments cards had ticked that they were not satisfied with the overall care the home provided and another card had recorded that they were ‘mostly’ satisfied. One relative/visitor had recorded that ‘frequent appointments with the Manager are necessary to try and maintain a satisfactory level of care’. It was evident from talking to the Residents’ that they were encouraged to make their own decisions about their life style, which included taking risks. Lorne House DS0000000011.V295902.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, 15, 16 and 17 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ have the opportunity for personal development and take part in age and peer appropriate activities and have personal relationships. Their rights and responsibilities in their every day lives are acknowledged and respected. Residents’ are offered a healthy diet, which they enjoy. EVIDENCE: Residents’ engage in personal relationships if they so choose. One Resident stated that s/he had a close friendship with another Resident living in the home. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 12 Discussion with Residents’ confirmed that they had opportunities for personal development. The Residents’ spoke about their time spent at college or day centres. One Resident stated that s/he worked hard at his/her job at the day centre but it was worth it as it was enjoyable. Another Resident stated that s/he enjoyed visiting his/her family and always enjoyed the disco evenings. One Resident informed the Inspector that the ‘food was good’ and another described it as ‘smashing’. An alternative meal is available if required. There was evidence on the menu that the Residents’ had been involved in choosing what meals were served. The acting Cook informed the Inspector that she prepared the meals during the week and the Residents’ helped at the weekend, often baking cakes and scones. A Resident who spoke to the Inspector confirmed this. The Residents’ are encouraged to make themselves a hot drink as long as they are able to do so. Residents’ are also encouraged to wash up and keep the kitchen clean and tidy. There was a good store of dried and frozen food. Fresh vegetables were evidenced. Lorne House DS0000000011.V295902.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 Good. This judgement has been made using available evidence including a visit to this service. Residents’ receive personal support in the way they prefer and their physical and emotional needs are met. Medication is dispensed appropriately and Residents’ are protected by the home’s policies and procedures for dealing with medication. EVIDENCE: The Residents’ who spoke to the Inspector stated they were happy with the personal support they received from the staff. One Resident stated that the staff were nice and s/he felt safe. This Resident went onto say that the staff let him/her stay in his/her bedroom to watch DVD’s and video’s but knew that the staff were available should s/he wish to talk to them. Another Resident stated that the staff were nice and would chat with her/him. The Resident went onto say that s/he does a bit of hoovering and likes to keep his/her bedroom clean and tidy. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 14 There was evidence in the Residents’ notes that staff offered support to the Residents’ at a level that was acceptable to them. There was a policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. Two members’ of staff dispense medication. No Resident currently self medicates. On the second visit to the home the Inspector was informed that the Pharmacist and her Assistant, from Stockton Primary Care Trust was also in the home carrying out an audit as well as offering support and advice to the care staff. Lorne House DS0000000011.V295902.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 Adequate. This judgement has been made using available evidence including a visit to this service. The Manager needs to ensure that there is a clear and effective complaints procedure and a record kept of all complaints’ and the resulting investigations. The home has the Teeswide Protection of Vulnerable Adults Guidance. Staff are aware of the action to take should they witness any form of abuse. EVIDENCE: The home’s complaints form was also in a pictorial format, which also included some sign language, which was user friendly. There is a complaints policy and procedure available and was updated in September 2005. There was conflicting information regarding complaints. There were no complaints’ recorded in the complaints folder, however, the Manager had recorded on the pre-inspection questionnaire that he had received one complaint and six of the eight comment cards returned by Relatives/Visitors had ticked that they had made a complaint. The Manager should ensure that there is a clear and concise complaint procedure for the staff to follow and the recording of complaints should be reviewed. The Residents’ who spoke to the Inspector stated that they would speak to the Manager if they were unhappy with something. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 16 The home has the Teeswide Protection of Vulnerable Adults Guidance as well as its own policy and procedure. The staff that spoke to the Inspector were aware of what action to take should they witness any form of abuse. Staff require training on the Protection of Vulnerable Adults. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Although Residents’ live in a homely and comfortable environment, it is not well maintained and some required work has been outstanding for some time. EVIDENCE: Residents’ bedrooms were very personalised and had pictures and personal effects in place. There is still a large crack running up the skirting board from the floor to a height of approximately one and a half feet in the front sitting room. This defect was first reported in the August 2005 inspection report. The carpet in the front lounge needs replacing, as there is a patch in front of the TV that is well worn. The dining room requires a new carpet and the lounge opposite the dining room requires decorating. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 18 The flooring in the bathroom with the Kingcroft bath requires a deep clean and the walls decorating. The toilet (opposite the staff cloak room) needs to be decorated and the flooring requires a deep clean. There are a range of doors and doorjambs that are damaged and require attention. The Inspector was informed that the ground floor corridor was due to be decorated but was not told when the work would take place. On the day of the inspection, the home was clean, tidy and hygienic, with no offensive smells. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 19 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): 32, 33, 34, 35 and 36 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The Residents are protected by the home’s recruitment practices. Only minimal training is being given to the staff to ensure they can provide the required care; regular formal supervision is not taking place. The Manager must ensure that sufficient staff are on duty to meet the needs of the Residents’. EVIDENCE: It was recorded in the Pre-Inspection Questionnaire that 40 of staff had been successful in obtaining their NVQ Level 2, which is the same as recorded in the previous inspection report. An audit of the duty rota showed that there were four staff on duty from 7 a.m. to 9 p.m. and two staff on a night shift. On the first day of the inspection the Inspector was told that there were four staff with the Residents’ who were on holiday in Blackpool. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 20 The Residents’ who spoke to the Inspector stated that there were times when they had to wait for attention from a member of staff. Four of the Relative/Visitor comment cards had recorded that in their opinion there was not always sufficient staff on duty. One relative had recorded that they had spoken to the Manager about the staffing levels and how they felt that ‘at times there is a situation where an accident is being invited to happen’. The staff that spoke to the Inspector felt that there was sufficient staff on duty. When the staffing was discussed with the Manager he stated that he had recently employed more staff. An audit of four personnel files showed that the home complied with the requirements stipulated in Schedule 2 of the Care Home Regulations 2001. An audit of the training files showed that minimal training had taken place since the last inspection e.g. some staff had received mandatory training and epistat training. There was evidence in the personnel files that supervision for the staff had commenced but not on a regular basis. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 21 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 Adequate. This judgement has been made using available evidence including a visit to this service. The Manager has the qualifications and experience to manage the home and is working towards developing an effective quality assurance and quality monitoring system. There are policies and procedures in place to ensure the welfare of the Residents’ and staff are promoted and protected. EVIDENCE: The staff and Residents’ spoke well of the Manager. The manager has a professional social work qualification and a management qualification. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 22 There was evidence that the Manager had commenced an auditing system for the home, which included staffing, medication and Resident/family questionnaires. However, the Manager must record his findings and not just tick a box to confirm that the audit has taken place. The Inspector suggested that a yearly quality assurance report would be beneficial. The Manager must ensure that the questionnaires that the Residents’ and their family members are asked to complete are dated. There are policies and procedures in place to ensure the welfare of the Residents’ and staff are promoted and protected. It was recorded in the pre-inspection questionnaire that maintenance of the home takes place for example the emergency call systems had been checked in December 2005 and the fire equipment was due for its annual check. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 23 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 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 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 2 X 2 X X 3 X Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2YA2 YA6YA6 Regulation 24 Requirement The Registered Person must ensure that the Resident and/or their next of kin are involved in assessing, planning and evaluating care and that the information is up to date and reflects the current needs of the Resident. THIS IS OUTSTANDING FROM THE JANUARY 2006 INSPECTION. The Registered Person must ensure that the Residents’ contracts include information relating to additional cost; and reflect the actual cost of the placement. THIS IS OUTSTANDING FROM THE OCTOBER 2004 INSPECTION. The practice of the home using residents personal allowances to pay the cost of staff entry when supporting service users on outings must be discontinued. THIS IS OUTSTANDING FROM THE OCTOBER 2004 INSPECTION. The Registered Person must ensure that the crack to the wall in the front sitting room be repaired and made good. DS0000000011.V295902.R01.S.doc Timescale for action 30/09/06 2. YA5YA5 5 30/09/06 3. YA14YA14 5 30/09/06 4. YA24YA24 23 30/09/06 Lorne House Version 5.2 Page 25 5 YA23YA23 YA35YA35 18 6 YA39YA39 24 THIS IS OUTSTANDING FROM THE AUGUST 2005 INSPECTION. The registered provider must ensure that all staff receives training to ensure they can provide the required care. THIS IS OUTSTANDING FROM THE JANUUARY 2006 INSPECTION. The registered manager must introduce an effective system to review the quality of care at the home in accordance with Regulation 24 of the Care Homes Regulations 2001. THIS IS OUTSTANDING FROM THE OCTOBER 2004 INSPECTION. 30/09/06 30/09/06 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. 2. 3. 4. Refer to Standard YA22YA22 YA32YA32 YA33YA33 YA36YA36 Good Practice Recommendations The Manager should ensure that there is a clear and concise complaint procedure for the staff to follow. The Manager should ensure that a minimum of 50 of care staff should hold NVQ level 2 or 3 in care. The Manager should ensure that there is sufficient staff on duty to meet the needs of the Residents’. The Manager should ensure that staff receives supervision six times a year. Lorne House DS0000000011.V295902.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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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