Inspection on 11/12/06 for Lotus House

This inspection was carried out on 11th December 2006.

CSCI 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 CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lotus House 23/11/07

Lotus House 20/12/05

Lotus House 12/05/05

Lotus House 15/10/04

Lotus House 20/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Lotus House 34 Lansdowne Road Bedford Bedfordshire MK40 2BU Lead Inspector Mr Ian Dunthorne Unannounced Inspection 11th December 2006 09:00 Lotus House DS0000057612.V323139.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 Lotus House DS0000057612.V323139.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. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lotus House Address 34 Lansdowne Road Bedford Bedfordshire MK40 2BU 01234 350600 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.mentauruk.com Mentaur Limited Marianne Kimani Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service users who need the assistance of a mobility aid shall be admitted to the home. 20th December 2005 Date of last inspection Brief Description of the Service: Lotus House was first registered in April 2004 to provide care for up to seven adults with learning disabilities. The purpose of the home is to provide care to people with complex needs, which may include those who have a mental health need and/or behaviours that challenge, in addition to their learning disability. Due to the physical environment, the home is not able to take people who have any mobility difficulties. The home aims to provide a 24-hour package of care, including day activities where necessary. The accommodation is in a converted Victorian semi-detached house in the centre of Bedford. The accommodation is arranged over three floors and all service users have their own bedroom with en-suite facilities. There are three communal areas, one on each of the floors, and bathing facilities on each floor. The home has a small patio to the side of the house. The home is owned by Mentaur Ltd, who also own a number of other similar homes in Northamptonshire and Leicestershire. Information relating to the homes range of monthly fees was available and provided on 21st December 2006. However the information does not include or specify any additional charges that may be made, that are not included within the fee. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over eleven hours during two afternoons and early evening and it was unannounced. Prior to the inspection time was taken to review the information gathered since the last inspection and plan this inspection visit. This report also includes feedback from service users obtained from postal surveys. The inspection included a tour of the communal areas and several bedrooms, inspection of certain records, discussion with staff and the manager, discussion with service users and observation of the routines of the home. No relatives were available during the inspection to speak with. The method of inspection was to track the lives of several service users. This was done by speaking to them about the service they receive, observing their life in the home, talking to staff and relatives and reviewing their records. What the service does well: • The staff had the skills and experience to deliver the service the home said it could provide. One service user said, “ the staff have helped me to live more independently whilst I have been living here”. The home and staff support the service users to pursue meaningful leisure activities, relationships & community links. The home provides a committed and positive staff team. The home had received no complaints since the last inspection. • • • What has improved since the last inspection? • • • The one requirement from the last inspection has been met. Service user plans have been introduced and are reviewed regularly. The manager said that the service user plans had improved since the last inspection. The home had increased its size by adding an extension, which benefited service users. Lotus House DS0000057612.V323139.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. The summary of this inspection report can be made available in other formats on request. Lotus House DS0000057612.V323139.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 Lotus House DS0000057612.V323139.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided sufficient information for prospective service users, however it sometimes failed to identify the fees payable, which did not allow all service users to be aware of the fee and what they may need to pay. The information also needed to be updated and in a suitable format, to ensure service users received the correct details and could understand them. EVIDENCE: The homes service user guide was not available entirely in a suitable format for the service users intended, however it provided some information to enable prospective service users to make an informed choice about where to live if explained to the service user. Evidence from service user surveys sent, identified that the service user’s felt they were given enough information about the home before they moved there. Some of the information was not up to date and not all the areas specified in this standard were included within the information. Fees charged and what they cover was included within the information, however it did not include the cost of any ‘extras’ that may not be included within the fee. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 9 The homes last inspection report was available within the home, but only accessible upon request. The manager explained that this was because some service users may remove the inspection report if displayed. However there was no evidence at the time of the inspection, demonstrating that service users, relatives and visitors had been informed of this, or any document telling them how they could access the last inspection report. There was evidence that the home had assessed the needs of the service users, however the documentary evidence of this had not been completed in full and were not dated. They had however been signed by the individual service users whose lives were tracked as part of this inspection process. The home was able to demonstrate that it could meet the assessed needs of individuals admitted to the home. Staff individually and collectively demonstrated that they had the skills and experience to deliver the service and care which the home said it could provide. Each service user had an individual contract, which had been signed by them as well as their relative, and the company’s operational director. However the contracts were not in an appropriate format for service users to understand, but the staff said they had explained them to the service users before they had been invited to sign them. The home had failed to include fees charged within the terms and conditions. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans and risk assessments were sufficient. However further development was needed to ensure they supported each other’s information and that they contained all relevant information, drawn up involving others as appropriate, in a suitable format for the service users to understand. Therefore minimising risk to service user’s and supporting them to understand and participate in decisions about their needs and personal goals. EVIDENCE: A sample of the service user’s plans and supporting documentation were examined and found to contain suitable and sufficient information to help meet generally their changing needs and personal goals were identified and reflected in their individual plan. However, further development was required in some areas, as some goals and actions although identified could sometimes be unclear, misleading and without a positive outcome for the service user. The Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 11 plans included individualised procedures for service users likely to be aggressive, however did not demonstrate adequate behavioural management guidance or a person centred approach. Some supporting documentation was incomplete and had not been reviewed which created confusion for carers to read and follow. There was inconsistent evidence that the service user’s family, friends or advocate had been involved in completing the plans and none were available in a suitable format that the service user could understand, although each service user’s plan had been signed by the individual service user. There was evidence that the plans had been reviewed at regular intervals. Some terminology used within the service user plans was inappropriate, which could potentially be misleading about the service user’s care being received. There was evidence from speaking with service users and records examined that service users were assisted as necessary to make decisions about their daily lives. Service users were supported by staff to participate in an advocacy service provided if they wished. Limitations on facilities for one service user to prevent self-harm and harm to others were documented in full and demonstrated that this limitation was made only in this service user’s best interests and was supported by external clinical practitioners. Service users were observed participating in daily routines of the home and service user meetings are held within the home and documented. However not all information about the homes’ policies, procedures, activities & services were available to service user’s in suitable formats, to enable them to participate fully in all aspects of life within the home. Risk assessments were in place for service users within the home, which supported individual service user plans. They had been reviewed regularly, although in some cases a change in need had been identified by the care plan and a subsequent increase in potential risk to the service user. However this was not always reflected in the risk assessment score level when reviewed, as no change may be identified and therefore sometimes did not correspond with the service user plan, causing confusion. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home and staff support the service users to pursue meaningful leisure activities, relationships & community links. However further development was required, to ensure that service users nutritional needs were reviewed and action taken as necessary, to ensure that their health and wellbeing was maintained. EVIDENCE: It was evident that service users were given the opportunity for personal development. One service user was supported to develop and maintain independent living skills, as the staff had enabled the service user to have the opportunity with their support to go to the local college to learn maths and financial skills. Service users were supported and provided with the opportunity by staff to fulfil their spiritual needs, some service users were supported to visit church when they requested to. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 13 The home supported service users to attend a local college during the week and many were also supported by the home to regularly visit a local day centre, which provided planned educational and training activities. Staff were observed supporting those service users who wished to, to go swimming during the evening in the local community, which demonstrated a flexible approach to their support. Several service users spoken to said they were supported by the home to use local facilities such as the cinema, pubs, leisure centres, shops and churches. One service user said “I like to go to the pub, the staff take me when I want to go, I go to different ones that I like, they are taking me swimming this evening”. All service users who responded to the surveys sent said that they were able to choose what they wanted to do during the day and evening themselves. This was evidenced by minutes sampled of service user meetings, which had been held within the home, which also demonstrated that staff were supported and encouraged to pursue their own interests. There was no evidence that entertainment was brought into the home, however service users who shared the same interests had undertaken trips supported by the home. There was evidence that the home supported service users to maintain family links and friendships inside and outside the home, in accordance with their wishes. Several service users spoken to said they were supported by the home to visit, phone and look after their family when they visit. A mealtime was observed, at which a friend of one of the service user’s whose birthday it was, had been invited with the agreement of the other service user’s to join the service user’s for a birthday tea. Each service user has a service user plan detailing individual arrangements for their mail in agreement with them and their needs. Similarly several service users had their own room key, but not all, which was dependent upon their risk assessment and those who did not, was demonstrated by the home as not in their best interests. Staff were observed knocking on service user’s bedroom doors before entering and waiting to be invited into their bedrooms. Service users had restricted access to the home and grounds and the front door was kept locked. Reasons for this to be imposed upon all service users were not evidenced or documented on an individual basis for each service user, but appeared accepted practice within the home. Service users were observed during several mealtimes, including a birthday tea. Service users were offered a choice of menus and were actively supported to help plan meals at a weekly meeting. One service user said, “ I like the food and get to eat what I like”. There was evidence that service user’s nutritional needs had been assessed, although risk factors associated with one service user’s weight loss had not been identified or reviewed placing the service user Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 14 at potential risk. Staff were observed eating at the same time as the service users in the same room, although they were not engaging or participating with the service users during this time. Lotus House DS0000057612.V323139.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a suitable medication policy and staff had received satisfactory training in medication administration. However the delivery of the medication systems within the home required some improvements, to safeguard the wellbeing of the service users, to prevent placing them at potential risk. EVIDENCE: Service users spoken to said they enjoyed living at the home and that they felt supported by the staff. Records viewed suggested service users received personal support in the way they preferred and most were encouraged to maximise their independence. This was supported by observations and discussions held with service users. Each service user had a key worker, who they were each able to identify and those service users spoken to said they were happy with the support from them and the relationship they had developed with them. One service user said, “staff help me with my clothes but support me to shave and wash myself”. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 16 One service user’s sexual needs were not being fully respected by the home regarding their privacy, as detailed on the service user’s plan for the staff to intervene after a time period and interrupt the service user. There was evidence that the home accessed outside healthcare professionals and services as required; in order to meet the healthcare needs of the service users. There was evidence that the healthcare needs of one service user had not been recognised or addressed regarding nutrition, see ‘Lifestyle’ section of this report. Service users were supported by the home to attend outpatient and other appointments. Samples of medication records, storage and procedures were checked, of those service users whose lives were being tracked as part of this inspection. Staff administering medication was observed in part. Staff had received satisfactory training in medication administration. No service users were responsible for administering their own medication within the home. Some had signed a consent form agreeing to this practise, others had not, which was not consistent. It would also be expected that an advocate or family member may have also signed some of these consent forms as necessary, which was not the case. The homes procedures for the administration of medication in some areas required some improvements, to reduce the potential risk of errors taking place and therefore placing service users at risk. As and when required medication balance sheet for one service user detailed an incorrect balance. It was observed that the staff member, who dispensed the medication and then signed the medication administration record indicating they had administered it, was not the same staff member who then actually administered that medication. The staff member who dispensed the medication then gave it to another member of staff to give to the service user. Lotus House DS0000057612.V323139.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for protecting service users were satisfactory. However, further development was needed to ensure service users money & valuables were stored safely to protect service users from possible abuse. EVIDENCE: The home had received no complaints since the last inspection. A record was kept of all complaints. The home had a satisfactory complaints policy and procedure in place, which enabled them to deal with complaints received. The complaints procedure had also been produced in an illustrated, picture format for service users with limited communication skills. Three out of four service user’s who responded to the surveys sent to the home said they knew how to make a complaint and who to talk to if they were not happy. All survey respondents said that carers listened and acted upon what they said. However the commission for social care inspections details contained within the complaints procedure were incorrect as they were old and required updating. All service users are spoken to as part of this inspection said they had no complaints to make and were happy. The home had a Protection of Vulnerable Adults (POVA) policy in place, which included whistle blowing and staff spoken to said they were aware of the procedure. Several staff had also attended POVA awareness training and some Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 18 challenging behaviour, abuse and all staff had received training in control and restraint techniques. Since the last inspection there had been three notifiable incidents in accordance with the POVA policy and guidance, which were reported to CSCI at the time. Evidence examined, supported a process that had been followed to safeguard and protect service users. Staff spoken to were able to describe ‘break away’ techniques in the event of dealing with physical or verbal aggression by a service user and described the use of physical intervention in accordance with their training, which was a practise that was only employed as a last resort to protect the service user from harm if all other de-escalation techniques had failed. Staff spoken to said they felt confident following their training, in dealing with physical or verbal aggression by a service user. The homes incident recording of these events were insufficient in their detail and required further development and improvement, to enable the information to be useful. The homes policies and practices regarding service users money and financial affairs were generally satisfactory and protected service users from abuse. However, this did not extend to the storage of service users money, which was inadequate and unsafe for the amount of money & valuables being held accumulatively, on behalf of the service users. Lotus House DS0000057612.V323139.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. There were identified risks and a poor standard of décor in various areas of the home and the ‘tiredness’ of the building detracted from the homeliness of the environment. EVIDENCE: The home was a converted Victorian semi-detached house. There was evidence that the environment had not been well maintained and that as a result a program of refurbishment and maintenance had been planned for the New Year. The building was excessively warm and temperatures in one lounge area were being recorded between 26C and 29C, which felt uncomfortable for service users to use. Some furnishings appeared tired and worn. The home was close to local amenities and transport if required. The homes fire risk assessment had recently been reviewed and updated, the home was waiting Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 20 for the final version, therefore it was not available to view during this inspection. One service user said that they had everything they needed and wanted in their bedroom. Another service users bedroom was observed to reflect their needs and lifestyle. All rooms were single occupancy with en suite provision. Service users spoken to were clearly happy with their individual bedrooms and were encouraged to take responsibility to maintain their cleanliness. However some bedrooms were in need of decoration, one bedroom had a substantial damp patch on the ceiling. One service user explained that he had chosen the painted colours of his walls and the curtains himself. Some bedrooms appeared dimly light. One service had limited furniture and restricted access to his bedroom and parts of the home. However this was agreement with the service user, their family and intervention with external clinical professionals supporting the service user’s needs. The home was able to clearly demonstrate that this environmental restriction placed upon the service user was in their best interests, to prevent them and others from potential risk and harm. Toilets and bathrooms appeared adequate and provided sufficient privacy, however some were in need of redecoration. The homes outdoor space appeared adequate, but was not accessible to service users. As detailed in ‘Lifestyle’ section of this report. The home had adequate washing facilities. A new single storey extension had been built providing the home with a larger dining room / lounge area. The home appeared clean and free from offensive odours, service users, care staff and night staff were responsible for ensuring this was maintained. The main kitchen did not have any hand wash detergent; this was not an effective infection control system. Hand washing facilities were not prominently sited or accessible for laundry facility areas, where infected material or clinical waste may be handled. This should form part of the homes planned refurbishment and decoration program. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff morale was high resulting in an enthusiastic workforce that works positively with service users, to improve their quality of life. EVIDENCE: Staff spoken to identified varied training which they had undertaken at the home and this was supported by evidence in their training records. Approximately 60 of the care staff had achieved NVQ at level 2 or above. There was evidence that some staff had received specialist training to support them to meet the needs of the service users. Staff spoken to had a good understanding of physical and verbal aggression as a way of service user’s communicating needs, preferences and frustrations. Staffing level numbers within the home were maintained to meet the appropriate ratio based upon the needs of the service user. Staff working over time without the need for external agency staff achieved this. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 22 Staffing level numbers fluctuated based on how many service users were in the home, they sometimes reduced at the weekends particularly if several service users had gone away. There was evidence that regular staff meetings took place. Morale within the home was high amongst staff, which was reflected by staff spoken to, one staff member said, “the home runs well, we work as a team and we feel supported by our manager”. Staff files that were examined, demonstrated that the home had obtained satisfactory checks and clearances on staff before their commencement, therefore the home was able to demonstrate that service users were protected by the home’s recruitment policy and practices. The home was able to access a structured corporate training plan. Which offered them the opportunity to nominate staff to attend varied statutory and specialist training, relevant to their roles and service user’s needs. This corporate plan included more than five training events a year for all staff. The home’s training register, which was examined, evidenced staff that had attended training events since the beginning of the year. Recently during November, staff had attended training in learning disabilities and mental health, abuse & challenging behaviour and food safety. However the home needed to develop further it’s own training & development plan, including individual assessments and plans for each staff member. Staff spoken to and records examined, provided evidence that staff received regular supervision. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ views were sought but there was no evidence that this changed how the home was run. Some aspects of the homes health & safety, safe working practice procedures and risk assessments, needed further development to ensure service users & staff would be protected from the risk of harm. EVIDENCE: The manager Marianne Kimani was present during part of this inspection. The manager demonstrated that she possessed the knowledge, skills and experience to run the home. Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 24 Developing and maintaining an effective quality assurance system within the home had not been successfully achieved. The home had not yet completed the full quality monitoring cycle, which could then be maintained systematically. The provider ‘Mentaur’ conducted quality monitoring centrally, which provided the home with some statistical information. However, the manager was unable to provide any evidence that this information was then used, to provide an annual development plan reflecting aims & outcomes for service users. There was evidence that the home maintained general risk assessments, including health & safety and fire, however the level of risk is not always clearly identified and they were not all completed appropriately. There was some evidence observed within the home’s main kitchen and other areas of the home that safe food hygiene practices were not being consistently maintained by staff. An electrician was present during part of this inspection completing the homes’ annual tests. Various records were examined to support adequate compliance with the following safe working practices, regarding health & safety including; accident records, water temperature checks and fire test and inspection records. Lotus House DS0000057612.V323139.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 2 2 2 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 2 28 2 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 3 X 2 X X 2 X Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 & 22 Requirement The home must update their service user guide to meet the requirements set out in NMS 1 for Younger Adults. The home must ensure that new service users are admitted only on the basis of a full assessment undertaken. Each service user must be provided with an individual written contract or statement of terms & conditions, which must include the amount and method of payment of fees. The home must make arrangements for service user’s to receive where necessary treatment, advice and other services from any health care professional. The home must make arrangements for the safe handling, recording, administration, safekeeping and disposal of medicines within the care home. A method or facility of safe storage for service users money & valuables must be arranged. A programme of maintenance DS0000057612.V323139.R01.S.doc Timescale for action 19/03/07 2. YA2 14 19/03/07 3. YA5 5 (1b) & (1c) 19/03/07 4. YA17 12 (a) & 13 (1b) 19/02/07 5. YA20 13 (2) 19/02/07 6. 7. YA23 13 (6) 23 19/04/07 19/05/07 Page 27 YA24 Lotus House Version 5.2 8. YA39 24 (1) (a) must be provided and implemented, to include the plans for renewal of the fabric and decoration of the premises where a need is identified. Arrangements must be made for the quality assurance system to be implemented in the home to review quality monitoring. 19/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The home should ensure that information about the home including service user contracts & the service user’s guide, are available in formats suitable for each service user. The home should ensure that service user plans are free from misleading terminology and in a suitable format for service users to understand with clear, outcomes & objectives. Also ensuring that they are drawn up with the involvement of others, such as family, friends or advocates as appropriate. The plan should include suitable behavioural management guidance included within individualised procedures, for service users likely to be aggressive, which focus on positive behaviour, ability & willingness. The home should provide service users with a front door key and allow unrestricted access to the home and grounds; or provide evidence dependent upon risk why this may not be in the service user’s best interests. The home should enable service user’s to have privacy to express their sexual needs, unless the home can demonstrate that it is not in the service user’s best interests, or presents a risk to themselves or to others. The home should ensure that it has a training & development plan, which includes a training & development assessment for the staff team as a whole, which then extends to staff individually. 3. YA16 4. YA18 5. YA35 Lotus House DS0000057612.V323139.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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