Inspection on 12/05/05 for Lotus House

This inspection was carried out on 12th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lotus House 23/11/07

Lotus House 11/12/06

Lotus House 20/12/05

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 Beds MK40 2BU Lead Inspector Fiona Mackirdy Unannounced 12 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lotus House Address 34 Lansdowne Road Bedford Beds MK40 2BU 01234 350600 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.mentauruk.com Mentaur Ltd Care home 7 Category(ies) of LD - Learning Disability registration, with number of places Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 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. 2. The manager must complete an NVQ level 4 in care and registered manager’s award by 31st December 2005 Date of last inspection 15/10/04 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. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place between 7.45am and 1.30pm. The care of two service users was tracked, which included observing the practice and routines, speaking with the service users and staff, looking at a sample of records, and a partial tour of the premises. There were only three service users living at the home on the day of this inspection. The manager of the home has recently left and a manager from one of the provider’s other homes is overseeing this home while a new manager is recruited. What the service does well: What has improved since the last inspection? What they could do better: The provider must appoint a new manager who can make sure that the standards at the home are kept up. As there are only three service users Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 6 living there at the home they must ensure that the home can care for everybody properly even when new service users move in. The home must make sure that service users’ health is promoted by helping them visit the dentists and opticians and by trying to prevent regular illnesses. They must also make sure they keep care plans and records about health appointments up to date. Some records need to be filled in properly, including records of why and how service users are physically restrained when they become upset or angry. The arrangements for managing medicines need to be improved so that the home can be sure that medication has been given to the service users. The home must make sure that service users are not restricted by the front door and kitchen being locked unless this is the only way of keeping them safe. The service users must also be kept safe by ensuring that fire doors are not wedged open. 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. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 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 standard(s) 5. The home is trying to provide information for service users in a way that helps them to understand what services the home will provide for them. EVIDENCE: No new service users had been admitted since the last inspection, so these standards were not assessed. Service users’ files contained statements of their terms and conditions with the home, but these were not in a format that could be understood by service users, although they had signed them. However, the area manager advised that the home’s service users’ guide and complaints procedure was available in a large print and audio format. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 & 9. The format used for care plans is good but care plans do not reflect all of service users’ current care needs and personal goals and therefore there is insufficient information to show how staff should support them in these areas. There are good basic systems for consulting service users and they feel included in day-to-day decision-making. EVIDENCE: The care of two service users was tracked. The care plan format was comprehensive and allowed for long and short-term goals to be identified. These had not been fully updated with recent changes to service users’ day activities or health needs. Care plans were supplemented by some guidelines in respect of specific areas of service users’ needs or routines, but some of these were not dated and it was not clear whether they were still relevant. Risk assessments for service users’ activities and environment had been completed and were being reviewed monthly. It was noted that there were some restrictions on the service users’ access to the kitchen and that the front door was kept locked. It was not clear from records or from talking to staff why these restrictions were in place, other than they had been necessary for a former resident of the home. These must therefore be reviewed. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 10 Service users said that they met as a group every Thursday to plan their weekly menu and to discuss any issues that they had. They also mentioned that they saw the provider quite often and could talk to her about issues. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 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 standard(s) 11, 12, 15, & 16. Service users have opportunities to take part in activities and develop skills, but these need to be better planned so that service users know they will receive the support they want. High priority is given to supporting service users to maintain contact with their family, which is valued by them. EVIDENCE: Service users all took part in meaningful activities on most days, which included attendance at external day care centres on a full or part time basis and college courses. Care plans contained some information about short and long term goals for service users, but there was not always specific information about how service users would be supported to work towards these. Similarly care plans did not contain the most current information about service users’ planned day care programme. Service users were supported to maintain contact with friends and family through visits and phone calls. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 12 The morning routine of the home was observed. This was relaxed and service users received appropriate support to prepare for their day centre. One service user was not able to attend his day centre on the day of inspection due to other staff commitments and no alternative arrangements had been made. However he was not clearly informed of this until after lunch, having been told earlier that he would be taken to the day centre about 12 o’clock. Service users confirmed that they were given keys to their rooms if they wanted. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 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 standard(s) 18, 19, & 20. The arrangements for supporting service users with their health and personal care needs are not sufficiently robust to ensure that their health is promoted. The systems for the administration of medication are good but are applied inconsistently and therefore the home cannot adequately demonstrate that service users receive medication as prescribed. EVIDENCE: Service users were supported appropriately with their personal care during the inspection. They were positive about the help that staff gave them. However, records indicated that one service user was woken up to three times during the night as part of a strategy to prevent incontinence. However there was no evidence that account was taken of the effect of interrupted sleep on his wellbeing and health. This practice must therefore be reviewed in conjunction with the continence advisor and the service user. The home had made links with multi-disciplinary professionals at the learning disability resource centre and had made referrals to specialist services as needed. Records relating to the outcome of health appointments were incomplete and one care plan did not identify what support and preventative measures were in place for a service user who was suffering from recurrent infections. There Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 14 were no records relating to any dental check ups or care provided by the home in the year since the service user had lived there. The medication storage was in order and the monitored dosage systems indicated that medication had been given. However, medication records seen had been altered, and the communication book indicated that there was an ongoing problem with the recording of medication given and tablets not being accounted for. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 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 standard(s) 22 & 23 The systems for supporting service users who display difficult behaviour are applied inconsistently and therefore the home cannot demonstrate that service users are kept safe when staff intervene. There are robust systems for dealing with complaints and service users know how to use them. EVIDENCE: Service users confirmed that they knew how they could complain and that they had regular opportunities to discuss issues either in their weekly meetings or with the owner when she visited. Staff had received training in the protection of vulnerable adults and in the use of non-aggressive physical interventions. However, records of incidents where service users had become aggressive and had been restrained did not contain sufficient information about the de-escalation techniques, or the length or type of restraint used. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28 & 30 The standard of the environment in this home is mostly good, providing service users with an attractive and homely place to live. EVIDENCE: The communal areas seen were generally in good decorative order and furnished in a domestic way. In practice, the lounges on the upper floors were not used a great deal and therefore the home must consider whether there will be enough communal space if the home becomes fully occupied. The home had applied for planning permission to extend the home to the rear, with a view to providing more communal space, but this would mean the home would have virtually no useable outdoor space. The providers should therefore consider whether it would be more suitable to turn one of the ground floor bedrooms into a lounge in the longer term. Service users had personalised their bedrooms and any outstanding maintenance items such as damage to plaster had been reported, with repairs planned imminently. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 17 Access to the washbasin in the laundry area was restricted and staff confirmed that in practice they washed their hands in a nearly bathroom. Vinyl gloves were also disposed of in an open bin in this room, a practice which must be reviewed to ensure adequate infection control and to minimise risks to service users. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 33. The home has a low staff turnover and service users have benefited from having staff who know about their needs. EVIDENCE: Most staff at the home had worked there for over a year and the home provided a high ratio of staff to service users. Service users spoke highly of staff and the relationships that they had built up. Staff were observed interacting very positively with service users and they could describe how they met their day to day needs. Staff said they received ongoing training and support in the specific needs of service users. Staff were working towards their NVQs in care. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 42. There has been a number of changes in manager in the home in the last twelve months and therefore there has not been consistent leadership to enable the home to develop. EVIDENCE: Since May 2005 the home has had three managers, and the position was vacant at the time of this inspection. There had also been a number of changes of deputy manager over the same period. A manager from one of the provider’s other homes was overseeing the management of the home. Staff said that they were well supported but commented on the lack of continuity and consistency in how the home had been operated under the different managers. The provider was advertising for a new manager. A number of fire doors in the home were wedged open with furniture and the front door, which was a designated fire exit, was locked. Not all staff had keys to this which was in breach of the arrangement agreed by the fire officer. An immediate requirement was left at the home about this matter. Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 2 Standard No 11 12 13 14 15 16 17 2 2 x x 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lotus House Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1, 5 &6 Regulation 5 & 12 Requirement Provide the service user’s guide, statement of terms and conditions, care plans and complaints procedure in a format which is meaningful to each service user (Original timescales of 30/10/05 and 31/3/05 not fully met - the complaints procedure and service users guide were now available in alternative formats) 2. 6 15(2) Ensure that care plans are reviewed and updated with changes to service users needs and goals, including short term changes to health needs Review the practice of locking the front door and kitchen to ensure that service users are not subject to restrictions unless it is part of their risk management plan Review the practice of waking service users at night Ensure that service users are supported to attend dental and optical check ups and that records are kept of the outcome of all health appointments 30/9/05 Timescale for action 31/10/05 3. 9 12, 13(7) 30/6/05 4. 5. 18 19 12 17 31/7/05 31/8/05 Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 22 6. 20 13(2) & 17 7. 8. 23 30 17 13(3) & (4) 8 23(4) 9. 10. 37 42 Ensure that accurate records are kept of all medication administered and that all prescribed medication can be accounted for Ensure that full records are kept of all incidents involving physical restraint of service users Ensure that vinyl gloves are disposed of safely to ensure control of infection and to minimise risks to service users Appoint a manager to the home Ensure that fire doors are kept closed to the rebate unless they are held open by a device approved by the fire authority 31/7/05 30/6/05 31/7/05 31/8/05 30/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 12 Good Practice Recommendations Ensure that staffing arrangements are sufficient to support service users attendance at their day activities Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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. Extracts may not be used or reproduced without the express permission of CSCI Lotus House I51 S57612 LOTUS HOUSE V221499 120505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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