CARE HOME ADULTS 18-65
Lotus House 34 Lansdowne Road Bedford Bedfordshire MK40 2BU Lead Inspector
Dragan Cvejic Unannounced Inspection 30th December 2005 09:00 Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 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.V275665.R01.S.doc Version 5.1 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.V275665.R01.S.doc Version 5.1 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) Mentaur Limited Mrs Rosana Goodyear Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No service users who need the assistance of a mobility aid shall be admitted to the home. The manager must complete an NVQ Level 4 in care and registered manager`s award by 31st December 2005. 12th May 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. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during 3 hours in the morning a day before New Years eve. Four service users were present in the home and two of them commented on their lives in the home and one generally chatted to the inspector, mainly due to his limited communication skills. A case tracked service user did not have clear communication ability and exchanged just a few basic words with the inspector. Two staff members and the manager provided information, too, for this report. A partial tour of the house showed that the home was well maintained and clean. A service user invited the inspector into his room and one more bedroom was inspected as part of the case tracking methodology. The home seemed settled, stable and pleasant to live and work in, and the atmosphere created by the new manager was positive, open and inclusive. At the time of the inspection all service users were male, but both manager and users spoken to stated that a female user could be admitted if referred. What the service does well: What has improved since the last inspection? Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 6 The biggest improvement since the last inspection was the appointment of the new manager. She was experienced and skilled. She created an open and inclusive atmosphere. Not only staff, but the service users too, felt empowered and respected in a pleasant environment with the new manager in post. One service user called her by name and stated: “She is the best manager.” The manager responded to the requirements from the last inspection and arranged for a chiropodist and optician to see all service users. A newly admitted user was allowed to remain registered with his GP and dentist, as he wanted. The manager addressed maintenance issues and most identified faults, such as damp on one wall, were resolved and repairs were carried out promptly. 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. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 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.V275665.R01.S.doc Version 5.1 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): 1,2,3,5 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: The new manager reviewed and updated the statement of purpose and the service user’s guide, illustrating changes regarding her appointment. Service user’s guide was revised after consultation with service users and their relatives. The manager stated that the user’s guide was explained to service users that were unable to fully understand its content in the presented format. The latest admission demonstrated that all aspects of needs were assessed and information about user’s needs were gathered and analysed carefully before the decision on admission was made. The trial period for a new service user also effectively confirmed that his identified needs could be met. The continuing support by previous professionals involved in the care of the new user was negotiated and ensured. The service users spoken to stated that their needs were met, but the manager re-designed the format for care plans to be able to record how needs were going to be met. The draft form had not been used by the time of the inspection. A signed copy of the contract demonstrated that terms and conditions were provided in written form and explained to service users and their relatives. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 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): 6,7,8,9,10 The new suggested format for care plans was more appropriate. Once the home starts using this format, including a description of how the goals would be met, the outcomes would be evidenced and visible. However, at the time of the inspection this was not the case. There are good basic systems for consulting service users and they feel included in day-to-day decision-making. EVIDENCE: The existing care plan did not indicate how needs would be met. Therefore, the manager devised a new format for recording the planned and agreed actions. This new format was in a draft form at the time of the inspection. The existing risk assessments were very detailed and were not used as working documents. This was another document revised by the manager in order to summarise risks, detailing the most hazardous, and to be used as working documents by all staff and not to represent a paper exercise. There was a plan to transfer some aspects of care from risk assessments to the new care plans and to bring both documents closer to Care Standards requirements, but the action was not executed by the time of the inspection.
Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 10 Service users confirmed that, with the new manager in post, their decision making rights were much more promoted and respected. A service user expressed the wish to save money and learn about the management of his financial affairs. He also stated that he planned to start college next year and needed staff support to do that. The manager improved service users participation in the daily life of the home. She introduced regular meetings and added an agenda item of updating service users when new policies and procedures were introduced by the organisation, or asked users for their comments when policies and procedures were reviewed. Service users spoken to confirmed that they were informed and included in this process. The home displayed the Data Protection Act and the manager promoted confidentiality. However, when new care plans become operational, the home would need to prove how the service users were involved in the planning process. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 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): 11,12,13,14,15,16 The home encouraged service users to positively engage in personal development and, using the support provided by the home, to work towards their own goals and objectives. EVIDENCE: Service users spoken to confirmed that there were opportunities for them to work on personal development. A user stated: “I can use my karaoke machine when I want. I attend college, too and I have just got a certificate for the course I finished.” The manager displayed the certificate that encouraged other users to think positively of training and education. Another user expressed the wish to attend college next year and the manager stated that she would personally support him. Another service user was working voluntarily in a day centre’s woodwork workshop. The home provided information about local events and opportunities regularly to service users and this was one of the agenda items on users’ meetings. The manager was providing transport for a user who was going home for New Years eve on the day of the inspection.
Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 12 Karaoke, playing guitar, going for swimming and many other activities were provided in and out of the home for service users. Staff were observed talking to service users during the inspection in a respectful and friendly way. Staff did not enter users’ bedroom without users’ permission. Service users were deciding on daily routine on their regular weekly meetings. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 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): 19,20 The home promoted service users health by arranging for regular health checks with relevant appropriate professionals. Medication process needed re-arrangement in order to ensure potential for effective monitoring and auditing. Once introduced, these measures would promote the protection of service users. EVIDENCE: Service users spoken to confirmed that their healthcare needs were met. The manager explained that the home engaged external professionals to ensure that these needs were met. She counted professionals involved: physiotherapist, occupational therapists and community psychiatric nurses, among others offering primary healthcare support. All service users had been seen by a chiropodist and an optician since the last inspection. Medication procedure was appropriate. Records checked against amount of medication were correct. Some medication was delivered in blister prepackaged containers, while some was still delivered in boxes. The manager had difficulty in monitoring and auditing medication due to this existing system. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 There were robust systems for dealing with complaints and service users knew how to use them. EVIDENCE: The home had a clear and straightforward complaints procedure. A simplified, illustrated procedure was produced for service users with limited communication skills. The home had not received any complaints since the last inspection. A service user spoken to stated that he knew how and where to complain if he wanted to. Another user asked for contact details to the CSCI inspector as he stated: “Just in case”, and two cards with contact details were given to both users, in addition to the CSCI details already stated on their complaints procedure. The manager stated and two staff members confirmed that they attended POVA - Protection of Vulnerable Adults training. There were no POVA referrals. The home had a “Restraint procedure” in place that instructed staff that no physical restraints could be executed. The procedure referred to a “separation” restraint. The manager stated that by having sufficient staff on duty this procedure was rarely used and that any event that would require this intervention would be recorded and reported. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,28,30 The standard of the environment in this home is mostly good, providing service users with an attractive and homely place to live. EVIDENCE: The home was appropriate for service users and their conditions and regularly maintained to ensure comfort was offered all the time. Two users’ rooms were inspected and met their needs. One service user invited the inspector to show his room and proudly stated: “I love my room. I have everything that I need here.” The manager showed a respect to a service user who wanted some pieces of furniture removed temporarily. A wardrobe and curtains were temporarily removed from the bedroom on the specific user’s demand, but the manager explained that staff would talk and explain to this user the necessity of having those items in the bedroom and return them when the user agrees. The shared space in the house was appropriate for existing service users and staff and allowed staff to work effectively with users who felt comfortable in these areas. The home had adequate washing facilities. It was clean and bright at the time of the inspection.
Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 16 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): 31,33,34,35 A competent, committed and skilled staff team ensured that consistency of care and protection of service users was ensured. Staff were well supported in their hard work with service users. EVIDENCE: The staff spoken to expressed a good knowledge of their roles and duties. Two staff confirmed that they were familiar with the aims and objectives both of the home and individual service users. A service user talked about his key-worker with enthusiasm and trust. The atmosphere of friendliness and trust was observed several times during the inspection. The manager stated that the staff team was compact and with a full staff complement, the rota ensured appropriate staff cover at all times. Some staff were trained in Makaton and all staff could effectively communicate with service users. Weekly appointments with external professionals were planned in advance. External professional were engaged and involved in the care process and the home kept records of their visits and input. The training programme included more than five training events in a year for all staff. At least one training event took place in the home every month. The latest training session organised was one on combined mental health and
Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 17 learning disability, and on appropriate recording of epileptic related reactions for individuals suffering from epilepsy. Recruitment process was done co-operatively with HR from head office and the manager was a member of the interviewing panel. The company’s HR ensured that all pre employment checks were carried out. The copies of staff documents were kept in the home. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 37,38,42 The home was managed in an open and inclusive style. Service users benefited from the management style, as their views were taken into account and their rights promoted. EVIDENCE: The new manager had settled in the post and had just submitted her application for registration. She created an open and innovative atmosphere, where staff potential was effectively utilised to meet the needs of service users and to achieve the home’s objectives. Staff confirmed that they enjoyed working in this home with clear and effective leadership. Two staff spoken to stated that they felt well supported and trained to do their jobs. All staff were familiar with company and the home’s policies. Any change or new policy was discussed at regularly held staff meetings. New relevant policies were also put on the agenda of service users’ weekly meetings and allowed their involvement. Safe working practices were in place and were promoted. All staff attended refresher training for all mandatory courses. In addition, the observed practices of work demonstrated safe conduct.
Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 3 3 X X X 3 X Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement The manager must ensure that the new, drafted format for care plans is introduced into working practice and filled in and reviewed regularly for each service user. Timescale for action 31/03/06 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 Refer to Standard YA7 Good Practice Recommendations The service users’ rights to control their finances and receive regular updates on the balances should be introduced as a regular working practice and documented in care plans and other appropriate documents. The manager should continue with the development of risk assessments in a format that would be used in practice and ensure that users are not limited to explore new areas of their interest with measures in place to minimise the risks. The home should negotiate and arrange for all regular medication to be delivered pre-packed in blister packs, already in use to avoid confusion and minimise the risk for
DS0000057612.V275665.R01.S.doc Version 5.1 Page 21 2 YA9 3 YA20 Lotus House mistakes. Lotus House DS0000057612.V275665.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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
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