Inspection on 10/01/06 for Loxwood House

This inspection was carried out on 10th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Loxwood House 30/09/08

Loxwood House 16/11/06

Loxwood House 05/09/05

Loxwood House 02/03/05

Loxwood House 06/07/04

Loxwood House 01/08/02

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

CARE HOME ADULTS 18-65 Loxwood House 17 Old Shoreham Road Hove East Sussex BN3 6NR Lead Inspector Niki Palmer Unannounced Inspection 10th January 2006 09:30 Loxwood House DS0000014210.V276651.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 Loxwood House DS0000014210.V276651.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. Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Loxwood House Address 17 Old Shoreham Road Hove East Sussex BN3 6NR 01273 503586 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) Loxwood House Limited Mr & Mrs Mallinson Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Only adults with a learning disability who have been assessed as requiring residential care are to be accommodated. The maximum number of service users to be accommodated is 12. Service users must be aged between 18 and 65 years on admission. Date of last inspection 5th September 2005 Brief Description of the Service: Loxwood House is a family run home, which is registered to provide accommodation and personal care for up to 12 adults with learning disabilities. The Registered Providers and Managers are Mr and Mrs Mallinson who have owned the home since 1985. The home is located in Hove near Brighton. It has good access to local transport, shops and other amenities. Loxwood House is a large detached property set out over three floors. There is no lift provided at this home. The home comprises of eight single and two shared bedrooms. Two lounge areas are available for residents to use and a large garden area to the rear of the property, which can be used when the weather permits. Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Loxwood House will be referred to as ‘residents’. This unannounced inspection took place on Tuesday 10th January 2006 between 09:30am and 5:00pm. The inspection began by having discussions with the owners of the home in respect of progress made since the last report. In order to gather evidence on how the home is performing, individual discussions took place with six residents and four members of staff. 12 residents were accommodated at the time of the inspection. Other records and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, two care planning records, the home’s systems in place for the protection of vulnerable adults, staffing levels, staff recruitment files and conduct and management of the home in respect of health and safety. Following the inspection, the Inspector made telephone contact with two of the local day services used by residents. Their feedback has been reflected throughout this report. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection report carried out on 05th September 2005. What the service does well: What has improved since the last inspection? All records required were available for inspection on the day. Staffing hours have been increased, which enables residents to spend time doing a one-to one activity of their choice. Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 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. Loxwood House DS0000014210.V276651.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 Loxwood House DS0000014210.V276651.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 and 2. Sufficient information is provided to prospective residents in order to help them make a decision of where to live. All residents’ needs are assessed prior to admission; this helps to ensure that no person is admitted to the home whose needs cannot be met. EVIDENCE: The home has a detailed Statement of Purpose and Service Users’ Guide in place, which includes details of the homes’ overall aims and objectives, organisational structure, admissions procedure, the arrangements in place for residents to engage in social activities, the homes complaints procedure and fees charged. Although both documents provide the reader with sufficient information to help them choose if the home is appropriate for them, it is required that the address and telephone number of the local Commission for Social Care Inspection (CSCI) office be included within the Service Users’ Guide. Most of the current residents accommodated have lived at Loxwood House for a number of years. There have been no new admissions since the last inspection. The owners confirmed that previous referrals have been made to the home by either local or out of county Social Services Teams. Two preadmission assessment forms for existing residents were seen during the inspection. A thorough assessment of individuals’ needs had been carried out prior to admission by the owners alongside the prospective residents and their families / representatives. Loxwood House DS0000014210.V276651.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 and 7. Residents are supported well by the home to make individual choices regarding many aspects of their lives. This helps to ensure that individual needs and aspirations are achieved. EVIDENCE: Two individual plans of care were examined in some detail during the inspection. Both were found to be sufficiently detailed and provide staff with sufficient information in order to ensure that all activities of daily living are met. A good level of personal information and individual profiles are also detailed. It was pleasing to note that clear goals for the future had been devised alongside the residents and recorded within the plans of care. These are reviewed on a regular basis. A recommendation has been made for the home to include personal achievements that have been reached for residents since the last review. Many of the residents attend local day centres, where they have access to advocacy groups. Whilst all of the residents spoken with said that the care staff support them to make their own decisions with regards to many aspects of their lives to the best of their capabilities, multi disciplinary support is also sought by the home on an individual basis. Care plans showed that where this Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 10 has taken place it has been very well handled and documented in order to support individuals to make an informed choice and decision about his or hers lives. Loxwood House DS0000014210.V276651.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): 12, 16 and 17. Loxwood House provides residents with a varied lifestyle and different opportunities to meet individual needs. EVIDENCE: All residents attend a number of day centres in close proximity to the home – anything between one to five days a week. Should someone wish to stay at home during the day if they are feeling unwell for example, one of the owners is always available. A number of evening groups are also available: music and dance, advocacy and a local learning disability club. Residents confirmed that generally weekends are very relaxed and they can choose whether or not to go shopping, out for lunch, day trips or just stay at home and watch television. Since the last inspection one member of staff has been allocated seven ‘floating hours’ per week. This provides residents with opportunities to be assisted with one-to-one activities of their choice. Some of the care staff spoken with commented that one of the older residents spends much of her time at home, particularly on a Friday. It is recommended that the allocation of ‘floating hours’ be reviewed in this instance to ensure that some one to one time is given to this particular resident on a Friday. Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 12 Most of the residents returned home from their day centres at approximately 3pm on the day of the inspection. It was evident during this time that residents have developed positive and close relationships with each other, the owners of the home and care staff. All residents are addressed by their preferred term and are treated as valued and respected members of the home. During the period between arriving home and before dinner, most of the residents spend time relaxing in their rooms or engaging with each other. Some of the residents help to prepare for the evening meal i.e. laying the tables and bringing food in from the kitchen to the dining areas. Despite the owners saying previously that they plan to involve residents more in some aspects of food preparation, this has yet to be implemented. Loxwood House DS0000014210.V276651.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. The healthcare needs of residents are well met and there is evidence of good multidisciplinary working taking place. EVIDENCE: All residents are registered with a local General Practitioner and dentist. They are supported to all healthcare appointments by either one of the owners or care staff. It was pleasing to note that regular input is also sought from the local Community Learning Disability Team comprising of Community Nurses, Psychologists, Speech and Language Therapy and Psychiatry. All specialist input is detailed within individual plans of care. The owners have a good understanding of individual healthcare needs. Where necessary they arrange regular blood tests to monitor particular medication levels. Although details of all healthcare appointments are recorded centrally within the home, it is recommended that records are also made within individual care plans. It was noted in one individual care plan that one resident has a diagnosis of epilepsy and is prescribed medication accordingly. Although he has not experienced a seizure for many years, the home must detail the action that staff must take in the event of a seizure occurring. Loxwood House DS0000014210.V276651.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): 23. In order to safeguard residents from harm, the home needs to ensure that all suspected abuse is reported without delay to the appropriate agency. EVIDENCE: The home has a detailed policy and procedure in place for the Protection of Vulnerable Adults in accordance with local multi-agency guidelines. Whilst the owners and care staff were able to demonstrate a sound knowledge of what constitutes abuse, a recent incident occurred, which was not reported to Social Services at the time. Although comprehensive strategies were introduced by the home immediately to safeguard the resident from harm, the correct procedure was not followed in this instance. The home is required to review the current procedure and refresh all staff with in-house training. Loxwood House DS0000014210.V276651.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. This home provides residents with an attractive, clean and homely place to live. EVIDENCE: A brief inspection of the premises took place. All areas were found to be clean, tidy and well-maintained. A housekeeper is employed to work 22 hours per week. All residents’ bedrooms are decorated to their own preferences, and furnished with personal belongings. Some of the residents have a key to their bedroom door. Those spoken with said that although they have never had a need to worry about their personal belongings, having a key makes them feel more independent. Loxwood House DS0000014210.V276651.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): 34 and 35. The recruitment and training of staff needs to be developed to ensure that resident’s individual and joint needs are appropriately met. EVIDENCE: Three staff recruitment files were seen during the inspection. Although all were found to contain a recent Criminal Record Bureau (CRB) and PoVA First check, concerns were raised in respect of references. The owners were reminded of their responsibilities to ensure that two suitable references are obtained prior to employment. It is not acceptable for references to be supplied from family members or close friends. Three staff induction and training records were seen. The vast majority of the staff team have up to date fire training, basic food hygiene, medication and adult protection training. Indeed, medication training was delivered to all staff by a local pharmacist on the day of inspection. It is outstanding for one member of staff to have up to date training provided for moving and handling. The owners were also reminded of their responsibility to ensure that all mandatory training is provided and updated as necessary. Details of these have been provided by the CSCI. Whilst staff confirmed that thorough induction training to the home is undertaken within the first two weeks of employment, not all records were signed and dated. A requirement has been made in respect of this. Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 17 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): 41 and 42. Loxwood House is a well-run family home, however the safety and welfare of residents is compromised. EVIDENCE: It was pleasing to note that the vast majority of records requested on the day of inspection were available. This has improved since the last inspection. A number of the home’s records in respect of health and safety checks were available, but not all had been regularly and recently completed. For example: hot water checks, fire drills and emergency lighting. Requirements have been made in respect of this. It became apparent through discussion with the owners that there is a need for them to familiarise themselves with the current legislation and requirement checks under the National Minimum Standards (42). Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 18 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 X X X X X X 3 1 X Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5(1)(f) Requirement That the address and telephone number of the local CSCI office be included within the home’s Service Users’ Guide. That detailed actions for staff to follow in the event of a seizure occurring are recorded within the individual’s care plan. That refresher training is provided to all staff in relation to the procedures that are to be followed in the event of reporting suspected abuse. That two written references are obtained prior to employment. That manual handling training is provided for one staff member [THIS IS OUTSTANDING FORM THE PREVIOUS INSPECTION REPORT]. That induction records are signed and dated once complete. That mandatory training is planned and budgeted for all staff. That the owners familiarise themselves with requirements under NMS 42 and ensure that all health and safety checks are carried out as necessary and DS0000014210.V276651.R01.S.doc Timescale for action 30/04/06 2. YA19 15(1) 28/02/06 3. YA23 13(6) 28/02/06 4. 5. YA34 YA35 18(1) & Sch 2. 18(c)(i) 13(5) 10/01/06 30/04/06 6. 7. 8. YA35 YA35 YA42 18(c)(i) 18(c)(i) 12(1)(a) 30/04/06 30/04/06 28/02/06 Loxwood House Version 5.1 Page 20 recorded. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA6 YA12 YA17 YA19 YA34 Good Practice Recommendations That residents’ personal achievements that have been reached since the last review are recorded within their plans of care. That the allocation of ‘floating hours’ be reviewed in order to engage one resident with one-to-one support on a Friday. That residents are encouraged to participate in the preparation of food. That details of all healthcare appointments are recorded within individual care plans. That the home’s application form is amended to allow for details of the referees capacity in which known to the applicant. Loxwood House DS0000014210.V276651.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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