Inspection on 23/06/08 for Lucerne House

This inspection was carried out on 23rd June 2008.

CSCI found this care home to be providing an Poor service.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lucerne House 22/12/08

Lucerne House 05/09/07

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Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME ADULTS 18-65 Lucerne House 12 Mitten Road Bexhill-on-Sea East Sussex TN40 1QL Lead Inspector Alexis Reilly Unannounced Inspection 23rd June 2008 09:30 Lucerne House DS0000069865.V367564.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 Lucerne House DS0000069865.V367564.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. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lucerne House Address 12 Mitten Road Bexhill-on-Sea East Sussex TN40 1QL 01424 224181 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) lucernehouse@fsmail.net Care Pro (South East) Ltd Mr Ian David Watson Care Home 8 Category(ies) of Learning disability (0) registration, with number of places Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 8. Date of last inspection 5th September 2007 Brief Description of the Service: Lucerne House is a detached property located in a quiet residential area of Bexhill within easy walking distance of the town centre shops. There is a large garden for use by residents. At the rear of the house, a chalet-type summerhouse serves as an administration office. The home is currently registered for eight adults with learning disabilities. Residents private and communal accommodation is provided on three floors and maintained to a high standard. All but one of the rooms has en-suite facilities and one of the bathrooms has a hoist to enable assisted baths. The home has its mini-bus type vehicle. A suitable laundry room to replace the shed type facility is currently in the process of being finished. The current fees charged ranges from approximately £400 to around £850 per week. The current 8 Residents have lived in the home for several years. The latest Inspection report is sent out to any enquirer who expresses an interest in the home. A copy of the report is kept on display in the home with a copy obtainable via the manager. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an Unannounced key Inspection, which included a visit to the home which took place between 9.30am and 2.30pm on the 23rd June 2008. During the inspection the inspector looked at a number of documents, these were the staffing rota, complaints book, incident book, accident book, care plans and risk assessments, recruitment files, adult protection procedure, and sheets which record the administration of medication. The Inspector also examined the service user guide, looked for evidence of person centred care plans, comprehensive risk assessments and the promotion of advocacy services. During the inspection the inspector spent time talking to three residents at the home, the other residents were at a day centre or staying with a relative. The inspector interviewed two staff and spoke with the Registered Manager. Due to an ongoing Adult Protection Investigation comments from external agencies are not included in this report, as it may be detrimental to the investigation. This inspection focused on assessing whether the home was building upon adequate outcomes, in order to improve quality of life for the residents placed in the home and meet their individual needs. During the Key inspection on 5th September 2007 a number of requirements were made. During this current inspection it is evident that those in relation to the following standards YA 5,9,12,20,30,33,35 and 39 have still not been met, and the timescales have elapsed. These cover the following areas of the service, residents’ terms and conditions and use of mobility allowance, risk assessments, activities available within the home, the correct procedures for administering medication, laundry facilities, staffing levels, induction for staff and the annual development plan. During the last key inspection on the 5th September 2007 previous good practice recommendations were made in relation to standards YA 1 and 7, service user guide and advocacy. These had also not been addressed by the Registered Manager and are now requirements. As a result of this inspection new requirements have been made for the following standards YA 6, 34, and 36. These are in relation to the need for person centered care plans, and the correct procedures with regard to supervision and recruitment of staff. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 6 Of most concern to the Inspector was that all but one resident had been taken on holiday abroad and no risk assessments had been produced or put in place for this. Of eight-outcome areas, three are judged to be adequate and five are judged to be poor and need urgent improvement. What the service does well: What has improved since the last inspection? The current building work is nearing completion which will allow for a purpose built laundry room, office and three extra bedrooms. Residents care plans have improved and are now all the same format. The Registered Manager now shows clearly which of his hours are used for Management and which of his hours are for care. Staff within the service have received a variety of training over the last 12 months this includes Adult Protection Training January 2008, Learning Disability Today October 2007 Food Hygiene October 2007, Moving and Handling October 2007, First aid for Carers September 2007, Rectal diazepam October 2007, Fire Safety Training October 2007, Managing Adult Protection Concerns May 2007, Fire Prevention and Protection April 2007, Health and Safety and Infection Control November 2007. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 7 What they could do better: The Registered Manager and Registered Provider have not ensured the residents are protected and their best interests are safeguarded. The Registered Provider has not ensured that residents have appropriate terms and conditions of contract which in particular clarify the use of mobility allowances the residents receive and how residents will be charged for mobility services. This was a requirement from the previous inspection and the timescale of 5th December 2007 has lapsed. The Registered Manager must ensure all residents have a risk assessment, and that they are comprehensive and reviewed. These should include personal risks as well as environmental risks. The Regulation Inspector was extremely concerned to find that all but one resident left the country to go on holiday and no risk assessments for this activity were in place. This was a requirement from the previous inspection and the timescale of 5th December 2007 has lapsed. The Registered Manager has not ensured there are any activities of any substance organised within the home, the Registered Manager must ensure that residents are consulted with in relation to creating suitable activities which meet their diverse needs. This was a requirement from the previous inspection and the timescale of 5th December 2007 has lapsed. The Registered Manager has not ensured that medicines are administered following the Medicines Act and guidelines from the Royal Pharmaceutical Society. This was a requirement from the previous inspection and the timescale of 5th December 2007 has lapsed. During the inspection only two staff were on duty and this is the normal practice of the home, this is insufficient to meet the comprehensive and full needs of the residents placed within the service. The Registered Provider has failed to ensure that a review of the staffing levels is carried out in relation to the assessed needs of the residents. This was a requirement from the previous inspection and the timescale of 5th December 2007 has lapsed. The Registered Manager has not ensured that all new staff receive an appropriate induction in to the job, and new staff have started without the 12 week skills for care induction. This was a requirement from the previous inspection and the timescale of 5th December 2007 has lapsed The Registered Provider and Registered Manager have failed to ensure that time is allocated for reviewing the quality of the service on a sufficiently regular basis. This includes all aspects of the home in particular person centred care plans, risk assessments and available activities. The Registered Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 8 Manager and registered Provider have failed to produce an annual development plan for 2008, which is based on the views, needs and wishes of the residents placed in the service. This was a requirement from the previous inspection and the timescale of 5th December 2007 has lapsed In addition to the above concerns one member of staff was working without a recruitment file in place and without references. Advocacy services were not in place. The Regulation Inspector also found that incidents were not reported to the relevant organisations and that staff supervision is not carried out for staff or Management within the home. The Registered Manager has made statements in the AQAA and the inspector had not been able to find sufficient evidence to confirm these statements during the inspection. The service has a current Adult Protection investigation taking place. All current staff members including the Registered and Deputy Manager in the home have currently been suspended pending the outcome of the investigation. 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. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 9 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 Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 10 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 & 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. The home needs to ensure residents have sufficient information about the service prior to moving in to enable prospective residents to make an informed judgement. This has not been achieved by the service user guide Charges and use of the service users mobility allowance remain vague. The service does not promote person centred planning. EVIDENCE: The home has not yet devised a Service User guide in an accessible format suited to the diverse communication needs of Residents. The Registered Manager has updated the Service User guide with some pictures however this is still not sufficient to enable prospective residents to make an informed choice about the service. The statement of purpose and the resident guide do not give prospective residents clear relevant information about the home. The Registered Manager informed the inspector that person centred planning has been put on hold until the building work is finished, and then they have an Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 11 interactive computer system which will allow staff to look at residents hopes and dreams with them and do more person centred work. The Registered Manager has still not ensured that revised contracts clarify the use of mobility allowances and additional charges. Therefore the terms and conditions documents do not reflect the information required by the changes to regulations effective from 2006 such as specific reference to extras. Residents and their families are not clear about what is covered by the fee and may find they need to make additional payments for services. The current range of fees is from £400 to £854.34 per week. Residents have moved into the home for several years. No new The Registered Manager discussed with the Inspector his plans to create a introduction DVD ‘welcome to our home’, which will be made available to all prospective residents, along side this will be created a welcome pack which includes a easy read service user guide and statement of purpose. The inspector saw no sufficient steps achieved to creating this at the inspection. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. Residents do have care plans in place however these are not person centred. Not all residents have risk assessments in place, and of most concern is that all but one resident was taken abroad on holiday and the Registered Manager did not produce risk assessments to protect the residents from risk. Routines at the home are not person led. Residents would benefit from having more control of their own life and by having the opportunity to make their own choices and decisions, by being treated as an individual and being involved in the development of their care plan. Contact with advocacy services is not promoted. EVIDENCE: Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 13 Routines at the home are task based and not person led. The inspector saw no evidence of people living in the home having real choice other their lives, and being given the opportunity to make their own choices and decisions. The service has limited knowledge about communication styles, this is evident in the attempt to produce a pictorial service user guide. This results in people who use the service having very limited opportunity to express themselves’ and to be treated as an individual. There is no evidence of the individual being involved in the development of their care plan. The Inspector examined all the care plans of the residents placed within the service. Residents within the service do have a current care plan in place, however these are not person centred. The Registered Manager informed the inspector that he would be looking at person centred work with the residents and identifying goals and aspirations when the new computer system is put in place. Current care plans include a preferred name, previous address, next of kin, and a list of medication on admission, a list of current medication was not recorded in the care plans. The care plans focus on residents long term needs assessment which includes, physiological, and physical assessments. Care plans are reviewed every 6 months, the following areas were covered or made reference to, eating and drinking, observations, personal care, dressing, mobility, vision, hearing, oral health, medical practice, foot care, working playing, personality, expressing sexuality, personal safety, risk, areas of need, personal hygiene, oral hygiene, eating and drinking, continence, mobility, sleep, social needs, behaviour and activities. The Registered Manger had stated in his AQAA he had evidence of person centred plans, the Inspector in discussion with the Registered Manger and examination of the care plans was unable to find evidence to confirm this statement on the day of the inspection. The inspector found that two residents had no risk assessment available at all. Of particular concern was the lack of risk assessments for any of the residents in relation to the recent holiday abroad, the inspectors concerns were heightened further by comments recorded in the risk assessments of the residents placed. Such as ‘high risk of leaving house without staff knowledge’ ‘risk of wondering’ ‘wondering off with strangers risk assessment’. One resident is at risk of seizures, information is included in their care plan and a risk assessment is in place. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 14 A requirement was made at the last Key Unannounced Inspection to explore advocacy services for residents’ this had still not been done at the time of the current inspection. This leaves residents vulnerable who have little or no family involvement, and ensures in turn that individuals are not aware of their rights in the home. In discussion with the three residents available during the inspection it was clear that they had enjoyed their recent holiday and the following comments were made. ‘Went out at night’ ‘I have a picture of me with the dolphins’,Could eat what we want’. ‘It was great’. One resident also commented on how she enjoyed splashing in the pool in the garden. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 15 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): 12, 13, 15, 16, & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. Residents do not have the opportunity to participate in appropriate activities within the home, they may access the local community however the Registered Manager has not ensured all resident have risk assessment in place to protect them from risk in this activity. Resident do help with getting the food shopping however it is unclear as to whether this is because they feel they are expected to go shopping or whether it is from boredom through lack of available activities in the home. EVIDENCE: During the morning of the inspection three residents were present in the home. The inspector joined the residents for tea in the morning in the garden, during the inspection the inspector observed the same residents sitting drinking more tea, and pegging out the washing, but not being directed or encouraged to participate in any meaningful activity. The Registered Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 16 Manager informed the inspector that art and aromatherapy are offered once a month. The Registered Manager also informed the inspector when challenged about the minimal staffing levels in the home, that if activities were to be offered the Registered Manager would ensure staff are brought in to provide extra hours to support this. The inspector was not made aware of the provision for any forthcoming activities or increased staffing hours within the home. Some residents attend day centres and they are involved in activities there. Contact with families and friends are encouraged. Menus rotate regularly and are varied. The Registered Manager informed the inspector that menus are discussed every Thursday with Residents, based on planning the following week’s menu along with the shopping required. The Inspector examined the food stocks on the day of the inspection, these were low but the Inspector was informed that the next day was the shopping day when more food would be brought. Resident do help with getting the food shopping however it is unclear as to whether this is because they feel they are expected to go shopping or whether it is from boredom through lack of available activities in the home. Residents are not consulted or listened to regarding their choice of daily activity. Staff choose the activities, if they are provided. There is a danger that the residents can become over-compliant with the routine of the home. The inspector found no evidence that the service is person centred in its approach to supporting people that use the service. Resident do have monthly meetings in the home, although the inspector did not examine these minutes during the inspection. The Registered Manager has detailed in his AQAA that he has tried to get a interpreter for one of the residents placed within the home but has been unable to do so. The Registered Manager detailed in the returned AQAA individuals are able to participate in lots of outside activities college, groups etc access to music therapy and aromatherapy’ ‘our evidence shows a broad variety of activities both in and out of the house’, the inspector was unable to find sufficient evidence to confirm this on the day of the inspection. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 17 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. People who use this service experience adequate outcomes in this area. Medication training is up to date for all staff. Personal care is administered correctly and choice is given to residents this is demonstrated in care plans. However good practice guide lines in relation to the administration of medication must be followed to ensure the residents safety at all times. EVIDENCE: Records indicated that no current Residents have been admitted to Accident and Emergency over the last year. Records and observation showed that a range of identified health needs are regularly and promptly met such as dental, eye tests, and epilepsy needs. Care plans demonstrated adequate practice in relation to delivery of personal care one example was of a resident being given choice out of three outfits to wear. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 18 Sheets which record the administration of medication were examined and found to be in order however the inspector found no sample list of staff signatures for administering medication and no up to date photographs of residents on the MAR sheets. Staff have completed the training on the safe handling of medication and also some training in particular for the medical needs of one resident. The service has a copy of the guidance form royal pharmaceutical society in the home. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 19 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 People who use this service experience adequate outcomes in this area. The service has a current Adult Protection investigation taking place. All current staff members including the Registered and Deputy Manager in the home have currently been suspended pending the outcome of the investigation. The service has a complaints and concerns recording system. There were no records of complaints made by residents kept at the home. There is no evidence of the service valuing complaints or improving outcomes for people as a result of complaints. The Registered Manager does not protect the interests of the residents placed within the home, and does not notify the relevant organisations about incidents which may affect the residents within the home. All staff have completed training on Adult Protection. EVIDENCE: There was one recorded complaint from a residents’ relative with regard to washing this was dated January 2008. The service has no information about Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 20 any complaints made by residents in the home. During the inspection the Registered Manager informed the inspector about an incident which happened with regard to a resident placed and transport to a day centre. This incident had not been reported to the relevant organisation or the CSCI, therefore the Registered Manager is not ensuring that residents are safeguarded and protected. The Inspector saw no evidence that complaints made by residents are acknowledged or valued, or responded to appropriately, this may be due to poor procedures and people using the service being disillusioned or scared of complaining. The service presents as being run ‘by the staff for the staff’ rather than the focus being on the protection of the person using the service or of working in a person centred way. This is evidenced by the lack of thought with regard to supervision of staff. Currently the Registered Manager and Deputy Manager and at least one care team member are related. The Registered Manager has given no thought or importance to ensuring that sufficient supervision procedures are in place to ensure whistle blowing or incidents of Adult Protection can be dealt with effectively. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 21 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, & 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service experience adequate outcomes in this area. Residents live in a well maintained home with a pleasant garden. sufficient laundry facilities within the home are still not in place. However EVIDENCE: The inspector toured all communal areas and the one bedroom, which is shared. The home was found to be clean, well maintained and homely. The Registered Manager confirmed that fire checks and training is carried out appropriately. The kitchen was found to be clean and well maintained. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 22 The care plans of two residents who share a room have now been updated to show agreement in writing. The home is currently finishing building work which will result in the creation of three further bedrooms and an office, and will resolve the long standing issue of having a suitable laundry room. The laundry currently is in a lean to in the back garden and does not benefit from suitable flooring and related infection control measures. The home’s fire procedure is well displayed throughout the home and benefits from a modern fire detection system. The outside garden is spacious, well-maintained, and popular with Residents. The residents and staff grow their own vegetables in the garden and this was also very popular with the residents spoken to on the inspection. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 23 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 poor This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. Residents would benefit from more staff to enable relationship building and provide a person centred approach to the delivery of care. Increasing the staff time would also enable a greater emphasis to be put on the provision of activities within the home. Residents are not protected by the recruitment procedures or staff supervision procedures within the home. EVIDENCE: The manager confirmed that he has the Skill for care 12 week induction in the home, and has these workbooks in place but had not completed them with staff prior to them commencing National Vocational Qualification in Care. The Registered Manager has now clarified the different hours he works within the home on management and caring, and mandatory staff training is up to date. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 24 However staff are not regularly supervised. The Registered Manager and Deputy Manger also have no formal supervision in place. The Registered Provider did carry out a regulation 37 visit the previous Saturday, this has not been forwarded to the CSCI. The Registered Manager is currently completing NVQ level 4, One staff member is dong NVQ level 2 and the rest of the staff are completing NVQ level 3 apart from one staff member who has currently achieved NVQ level 3. The inspector had a detailed conversation with the Registered Manager with regard to lack of risk assessments and staffing levels whilst on holiday. The Registered Manager informed the Inspector he had previously been told he didn’t need risk assessments if clients were on a one to one with staff. The Registered Manager informed the Inspector initially that seven staff members when on the holiday, after further consideration it became apparent it was actually six staff, one of whom did not have a recruitment file available to view at all on the day of the inspection, but did have a up to date CRB. In discussion with one of the staff members they informed the inspector ‘I wasn’t in charge of any of the residents as I had brought my baby on holiday with me, but I would stay behind if residents wanted to stay by the pool.’ With regard to the missing recruitment file, the Registered Manager did make a effort to find it and then stated he only had a CRB as the recruitment file had gone missing when the last Registered Manager had left. The current staffing levels of two care staff during waking hours does not allow for person centred support and means that personal care needs are the limit of support provided. The level of staffing severely restricts the ability of the service to deliver person centred support, or provide activities. Staff within the home have had a range of training in the last 12 months these include Adult Protection Training January 2008, Learning disability today October 2007 Food hygiene October 2007, Moving and handling October 2007, First aid for carers September 2007, Rectal diazepam October 2007, Fire safety training October 2007, Managing Adult Protection Concerns May 2007, Fire prevention and protection April 2007, Health and safety and Infection Control November 2007, Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 25 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, 38, 39, & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. Residents would benefit from a Registered Manager who formally evaluates the service and has a plan in place to move the service forward. The Registered Manager does not ensure the residents within the service receive person centred care and residents are put at risk from poor practices within the home. The Manager must ensure all risk assessments are in place and that staff are recruited and supervised in line with the National Minimum Standards. EVIDENCE: The registered manager has not ensured the residents are protected and their best interests are safeguarded, residents risk assessment are not in place, no Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 26 activities of any substance are organised within the home, staffing levels are minimal, recruitment files are not up to date, and advocacy services are not in place. Incidents of note are not reported to the relevant organisations. Supervision is not carried out for staff or Management within the home. However mandatory training is up to date and the Registered Manager is enrolled on NVQ level 4. The Annual Quality Assurance Assessment has been returned by the Registered Manager and has informed this inspection. The Registered Manager has made statements in the AQAA and the inspector has not been able to find sufficient evidence to confirm these statements during the inspection. The Registered Manager also documented in the AQAA ‘reviewed risk assessments’, this is obviously of concern as no risk assessments were in place for taking any of the residents on holiday abroad. The AQAA lists that all the following equipment has been serviced and tested electrical, fire detection and fighting equipment, emergency call equipment, and the heating system, and that the service has a written assessment on control of substances hazardous to health, and that a policy is in place for preventing infection and managing infection control, and the Department of Health guide Essential Step to Assess your Current Infection Control Management is used within the home. The service has a range of policies and procedures in place that the Registered Manager has confirmed have been reviewed. The manager does not improve services or the quality of life for residents. There is no real focus on equality and diversity issues or promoting human rights in any areas. There is limited or no understanding of person centred thinking in the service. There is no evidence that the management hierarchy respects or indeed protects the residents who use the service. Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 27 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 1 2 1 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 3 1 X LIFESTYLES Standard No Score 11 X 12 1 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 1 X x 1 x Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 5 (1) & 5a Requirement That the home ensures the Residents Guide is in a format more accessible to the communication needs of current residents. This was a recommendation from the last report, and has not been sufficiently addressed. The Registered Provider must ensure fees payable in respect of the service users for the provision of services is clearly recorded. That unless it is impracticable to carry out such consultation, the registered person shall after consultation with the service user or a representative of his, prepare a written plan ‘the service user’s plan’ as to how the service user’s needs in respect of his health and welfare are to be met. That the Registered Person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and DS0000069865.V367564.R01.S.doc Timescale for action 23/10/08 2. YA6 15 (1) 01/10/08 3. YA7 12 (2) 01/09/08 Lucerne House Version 5.2 Page 29 4. YA34 5. YA36 6. YA20 7. YA12 8. YA33 9 YA39 their health and welfare. The Registered Manager must ensure they have taken action to explore the possible role of advocates for the resident in their service. Particularly for those who lack active family involvement. This was a recommendation from the last report, and has not been addressed. 19 (4) b That the registered Person shall not employ a person to work at the care home unless – the employer has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 schedule 2. 18 (2) The Registered Manager must ensure all staff receive appropriate supervision, and that appropriate supervision is put in place for the Registered manager and the Deputy Manager. In that the registered person shall ensure that persons working at the care home are appropriately supervised. 13(2) The Registered Manager must ensure medication is handled and administered safely following appropriate guidance and procedures. 16(2) The Registered Manager must after assessment and consultation with individual service users provide suitable activities. 18(1)(a)(c)(i) The Registered Provider having regard to the size of the care home, and number and needs of the service users, ensure that at all times there are sufficient staff of duty. 24 The Registered Provider must DS0000069865.V367564.R01.S.doc 01/10/08 01/10/08 23/10/08 23/10/08 23/10/08 23/10/08 Page 30 Lucerne House Version 5.2 ensure a system is in place to evaluate the quality of the services provided at the care home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Lucerne House DS0000069865.V367564.R01.S.doc Version 5.2 Page 32 - 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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