Inspection on 05/09/07 for Lucerne House

This inspection was carried out on 5th September 2007.

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 no outstanding requirements from the previous inspection report, but made 12 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 23/06/08

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Southfields

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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 Lucerne House 12 Mitten Road Bexhill-on-Sea East Sussex TN40 1QL Lead Inspector Jason Denny Key Unannounced Inspection 5th September 2007 11:10 Lucerne House DS0000069865.V348458.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.V348458.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.V348458.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 01424 731150 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) 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.V348458.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 N/A. NEW SERVICE 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 planned as part of a new extension, which is awaiting planning permission. The planning notice has now expired August 14th 2007 and a decision on the extension is awaited shortly. 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.V348458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 11.00am and 5.00pm on September 5, 2007. This is the first inspection of Lucerne house since it was taken over by new owners in April this year and is therefore classed as a new service despite previous inspections. The service has been registered for many years with the Commission with the current residents unchanged. Any information prior to April 2007 will only be referred to where it is relevant to the current situation. The inspection focused on those residents with more diverse and higher needs along with looking at progress since the service was taken over such as around developing a staff team. Some diversity and equality areas were explored in relation to lifestyles. Care records for four Residents along with health and medication needs were looked at. Discussions with management looked at future plans such as training and current management hours. The inspector toured all communal areas of the home with meal arrangements examined. A record of complaints was inspected. Staffing was looked at in detail along with how quality is maintained and improved upon. All of the eight current Residents were spoken with in detail during the inspection. The visit also included discussion with some staff and observation of care-practices. The home was sent by the Commission an annual quality assurance assessment [AQAA] on August 14, 2007..This AQAA had not been received by the day of the inspection due to the timing of the inspection occurring before the AQAA was due back meaning that it could not be used to plan the inspection or inform the draft report. The AQAA will inform the next inspection. Survey cards were sent to the home two weeks before the inspection with some completed by three relatives prior to the visit. Due to the tight timescales with survey cards the inspector phoned a number of relatives and professionals involved with the home following the visit. Two areas are judged as Good, and the other six as Adequate and in need of some improvement. What the service does well: Comments received from residents who could offer an opinion all described the home in positive terms with typical statements such as “Food is good…you have freedom, can now go out when you want… staff are good…there is a good atmosphere here… I would be confident approaching the manager if I had a problem”. Comments received from relatives of residents were positive about the home and described how the atmosphere had become more relaxed recently and the benefits to Residents of the home finding some new staff who have skills and interests similar to current Residents such as art, sports and Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 6 cooking. Relatives feel that the home maintains good communicates and keeps them well informed. Residents benefit from a homely and well-maintained environment which is excellent in most respects and which allows everyone ample communal space including three separate meeting/reception rooms. This supports a relatively calm and relaxed atmosphere. The home is good at ensuring that Residents are not unnecessarily restricted and as far as possible have freedoms. Despite the diverse range of Residents they were all observed to be comfortable and compatible with one another with the current group unchanged for many years. Residents benefit from having positive relationships with two key staff, the manager and deputy, who have worked in the home for many years. Resident’s benefit from an annual holiday, which they choose. Residents are protected by the service following strict recruitment practices. What has improved since the last inspection? What they could do better: The manager and deputy regularly work long hours per week as carers and then try and fit in management around this. More important for Residents is that the home receives sufficient management hours per week to ensure that quality is improved and the home meets all needs. Most of the requirements made in this report can be traced to the lack of management hours going into the home. The home’s rota needs to show what hours are being devoted to management. Sufficient management hours will enable the home to keep up to date with changing polices and procedures, address shortfalls in care-planning to ensure that are complete, and reviewed to show changing needs. The lack of management hours has meant that new staff inductions have not been thorough, which can place Residents at risk Having more staff to meet assessed needs will also free up the manager to mange the home, will also help those Residents who are less able and independent to have better activity schedules and structure assisting them to have more opportunities for mental stimulation. More attention is needed to enable the service to meet the diverse needs of some Residents. It is important that the manager continues to attend all relevant training along with the new staff team. In relation to improving quality the manager needs to ensure that all policies and procedures are up to date and understood by all those working in the home in order to protect Resident’s interests. The current situation relating to how mobility allowances of Residents are used, needs review. The home are therefore required to clarify their policy and Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 7 show in revised contractual terms and conditions what extras Residents are charged for, to protect their interests and demonstrate fairness. Care-plans are developing but need to be completed with information stored in different places to be brought together to form a clear plan for each Resident. Information in care-plans needs to be accurate and regularly reviewed particularly as new staff access them. Whilst it is positive that the home promotes Resident’s community independence clear risk assessments need to be in place to limit potential harm based on promoting Residents safety needed at all times. 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.V348458.R01.S.doc Version 5.2 Page 8 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.V348458.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, & 5. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing Residents with a good level of information although it could be more accessible. The way in which the home assesses prospective or existing Residents ensures that it currently meets needs. The home needs to improve contracts and clarify additional charges to ensure they are appropriate and protect Resident’s rights. EVIDENCE: The homes statement of purpose was found to have been updated to show the recent appointment of new staff along with listing their qualifications. The home has not yet devised a Service User guide in an accessible format suited to the diverse communication and learning disabled needs of Residents. The inspector discussed with the manager how photographs of the home and staff could be useful along with simplifying procedures such as complaints with symbols and whatever meets individual needs. The manager confirmed that he is accessing computer software and is planning to introduce communication aids to covey information. The home was found to have a notice board in the Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 10 dining room with useful information for Residents such as local facilities along with previous Inspection reports dating back several years. The manager and the deputy confirmed that the range of fees is from around £400 to £854.34 per week. The inspector sampled copies of contracts and saw the higher fee itemised for a resident. The home was found to have general terms and conditions within its own documentation such as in the Statement of Purpose and is given to people to look at when they make inquires. The manager confirmed that organising this and ensuring that the contract for all Residents has all the necessary information indicated in the new regulations would be done shortly. A concern passed to the new owner of the home, involves the inappropriate use of Residents mobility allowances. The manager and deputy explained how these allowances vary for each Resident who in turn have variable use of the home’s minibus. As seen in documentation and confirmed by the management of the home the previous owner retained all of this money into the transport fund. Subsequently, due to interventions by Social Services one resident now has all of her mobility allowances paid directly to her and makes a contribution when she uses the vehicle. The manager confirmed that the new owner is keen to sort out this situation so that all Residents are fairly charged for extras. The home is advised to ensure that revised contracts clarify the use of mobility allowances and additional charges. Those terms and conditions documents looked at did not reflect the information required by the changes to regulations effective from 2006 such as specific reference to extras. No new Residents have moved into the home for several years and assessment information on all Residents has previously been inspected. All Residents are currently monitored by Social Services and reviews of some individuals are planned shortly according to care managers the inspector contacted. Residents were observed to interact well with each other and make decisions together. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 11 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, & 9. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents clearly benefit from good, skilled and prompt care although better recording of how this is done and of each individual’s full range of needs would more clearly evidence that Residents are receiving care as they require it. Residents who enjoy Community independence need to be protected by careful written risk assessments, which show benefits and how risks are minimised. EVIDENCE: The inspector sampled four [4] care –plans, two of which related to Residents with higher and diverse needs. Residents were also selected on the basis of their diversity needs such as ethnicity and by which relatives returned survey cards to the Commission. It is evident that the home has recently from July 2007 attempted to improve care plans by transferring information into a new format. This has also allowed the home to reassess Residents such as one dated 6 July 2007 in order to update care-planning information. Some Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 12 descriptions of Residents such as “very noisy person” need more care is needed in relation to language used. Some diagnosis of Residents lacks evidence of specialist confirmation professional input with the deputy manager confirming that the hand written statement in one plan that one Resident has dementia has not been confirmed by anyone outside the home. The deputy manager confirmed that she did not think the person had the condition listed. This Resident was observed throughout the inspection and was found to retain good knowledge of the running of the home. Another Resident was described as no longer smoking, which was at a variance with observations during the Inspection and confirmations from staff working in the home. Some sections of the new care-plans contained good information particularly around personal care needs. Care-plans also had some details around health needs and what each individual has in relation to medication along with an explanation as to how and why. However, some sections of the care- plans are not filled in, such as goals. The inspector found separately stored personal centred planning booklets, which contain aspirations for Residents. One booklet had a goal of learning to read and write. This goal did not show how it will be achieved and what current progress is being made. The home was therefore advised to collate all relevant information in to one plan and identify how any goals will be achieved. Some goals for Residents were the same, such as going on holiday to Spain. A number of Residents have a range of community independence opportunities whether it is walking to and from day centres or visiting local centres such as churches. One particular Resident was described as sometimes not returning at agreed times and has a habit of either picking up cigarette buts or begging these from members of the public. No written risk assessments were found in the new care-plans to show the benefits of these activities and what controls are in place to minimise risks. The deputy and the manager confirmed that risk assessments need to be written and will devote time to this once they are freed up from working shifts. The deputy manager confirmed in discussion a clear knowledge of the risks faced by Residents and issues to be aware of It is noted in some care-plans that Residents do not have active family involvement. The home is advised to explore advocacy links so that Residents have an independent voice from someone outside of the home. The home explained how they have been frustrated in their attempts to get an interpreter to meet the diverse needs of one of their Residents. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,& 17. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. More able Residents and those funded for day care enjoy good structured and active lifestyles with regular opportunities for mental stimulation. However some other Residents are not benefiting from regular and structured opportunities based on needs. Residents benefit from freedoms and experience routines that are flexible and can be confident they will be treated as individuals. Residents enjoy food, which is popular, good, and under constant review. EVIDENCE: During the Inspection six [6] residents remained in the home until one went shopping at 3pm with one of the two staff members. The other two [2] Residents were at day centres and returned around 4pm, one independently. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 14 The inspector discussed current activity schedules with the manager who confirmed that some Residents have a lot more activities and opportunities for mental stimulation than others. This was attributed to the more able and independent Residents able to organise some of their own activities without staff support and others who have funded day centre care in the community. For other Residents evidence showed that was insufficient staff to support a full range of activities, which meets their needs. It was evident from observation as confirmed by the manager that more than 2 staff on each shift is needed at times to support a more diverse range of activities given the range of abilities of the Residents group. In addition the manager is currently working long hours on shift during which time some management tasks also need to be attended to along with emergencies. The manager confirmed that if the owner agrees to increase staffing ratios to release more management time this will also benefit the range of activities the home could provide. Only the manager can currently drive the minibus. Those Residents who are more able and independent or who are funded for day care evidently have more regular and wider ranging activities. It is positively noted that in recent weeks new activities such as banger racing and the installation of a gardening pool are popular with Residents. All were found to be looking forward to a forthcoming cruise to Spain. One resident who has diverse and ethnic needs was largely unoccupied during the Inspection apart from watching DVDs, which the home has recently obtained in his Mother tongue. Contact with families and friends are encouraged. Relatives and professionals indicated how they are encouraged to visit and find staff to be knowledgeable, friendly, and open. Menus rotate regularly and are varied. Residents confirmed that alternatives are available such as one who has special and diverse dietary needs. The list of the forthcoming weeks meals were found to be helpfully displayed on a menu board. Residents and records confirmed that menus are discussed every Thursday with Residents based on planning the following weeks menu along with the shopping required. A new staff member who is a talented cook has recently been working with Residents in relation to their cooking skills along with selecting dishes, which reflect different countries. The manager indicated that all Residents are encouraged to fairly divide cooking and cleaning tasks according to a rota. The manager also confirmed that a previous emphasis on Residents being pressurised to attend to domestic tasks has been relaxed and is based on choice. All Residents who could give an opinion indicated that they liked the food served and the portions. Fresh fruit was found to be available for Residents along with regular snacks between meals. Residents were observed to make a variety of lunchtime choices. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Quality in this outcome area is Good, This judgement has been made using available evidence including a visit to this service. The home meets Resident’s health needs. Residents will benefit from greater clarity around Medication arrangements. EVIDENCE: All residents who could give an opinion indicated that they were happy with the support that they receive from staff that they viewed as helpful and respectful. 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. This was evident in the records for the four Residents looked at in detail including discussions with them, staff, and relatives. Residents have clear personal care guidelines to support them to maximise their independence and develop skills. The medication cabinet was examined along with all records. All aspects of storage and administration were found to meet the standard and best practice. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 16 All homely remedies were labelled and accounted for on recording sheets. Staff interviewed were found to be knowledgeable about all aspects of medication including what each drug is for. All staff receive appropriate training before being assessed to be able to dispense medication. The home was not found to have an appropriate or comprehensive medication policy. An issue of confusion recently arose regarding how the home supports a Resident who takes medication to their day centre, which required Social Services to write to the home to advise. The manager also confirmed that he has needed to give guidance to the day centre on how to administer medication to a particular Resident. The manager on the day of the Inspection identified that the home lacks medication policy and is waiting revised guidance from the royal a pharmaceutical society. The manager was advised to put a policy in a place in the interim. The manager confirmed that all staff including those trained have planned medication training occurring in the next 2 months. Residents were observed to be alert and the assistant manager explained how medication is kept to a minimum to avoid the risk of over sedation. Residents receive regular chiropodist treatment as confirmed in records. Residents weight is recorded in the care plan to enable the monitoring of any weight loss or gain. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, & 23. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a home that encourages them to raise their views. Resident’s will be better protected once the manager and staff have undertaken all necessary training based on protecting vulnerable adults. EVIDENCE: The manager indicated that no complaints or concerns have been raised with the service since a change of ownership, or over the last year. Residents benefit from monthly meetings where they raise their views and make choices. Relatives spoken with or who returned survey cards described the management as approachable and positive with good communication maintained. The manager confirmed that none of the four new staff had been inducted in to a Protection of Vulnerable Adults Policy to ensure they understand how to detect alleged abuse and report it. Some of the new staff who started in July 2007 have not undertaken National Vocational Qualification in Care level 2 which make it more vital that they cover this important area to protect Residents interests. All staff were found to be booked on protection of Vulnerable Adult [safeguarding adults] training to take place on November 12, 2007. The manager confirmed that as priority new staff with go though an appropriate policy and sign it prior to the training in 2 months time. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 18 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, 26, & 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a fresh, clean, warm, homely, and impressive environment, which is spacious and well maintained. The rear garden is large and popular with residents, and the overall environment will be excellent once suitable laundry facilities are installed. EVIDENCE: The inspector toured all communal areas and the one bedroom, which is shared. The home was found to be clean, warm, spacious, comfortable and homely. The home is in keeping with local properties, is highly impressive and benefits from a front car park. The grounds are safe and well maintained. The home’s management confirmed that fire checks and training continues to be regularly organised. The home has taken advice from the local fire department and taken all necessary action as confirmed by the manager. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 19 The kitchen was found to be clean and well maintained. Both residents who share a room stated that this was their choice although this is not appropriately recorded in their care plans although relatives confirmed approval. The home has applied for planning permission, which expires on August 14, 2007 according to the notice. This proposal if approved will lead to the creation of 3 further bedrooms and an office, and will resolve the long standing issue of having a suitable laundry room. The laundry was found to be arranged in an outside shed structure, which does not benefit from suitable flooring and related infection control measures. A nurse call-system is in each bedroom and was found to be working in a bedroom inspected. 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. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 20 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): 31, 32, 33, 34, 35, & 36. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from good recruitment procedures and positive staff relationships based on treating Residents as adults and learning new skills. Staffing numbers need to be reviewed in order to improve further to ensure that all needs are met such as activities. To protect Residents interest new staff need to have thorough inductions into the job especially when they lack qualifications. EVIDENCE: On the day of the inspection the home was providing a service to 8 Residents. The rota on display in the home showed 2 staff on each shift. The rota indicted that the manager and deputy are working around 70 hours per week with it not indicated on the rota when they attend to the management of the home. The home has appointed four new staff since the takeover of the service by the new owner meaning that the home is not staffed just by management. Residents and relatives confirmed how this has seen staff of different ages, Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 21 and skills and interests such as swimming, art, and cooking bring variety into the home. It is evident by looking at the rota and assessed needs of Residents and the necessary management hours that more staff or staffing hours is needed The manager confirmed during the Inspection visit that 50 of all care staff now have a National Vocational Qualification at Care level 2 or above. This includes two of the new staff as confirmed in records. It is concerning that two new staff without National Vocational Qualification in Care level 2 have not started the necessary Skills for care 12-week induction from commencement of employment in the home from July 2007. The manager confirmed that he has these workbooks in place but need to find the time to carry out 12 weeks induction before staff go on to National Vocational Qualification in Care. The manager confirmed that these inductions will be prioritised. The home’s published training plan showed that range of relevant training which will benefit Residents is planed over the next 2 months. An inspection of five existing staff files showed all had suitable Police CRB Checks and that all necessary checks had been carried out prior to commencing employment such as POVA First [check against Protection of Vulnerable Adults register], written references and fully completed application forms. The deputy manager confirmed that an independent consultant carries out her supervisions and appraisals as they are related to someone working in the home. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, & 42. Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. Resident’s benefit from committed management who want to improve the service although more dedicated management hours are needed in order to address improvements in a timelier manner. Residents will continue to benefit from the manager accessing necessary training and putting this in to practice. EVIDENCE: The service benefits from the commitment of both the deputy manager and the Registered manager. The registered manager previously worked in the home for many years as the deputy under the previous owner/manager. The deputy has worked in the home for 6 years and is well qualified and popular with Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 23 Residents. The registered manager is currently studying for the necessary management qualification and had an appointment with his assessor during the inspection visit. An Inspection of the rota showed both the manager and his deputy working around 66- 70 hours per week on shift as carers. Staffing levels are 2 per shift to the 8 current Residents. It is evident that this does not allow sufficient additional time for managing the home with the manager having to fit administration around these care hours. The service was advised during the inspection that the manager needs to be freed up to manage the home. During the inspection phone-calls and other matters linked to the management of the home meant that the manager was occupied when also on shift as a carer. More time is needed to address quality issues and ensure that the home is up to date. This was evident in the number of policies and procedures such as medication, which needs review and new staff not having the required inductions. Care plans, along with administrative areas need attention. The owner of the home is working towards a business plan, which is aimed to address the need for a suitable laundry room and a possible extension to the number of bedrooms, which will also create a dedicated office area. The home is advised to develop an annual development plan once they have surveyed Residents and the representative’s views about the service. Residents, and relatives, spoken with praised the attention and care of the management team who maintain positive communication. A number identified how the atmosphere of the home had become more relaxed and how individual choices are being better supported. By the day of the Inspection September 5, 2007 the Annual Quality Assurance Assessment had not been completed or returned with the home still being within the timescales, [end of September 2007], for completion. Therefore the inspection and draft report have not taken into account the Annual Quality Assurance Assessment that will instead inform the next report. The management of the home in the absence of a completed Annual Quality Assurance Assessment to inspect in respect of health and safety checks and maintenance, verbally confirmed that all areas were in good order. The manager confirmed that a particular problem with a door in a Residents room is being immediately addressed. The manager confirmed in written evidence that all staff including the manager are booked to attend a comprehensive range of health and safety training including first aid, food hygiene and moving and handling over the next 2 months. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 24 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 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 2 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 3 X Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 25 No 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 YA5 Regulation 5 b [as amended 2006 Requirement Timescale for action 05/12/07 2 YA6 3 YA9 4 YA12 That the Registered Person must ensure that all Resident’s have appropriate terms and conditions [the contract] in line with the amended regulations. That particular attention is given to clarifying the use of mobility allowances and how Residents will be charged for extras such as use of the Minibus. 15 That the Registered Person must ensure that care-plans are comprehensive, accurately reflect needs, are complete, and reviewed and amended where appropriate. 13[4][b]&[c] That the Registered Person must ensure that Residents have appropriate riskassessments to cover activities such as independent access to the community and show how risks are minimised. 16[m]&[n] That the Registered Person must ensure that all Residents are consulted with in relation to creating suitable activities which meet their diverse needs. DS0000069865.V348458.R01.S.doc 05/12/07 05/12/07 05/12/07 Lucerne House Version 5.2 Page 26 5 YA20 13[2] 6 YA23 12[1][a] 7 YA30 13[4] 8 YA31 12[1][a] 9 YA33 18[1][a] 10 YA35 18[1][c] 11 YA37 12[1][a] That the Registered Person must ensure that medicines are handled according to the requirements of the Medicines Act and guidelines from the Royal Pharmaceutical Society. That the home ensures it has a comprehensive medication policy, which covers all necessary areas. That the Registered Person must ensure that all staff have read and understood the necessary procedure for identifying and reporting alleged abuse. That the Registered Person must ensure that suitable laundry facilities are provided for use by Residents. That the Registered Person must ensure that residents are protected by new staff having written job descriptions. That the Registered Person must ensure that a review of staffing levels is carried out in relation to the assessed needs of Residents. That the Registered Person must ensure that all new staff receive an appropriate induction in to the job. That skills for care 12-week induction commences when new staff start unless they have an equivalent qualification. That the Registered Person must ensure that sufficient and regular management hours are allocated to the home to ensure that the service meets Residents needs in a timely manner. That management hours are clearly shown on the home’s rota. That this revised rota is sent to the Commission DS0000069865.V348458.R01.S.doc 05/12/07 05/11/07 05/03/08 05/12/07 05/12/07 05/12/07 05/12/07 Lucerne House Version 5.2 Page 27 by the date shown. 12 YA39 24 That the Registered Person must ensure that time is allocated for reviewing the quality of the service on a sufficiently regular basis. That this includes all aspects of the home such as policies and procedures, care planning, and activities. 05/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA1 YA6 YA7 YA26 YA39 Good Practice Recommendations That the home’s Service User [Residents] Guide is reproduced in a format more accessible to the communication needs of current Residents. That all relevant information held by the home is combined together into single working document/care-plan. That the home explores independent advocacy for Residents particularly for those who lack active family involvement. That where Residents make a positive choice to share rooms that this decision is appropriately recorded to demonstrate consent. That an annual development plan for 2008 is produced based on the views and needs of Residents. Lucerne House DS0000069865.V348458.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local 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.V348458.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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