CARE HOME ADULTS 18-65
Lychgate House 145 Shrub End Road Colchester Essex C03 4RE Lead Inspector
Marion Angold Final Unannounced Inspection 14th September 11.05 Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 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 Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 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. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lychgate House Address 145 Shrub End Road Colchester Essex C03 4RE 01206 500074 01206 510916 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) Doobay Care (Lychgate) Limited Mrs Natascha Hill Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Persons of either sex, under the age of 65 years, who require care by reason of a mental disorder (not to exceed 12 persons) The manager must undertake NVQ Level 4 in management and care by the end of December 2005 5 January 2005 Date of last inspection Brief Description of the Service: Lychgate House is a detached property, situated in a residential area, close to a range of community activities and Colchester town centre. Accommodation is provided on two floors, with the upper floor being accessed via a passenger lift. Most bedrooms are single occupancy and there is a choice of communal areas. There is a good-sized garden to the rear. This home provides care in a homely and comfortable environment for twelve adults, of varying ages, with mental health problems. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection started at 11.05 and finished at 19.20 hours, assisted by the registered manager, Mrs Natasha Hill. Part of the inspector’s time was spent observing what was taking place in the home and speaking with the service users, a visitor and staff. A number of records were also inspected. Of the 22 Standards inspected on this occasion, 16 were met, 5 presented minor shortfalls and 1 a major shortfall. What the service does well:
Service users were benefiting from a home run on family lines, with a stable team of staff, who spent time with them and supporting their leisure pursuits. Lychgate House offered them an environment that was safe, clean and homely. Records evidenced that one service user, new to the home since the last inspection, had been admitted on the basis of a comprehensive assessment. Service users’ care plans were appropriately detailed in relation to needs and risks and had been evaluated on a monthly basis. Situations, where a person’s freedom was restricted in the interests of their safety, had been documented. Service users were observed moving freely about the home and making choices about how they spent their time. They had various opportunities for making their views and wishes known, both informally and at their house meetings. Service users, who spoke with the inspector, indicated their satisfaction with a range of aspects of life at Lychgate House including their routines and meals and the way staff treated them. A new member of staff had found Lychgate House to be a well run home with a friendly, approachable manager. They commented favourably on training opportunities for staff and their own induction training, which they felt had prepared them well for working in a new situation. A frequent visitor to the home said that service users always appeared well presented and the home clean. They were satisfied with the number of staff around when they had visited and found them always to be welcoming and accommodating. They confirmed that the service user they visited was supported in maintaining their chosen lifestyle and beliefs. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Minor amendments are needed to the Statement of Purpose, as identified in the main body of the report. There was scope for developing a more person-centred approach to care planning, with greater focus on maintaining strengths and interests and meeting personal goals. Certain descriptions, such as ‘uncooperative’ and ‘difficult’ contained in one service user’s daily records, implied value judgements and a lack of understanding of the person’s needs. Although service users enjoyed their meals, there was scope for giving them more choice. The arrangement for two service users to share a room was no longer ideally suited to the lifestyle of one of the occupants and they should be given first refusal of any single room that becomes vacant. There were no indications that staffing ratios were inadequate, but the manager was advised that they should be checked using a recognised tool, such as the Department of Health Residential Forum guidance, and reviewed regularly to take account of the changing needs of service users. The manager must adopt a more robust approach to recruitment, ensuring that all the checks and records, required by regulation, are in place before a person starts working at the home. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 7 Although the manager worked alongside staff and provided regular supervision, records of their formal one to one meetings indicated a need for discussions to have a stronger link to practice issues and meeting the needs and goals of individual service users. The manager was advised to progress training for the National Vocational Qualification in care, Level 4. 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. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 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 Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Prospective service users have adequate information to inform their decision to move in. Prospective service users needs are assessed prior to admission. Service users have appropriate contracts for living at Lychgate House. EVIDENCE: The manager had revised the Statement of Purpose and Service Users Guide since the last inspection. The Statement of Purpose was particularly well written. However, two areas needing further minor revision were identified. It should state the sizes of rooms and explain how the home ensures that service users have a three-month trial period, even though Social Services contracts give service users permanent status after one month. Records evidenced that one service user, new to the home since the last inspection, had been admitted on the basis of a comprehensive assessment. New service users’ Contracts/Terms and Conditions for Residence had been brought in line with National Minimum Standards 4 and 5, in that they now stipulated a twelve week trial period of residence. Rules on smoking should be clearly stated in the contract (NMS 16.11). Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Service users’ assessed needs and strengths were not fully reflected in their care plans. Service users were supported to make their own decisions and to minimise the risks involved. EVIDENCE: Care plans inspected had been completed and evaluated by the manager and were appropriately detailed in the areas they covered. However, the new service user’s care plan did not reflect all the strengths and needs covered by their assessment. Two other care plans sampled also focussed only on the main presenting needs and risks rather than adopting a person-centred approach to the quality of their daily lives. The home should address the use of descriptions, such as ‘difficult’ and ‘uncooperative’, found in service user’s daily records, which imply value judgements and a lack of understanding of the person’s needs. However, the manager and staff had recently attended a training session on care planning and the inspector looks forward to seeing this reflected in the home’s methodology. It was also encouraging to note that all service users had recently had a full medical review of their care.
Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 11 Records, various discussions and observation of service users during the course of the inspection, evidenced that they were supported to carry on their lives (for example, with respect to smoking and going out), having had the associated risks identified and addressed and any infringement of their rights documented. One person confirmed that the friend they visited was supported in maintaining their chosen lifestyle and beliefs. The manager had involved an advocate for one service user without family or other independent representation. She undertook the role of Department of Work and Pension’s appointee for three service users, an arrangement overseen in one case by the service user’s advocate. Records, receipts and balances kept by the home, in relation to any support given to service users with their personal money, were not inspected on this occasion but found to be in order at the inspection in January 2005. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 12 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): 14, 16 and 17 Service users benefited from flexible routines and staff support to engage in leisure activities but there was scope for a more person centred approach for the purpose of enabling individuals to achieve individual goals and aspirations. Service users received balanced meals, which they enjoyed, despite limited choice. EVIDENCE: Service users were observed moving freely about the home and making choices about how they spent their time. Those who spoke with the inspector indicated that they were able to get up and go to bed when they liked and have breakfast at a time that suited them. During the inspection one person’s tea was set aside for them as they did not feel ready to eat at the appointed time. Some service users went out to various activities and staff dedicated time each morning to supporting anyone who wished to participate in the in house
Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 13 activities. Service users were also observed carrying on their own interests, such as knitting and reading, outside of these sessions. Feedback from a sample of service users and a visiting relative was positive with regard to occupation. However, the inspector advised the manager about adopting a more person-centred approach to how service users spent their time, so that their personal strengths, interests, aspirations and goals were part of their care plan and regularly evaluated. This approach would benefit those service users with more active routines as well as those who were increasingly dependent on others for their quality of life. A balanced and nutritious hot lunch was being prepared from basic, fresh ingredients, when the inspector arrived. The new cook was familiar with individual needs and preferences and staff were maintaining a record of what people were eating. Choice was limited on this occasion to types of potato but an alternative had been prepared for someone with a vegetarian diet. Portions were generous and, although one service user said that there was little consultation about the menu, they and others confirmed they had enjoyed this meal and their meals in general. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 14 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): None of these Standards were inspected. EVIDENCE: Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Service users’ had various opportunities for expressing their views and wishes. EVIDENCE: The manger operated an open door policy and service users came to talk with her throughout the course of the inspection about matters of importance to them as individuals. Staff spent time informally with service users giving them opportunity to express their views. The key worker system provided similar opportunities for service users to be heard and regular service users’ meetings provided a more structured forum for the sharing of views. The complaints procedure was fully explained in the service users’ guide. NMS 23 was not inspected but the manager was advised to arrange for all staff to attend the protection of vulnerable adults training provided by the Essex Vulnerable Adults Protection Committee. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 25 Lychgate House offered residents a safe, clean and homely environment. One person’s bedroom did not completely suit their lifestyle. EVIDENCE: The home was clean and fresh and comfortably furnished in all areas inspected. Since the last inspection, the home had employed a new gardener and the grounds were attractively maintained, front and back. The manager reported that a builder had been commissioned to undertake various work on the premises, including a new porch and walk-in bath and shower facilities, upstairs and downstairs respectively. An extension was at the planning stage and, it was reported, would address the difficulties currently presented by two people sharing a bedroom, who had very different needs. Although the occupant, who experienced inconvenience from this arrangement, had chosen to move into the room, they should be offered a single room as soon as there is a vacancy (NMS 25.2). It was reported that, in response to the fire officer’s advice that the office door should be kept closed, the provider had ordered a closing mechanism, which would be activated by the fire alarm. Following matters raised a the last
Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 17 inspection, the ground floor main windows had been locked for security and written evidence was produced, confirming that radiators had low surface temperatures. A recommendation from the last inspection, that two service users with declining mobility be assessed by an occupational therapist, had been progressed by the home but met with a negative response from the GP. In both cases, the need for such a referral has been superseded, since this inspection, by other events. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36 Service users benefited from a stable and committed team of staff with clearly defined roles. The home’s recruitment practice had not been consistently robust to ensure maximum protection of service users. There was scope for developing the content of staff supervision. EVIDENCE: All staff job descriptions had been reviewed and their roles and responsibilities linked to meeting the needs of service users. The home had experienced some changes to staffing arrangements since the last inspection, the cook having left and their duties taken over by another member of the team and a person taken on for domestic duties. However, service users continued to benefit from a stable team of staff, most of whom had worked at the home for many years. The home continued to have three staff on duty between 7.00 and 14.00 hours (including the person responsible for lunch preparation and the manager, when she was there) and between 17.00 and 21.00 hours. Two staff covered the period between 14.00 and 17.00 hours and 21.00 and 7.00 hours (one awake and one asleep during the night) and a domestic person was employed Monday
Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 19 to Friday 9.00 to 12.00 hours. There were no indications that these arrangements were inadequate, but the manager was advised again to check them using a recognised tool, such as the Department of Health Residential Forum guidance and to keep them under review to ensure they accommodated the changing needs of service users. Criminal Record Bureau (CRB) Disclosures were inspected for all the care staff. However, the new member of the team, with domestic duties, had started work the day following their interview without a full CRB disclosure or written references. Although the manager said that the CRB had advised that a POVA First check would be adequate in the first instance, she was informed by the inspector that any such decision had to be at the discretion of the CSCI and, in the circumstances pertaining, would not have been granted. Since the last inspection, the home had arranged training sessions on care planning, diabetes (diagnosis and diet), infection control and administering medication. Forthcoming training included fire procedures, first aid and moving and handling. The new member of staff, employed as a domestic, had been encouraged to participate in the training and described a thorough induction appropriate to their role. Caring for two service users who have developed dementia since their much earlier admission to the home has taken staff into new territory for which they should receive appropriate training. Records inspected for two staff evidenced regular two-monthly supervision but the entries were very similar from one month to the next and were more in the nature of appraisal than focussed discussion of practice issues and service users’ changing needs and goals. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Service users were benefiting from a well run home, where their health and safety were promoted but their views had not become part of a systematic process for shaping and reviewing the development of the service. EVIDENCE: Natasha Hill’s application to become the registered manager of Lychgate House had been approved since the last inspection and the manager’s job description updated in line with National Minimum Standard 37.3. Natasha Hill was advised to check that her management qualification had covered all aspects of the Registered Manager’s Award and to progress training for the National Vocational Qualification in care, Level 4. Staff spoke positively about Natasha Hill’s style of management and good working relationships were demonstrated during the inspection. Regular staff meetings provided opportunity for a more formal sharing of information and views. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 21 Although the views of staff and service users were sought informally, and at their meetings, the manager acknowledged that the registered persons had not worked on their system of quality monitoring since the last inspection. The home’s accounts were made available for inspection. The inspector found nothing in these, the presentation of the home, or the care arrangements for service users, to suggest that the business was not financially viable. A number of examples were found of the home promoting the health and safety of service users, including the provision of staff training in the areas of infection control, safe administration of medication and first aid; the servicing of the gas boiler and central heating system by a corgi registered engineer and ensuring that service users were protected from contact with hot radiators; the provision for staff of personal protective clothing to control infection. Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 2 X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 2 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 X 3 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Lychgate House Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 3 2 X X 3 X DS0000017874.V249325.R01.S.doc Version 5.0 Page 23 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 YA34 Regulation 17 Sch 4 19 Sch 2 24 Timescale for action The registered person must 19/10/05 ensure they adhere to all the recruitment procedures required by regulation. The registered person must 30/11/05 continue to develop the home’s system of Quality Assurance in the manner prescribed by this National Minimum Standard. THIS REQUIREMENT HAS NOT BEEN MET WITHIN AGREED TIMESCALES. The registered person must 14/09/05 notify the Commission when any service user’s illness, or decline, necessitates their admission to hospital. THIS STANDARD WAS NOT INSPECTED AND THEREFORE THE REQUIREMENT HAS BEEN BROUGHT FORWARD FROM THE LAST REPORT. Requirement 2 YA39 3 YA41 37 Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The registered person should ensure that the Statement of Purpose gives the sizes of service users’ individual and communal rooms and that it provides the same information about service users’ trial periods of residence as their individual contracts. The registered person should ensure that care plans address the individual’s strengths and personal goals. They should also continue, where possible, to work towards service users and staff taking a more active part in the ongoing evaluation of care plans. They should ensure that words, which imply a value judgement are avoided in service users’ records and that the people responsible for using them understand the needs of service users in their care. 3 YA14 It is recommended that the registered person develop a person-centred approach to activities so that individual interests and aspirations are planned for and progress monitored. It is recommended that the registered person consider ways of increasing choice of menu. It is recommended that, should a vacancy arise in a single room, service users, currently sharing a room on the ground floor, are given first refusal. The registered person should check their staff ratios using the Residential Forum guidance, recommended by the Department of Health. It is recommended that the content of supervision is more clearly linked to the home’s Statement of Purpose and service users’ individual care plans. The registered manager should progress training for the National Vocational Qualification in care, Level 4. 2 YA6 4 5 YA17 YA25 6 YA33 7 YA36 8 YA37 Lychgate House DS0000017874.V249325.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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