Inspection on 26/10/06 for Lyme House

This inspection was carried out on 26th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyme House 08/03/06

Lyme House 14/09/05

Lyme House 14/02/05

Lyme House 09/08/04

Lyme House 17/03/04

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

CARE HOME ADULTS 18-65 Lyme House Grange Road Haydock St Helens Merseyside WA11 0XF Lead Inspector Mr Mike Perry Unannounced Inspection 26th October 2006 10:00 Lyme House DS0000022413.V311045.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 Lyme House DS0000022413.V311045.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. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyme House Address Grange Road Haydock St Helens Merseyside WA11 0XF 01744 609954 01744 609953 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) www.trurehab.com TRU Limited Mrs Elizabeth Ann Kettle Care Home 21 Category(ies) of Physical disability (21) registration, with number of places Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 21 PD One named service user sectioned under 117 Mental Health Act 1984 The service should employ a suitably qualified and experienced manager who is registered with the CSCI Date of last inspection Brief Description of the Service: Lyme House is registered to provide personal care and support to 21 service users with physical disabilities. Ages can range between 18 and 65 years. The home specialise in rehabilitation for service users who have acquired brain injuries and aim to assist them back to independent living. The home is owned by TRU (Transitional Rehabilitation Unit). The Registered manager is Ann Kettle and the Responsible individual is Mr Bill Kenyon. Service users are encouraged to undertake paid work at the home linked to achieving agreed aims and objectives on individual care plans. The home is part of a comprehensive rehabilitation service involving another Care Home and community services as well as a variety of work based units. The home is located in the rural area of Haydock and is set in its own grounds with gardens. The home receives referrals nationwide due to the specialist area of care given. The current fees for the service are £1645 - £2,695 Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over a period of 6 hours on one day. Day and recreation areas were seen and some of the bedrooms of residents. Records kept in the home were also viewed. Staff records are held separately at Margaret House, which is the administration sector for the organisation and these were viewed on a previous visit [6.7.06] and the evidenced used for his report. In total the inspector spent time with residents and spoke with 3 in more depth. There were no visiting relatives on the day although one was spoken to by phone. The manager, deputy manager and 5 care staff were also interviewed. The inspector also supplied some comment cards for residents to complete. The inspection is a ‘key inspection’ for the home and covered all of the key standards that the home is expected to achieve. What the service does well: The admission process for residents is very comprehensive. Preadmission assessment includes visits to the resident’s home by the nuoropsychologist and then by the clinical management team. Referral assessments by both health and social service professionals are also accessed. Care plans are comprehensive and well organised. Many professionals (e.g. speech therapist, occupational therapist, physiotherapist] have input into formulating a rehabilitation programs, which is specific to the residents needs. One resident discussed his care package, which included specific attendance at arts and craft sessions and physiotherapy sessions. He also described how he was trying to achieve one of his set goals aimed at improving social skills and interactions with staff and residents. The average day is tightly structured and another resident discussed his day so far which had included completing budgeting plans and working in the kitchen. Residents interviewed felt that the tight structure of the programme was beneficial. Residents reported regular contact with their families including visits home. One resident described how family members visit during the week and how he is able to visit them at the weekends. The relative stated that staff communicated well and the arrangements for visiting were always well organised. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 6 For the purposes of experiencing a ‘normal day’ the routines are organised with respect to routine daily activities of living such as getting up, washing, having breakfast etc with the purpose of reinforcing accepted social norms and behaviours. Some resident’s programmes include the use of local facilities such as the leisure centre and local shops and places to eat. The planned menu on the unit offers one main hot meal and then a choice of a snack type meal or a sandwich if this is preferred. Residents are working in the kitchen on a daily basis requiring different levels of support. Some budget and cook their own meals. Staff interviewed were clear of the principals involved in carrying out any personal care and were able to explain these. For example ensuring privacy and how a good standard of personal care for residents would assist in maintaining dignity. One resident who used a wheelchair evidenced diversity of care. Care had been taken by staff to ensure necessary equipment had been made available to assist with bathing for example. The provision of onsite physiotherapy was also part of the care package and the home had been in liaison with health care professionals regarding the ongoing management of the resident’s physical disability. The medication recording sheets were clear and residents reported that medicines are given on time. Due to the in-house medical support there are frequent medication reviews. It is clear that residents are free to raise issues of concern and that these are recorded and acted on. Residents interviewed felt reassured by the coaching system, which gives clear lines of communication. Internally the unit is maintained satisfactorily. Areas were clean. The housekeeper works alongside residents to ensure that basic standards are maintained. One resident said ‘we keep our own rooms tidy and we get some rewards for this’. Bedrooms were very well personalised and residents felt at home. Disabled access internally is satisfactory, the unit being all on one level. The staff ratio is very high and is important to carry out the coaching role that plays a vital part of the care system at TRU. Staff interviewed were very knowledgeable about the residents in their care and displayed a high level of competence in discussing the care programmes. Residents expressed a high level of satisfaction when talking about the ability of the staff. It was observed that staff were continually interacting with residents and supporting and providing feedback through out the day. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 7 The training programme in the home is very well structured, particularly around the clinical background of acquired brain injury and the behavioural techniques used by staff to work with residents. Comments received about the staff include: ‘Staff treat me well – they treat me like an adult and don’t talk down to me’ ‘Love it here – staff are very good. They listen and take things seriously’. The service is able to demonstrate ongoing review of the quality of the care through monthly review meetings. These form part of not only clinical update but also act as a quality assurance tool in terms of ensuring that the service is able to demonstrate development for each resident set against measurable targets and goals. Yearly objectives are identified in the development of the unit and an annual report is produced outlining achievements and targets for the forthcoming year. What has improved since the last inspection? What they could do better: There was some discussion around the use of restraint in the home and good practice guidance is followed with staff receiving appropriate training. The reporting process must include the completion of a report to the Commission [Regulation 37 form] and the manager was made aware of this. There was discussion around the use of local interagency procedures for alerting and referring allegations of abuse. It is recommended that the home Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 8 access local training by Social Services, which will compliment existing training by TRU. Wheelchair access to areas in the ground is satisfactory apart from some difficulty experienced by wheelchair users in trying to get across the car park to the activities unit, as the car park is uneven. The manager stated that this would be addressed as the grounds are further developed. The issue of the CCTV cameras was again discussed with the manager and also with staff and residents. The Commissions view remains the same and this has now been outlined in the previous inspection report and also a subsequent letter to the management requiring their removal. The argument about security does not outweigh the issue around the right to privacy. There does not appear to be any strong argument in terms of clinical need. The fire logbook was seen. Requirements were made on the last inspection for routine checks on testing of emergency lighting [monthly]. The records were still incomplete. 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. Lyme House DS0000022413.V311045.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 Lyme House DS0000022413.V311045.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 The quality outcome in this area is good. This is based on the available evidence on the inspection. The information available describing the purpose and activity of the home is generally comprehensive and assists residents in their choice of whether to accept admission. The assessment process is very comprehensive so that the home has a good base for meeting needs. EVIDENCE: The resident interviews revealed that the information supplied by Lyme House is generally quite comprehensive. Care files included a copy of service users rights, which outline rights and responsibilities whilst on the unit and residents signed these and they were also posted up in bedrooms. Terms and conditions of residency are also given to residents. One professional consulted was very impressed with the whole of the admission process including written information available. The assessment process prior to admission includes comprehensive assessment by the Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 11 neuropsychologist followed by a home visit by the unit management team. Residents stated that they were able to visit the unit prior to admission before making a decision to be admitted. Assessments seen on care files were very detailed. Additional assessments once admitted include a physiotherapy assessment for all residents. Lyme House DS0000022413.V311045.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality for this outcome group is excellent. This is based on the available evidence on the inspection. Staff agree a structured care programme with residents that also includes setting personal goals and targets so that residents are able to exercise some choice and control over the overall care strategy. Risk is managed appropriately so that residents are encouraged to involve themselves in daily living in a safe manner. EVIDENCE: Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 13 Three care plans were seen. All were comprehensive and well organised. Many professionals (e.g. speech therapist, occupational therapist, physiotherapist] had had input into formulating a rehabilitation program which was specific to the residents needs. A weekly meeting is arranged for residents and their key staff. Plans and progress are discussed as part of this session. The larger multi disciplinary team then reviews the plans and progress on a monthly basis. Professionals who had referred residents stated that the communication through these meetings was very good and comprehensive reports were available to monitor progress. One resident discussed his care package, which included specific attendance at arts and craft sessions and physiotherapy sessions. He also described how he was trying to achieve one of his set goals aimed at improving social skills and interactions with staff and residents. Some of the goals are ‘self determined’ and because of this they are open to choice and the resident exercises some control over the care programme. For example choosing different activities and work placements. The average day is tightly structured and another resident discussed his day so far which had included completing budgeting plans and working in the kitchen. Residents interviewed felt that the tight structure of the programme was beneficial. The home together with the other sites under the TRU banner operate an internal token economy system aim at rewarding met targets agreed on the care plan. All residents interviewed had a clear concept of this and were able to understand how it worked. The concept of risk is clearly understood by the care team and comprehensive risk assessments were seen in the care files. The clinical team assesses untoward incidences of aggression and there is always a plan formulated in terms of future management. There was some discussion around the use of restraint in the home and good practice guidance is followed with staff receiving appropriate training. The reporting process must include the completion of a report to the Commission [Reg 37 form] and the manager was made aware of this. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 14 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): All key standards The quality for this outcome group is good. This is based on the available evidence. There is a planned approach to the organisation of social activities and programmes in the home, which encourages personal development for residents. Residents are encouraged to make use of local facilities, which assists in community integration. Meals are well managed and provide opportunities for residents to develop social and domestic skills. EVIDENCE: The service does not have an open visiting policy. Residents reported that they did not always benefit from unplanned visits due to the wide variety of structured activities which they participate in. Residents reported regular contact with their families however including visits home. One resident described how family members visit during the week and how he is able to visit Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 15 them at the weekends. The relative stated that staff communicated well and the arrangements for visiting were always well organised. Staff reinforced the idea that family support and awareness is vital to progress made by residents and so contact is facilitated. The unit is registered for both male and female residents although on the inspection there were only male residents in the home. Staff reported that any female admissions to the home would have to be care fully assessed. There are no female only areas in the home. The inspector spoke to service users who explained that the daily routine is individually planned through the daily diaries in conjunction with coaching staff. For the purposes of experiencing a ‘normal day’ the diaries are written with respect to routine daily activities of living such as getting up, washing, having breakfast etc with the purpose of reinforcing accepted social norms and behaviours. Some resident’s programmes include the use of local facilities such as the leisure centre and local shops and places to eat. The planned menu on the unit offers one main hot meal and then a choice of a snack type meal or a sandwich if this is preferred. Residents are working in the kitchen on a daily basis requiring different levels of support. Some budget and cook their own meals. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 16 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): All key standards The quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. Personal care is offered on an individual basis, which encourages independence and helps ensure appropriate standards so that residents are supported. Health care is well managed including regular liaison with referring agencies so that health care needs are met. Medicines are well managed so that residents are protected by safe practice. EVIDENCE: Most residents are able to attend to their own personal hygiene needs and the staff role tends to be helping to set agreed goals and prompts in this area. Staff interviewed were clear of the principals involved if they were to carry out any personal care and were able to explain these. For example ensuring privacy and how a good standard of personal care for residents would assist in maintaining dignity. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 17 One resident who used a wheelchair evidenced diversity of care. Care had been taken by staff to ensure necessary equipment had been made available to assist with bathing for example. The provision of onsite physiotherapy was also part of the care package and the home had been in liaison with health care professionals regarding the ongoing management of the resident’s physical disability. Another resident had a pre-existing mental health problem that was continuing to be monitored with input from psychiatric services with regular medication reviews. There are no residents currently self-medicating. Lyme House is the first stage of a rehabilitation process that includes another unit and community support team so that self-medication is considered at a latter stage in this process. Staff were able to relate instances of self-medication at times on the unit, however, linked to individual need. The medication recording sheets were clear and residents reported that medicines are given on time. Due to the in-house medical support there are frequent medication reviews. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 18 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): All key standards The quality in the outcome group is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and this is used by residents to raise issues of concern, which are acted on. Adult protection policy has been highlighted in the homes training programme and awareness has been raised. There is a need to continually reinforce this on a regular basis with possible reference to external training. EVIDENCE: The complaints file was viewed. It is clear that residents are free to raise issues of concern and that these are recorded and acted on. Residents interviewed felt reassured by the coaching system, which gives clear lines of communication and residents felt comfortable that they were able to raise any concerns. Staff interviewed had had some recent internal training around the Protection of Vulnerable Adults. There was discussion around the use of local interagency procedures for alerting and referring allegations of abuse and the manager was aware of the need to do this rather than conduct any internal investigation. It is recommended that the home access local training by Social Services, which will compliment existing training by TRU. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 19 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): Key standards The quality in this area is good. This is based on the available evidence. The environment at Lyme House is generally being developed along appropriate guidelines and principals which helps ensure therapeutic, comfortable and safe living conditions for residents. There is an issue of privacy for residents at times due the highly structured nature of the care and the introduction of CCTV cameras must be reviewed in the context of this. EVIDENCE: The unit continues to develop with reference to good practice with the completion and now regular use of an activities centre onsite. There is also a small woodland area, which includes a pond for fishing. There are grassed areas for football and other activities including gardening. The activities unit was seen and residents interviewed where appreciative if this facility. Wheelchair access to areas in the ground is satisfactory apart from some difficulty experienced by wheelchair users in trying to get across the car park to the activities unit, as the car park is uneven. The manager stated that this would be addressed as the grounds are further developed. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 20 Internally the unit is maintained satisfactorily. Areas were clean. The housekeeper works alongside residents to ensure that basic standards are maintained. One resident said ‘we keep our own rooms tidy and we get some rewards for this’. Bedrooms were very well personalised and residents felt at home. Disabled access internally is satisfactory, the unit being all on one level. The issue of the CCTV cameras was again discussed with the manager and also with staff and residents. The last inspection report contained a requirement to remove these with the following rational: ‘Given the intensive nature of the therapy at TRU there is always going to be a trade off in terms of the amount of privacy afforded residents at times. The instillation of CCTV cameras does appear an unnecessary invasion however. The rationale of protection of residents in terms of security is not convincing given residents views and also the high staffing ratios on the unit’. The inspector gained views from residents interviewed who again stated that they had not been consulted on the instillation of the cameras although one resident echoed the general opinion which was ‘they are handy because you can see who has been in my room if anything goes missing’. [The resident was asked the reason why he did not lock his room and replied that he had lost his key to his room but did not want to pay the £3.00 fee for another one]. Staff feelings were mixed in that they found the cameras useful for locating people and also they could be played back in the event of any ‘incident’ and provide feedback for residents. Management and staff [and records] indicate that there has not been any particular reduction in serious incidents however although the complaints about petty theft from rooms has reduced. Both staff and residents felt that they ‘had got used to’ the cameras although those asked stated that the unit would not be any worse of without them. The Commissions view remains the same and this has now been outlined in the previous inspection report and also a subsequent letter to the management requiring their removal. The argument about security does not outweigh the issue around the right to privacy. There does not appear to be any strong argument in terms of clinical need. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 21 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): Key standards The quality in this area is good. This is based on available evidence. The staffing in the home is settled and minimum numbers are maintained. There is a good skill mix of staff so that residents who have brain injury needs can receive appropriate care. The recruitment processes are good and ensure that residents are protected. EVIDENCE: The staffing on the day of the inspection consisted of 11 care staff of different grades, the manager and assistant manager 1 psychology staff and 1 programme coordinator [RPC’s]. This is for 17 residents. The staff ratio is very high and is important to carry out the coaching role that plays a vital part of the care system at TRU. Staff interviewed felt that staffing was reasonably consistent and that this has gradually improved over the past year. Staff interviewed were very knowledgeable about the residents in their care and displayed a high level of competence in discussing the care programmes. Residents expressed a high level of satisfaction when talking about the ability of the staff. It was observed that staff were continually interacting with Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 22 residents and supporting and providing feedback through out the day. The care staff are supported by an internal team of psychology and medical support. The training programme in the home is very well structured, particularly around the clinical background of acquired brain injury and the behavioural techniques used by staff to work with residents. All staff undergo the same training programme, which is ongoing, and covers staff needs at different levels of clinical competence from induction to primary coaching and advanced training. The induction-training programme includes a prolonged ‘shadowing’ component which staff reported as being particularly useful. Comments received about the staff include; ‘Staff treat me well – they treat me like an adult and don’t talk down to me’ ‘Love it here – staff are very good. They listen and take things seriously’ Staff were questioned about the recruitment process and all were satisfied that the company had been very careful to collect references and also check for any criminal records. The staff records are maintained at Mgt House, which is the administration sector of the organisation. This was visited on 6.7.06 separately and the staff records seen were comprehensive and met standards [this followed requirements made on the last report]. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 23 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): Key standards. The quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. The manager of the home has the experience and qualifications to ensure that Lyme House is run satisfactorily and that residents best interests are maintained. The quality systems in place ensure good monitoring and ongoing improvements take place so that resident care can be progressed and procedures are appropriately managed to ensure smooth running of the home. EVIDENCE: The Registered Manager of Lyme House is Ann Kettle. Ann has been in post for since august 2005. She is currently undertaking an NVQ qualification in management [due for completion in December]. She is involved with staff training initiatives in the organisation. As with all staff that work for TRU she Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 24 has come through the organisation experiencing all staff roles and training in order to become the manager of Lyme House. The service is able to demonstrate ongoing review of the quality of the care through monthly review meetings. These form part of not only clinical update but also act as a quality assurance tool in terms of ensuring that the service is able to demonstrate development for each resident set against measurable targets and goals. The review process is attended by the resident and all concerned wit the care and support. Both verbal and written feedback is given to all parties including family and funders of the care. Case conferences are also held 3 monthly and referring health professionals, social workers and family can all attend. The professional interviewed, as part of the inspection, commented that the reporting system was very professional and helpful. One of the residents has the task of interviewing new admissions to the unit to get their views and report any issues. In terms of staff and systems audits the home has Investors in People status. Staff have regular supervision sessions. Yearly objectives are identified in the development of the unit and an annual report is produced outlining achievements and targets for the forthcoming year. The fire logbook was seen. Requirements were made on the last inspection for routine checks on testing of emergency lighting [monthly]. These routines are listed on the ‘fire schedules’ listed at the front of the fire logbook. The records were still incomplete. There remain some outstanding issues from the last CSCI inspection report that the management must now address. These are around the CCTV cameras and the recording of emergency lighting checks. The management response to inspection reports is normally positive. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 2 X Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 26 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 YA9 Regulation 37 Requirement Any incident involving the use of restraint must be reported to CSCI using the regulation 37notification process. The CCTV cameras installed in the home in al day areas must be removed to ensure some privacy for residents. [ last requirement date 1.5.06 not met] Fire records must be updated to include testing of emergency lighting [monthly] as indicated on the ‘fire schedules’ in the fire logbook. [Last requirement date 1.5.06 not met]. Timescale for action 01/11/06 3. YA24 12(4)a 01/12/06 2. YA42 23 01/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 27 1. 2. YA23 YA24 Social Services adult protection team should be contacted regarding updating policies and providing any training. The car park should be levelled and resurfaced to ensure satisfactory disabled access across site – particularly to the activities unit. Lyme House DS0000022413.V311045.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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