Inspection on 10/10/05 for The Lawns, Exmouth

This inspection was carried out on 10th October 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Lawns, Exmouth 15/08/06

The Lawns, Exmouth 24/05/05

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Lawns, Exmouth 52 Salterton Road Exmouth Devon EX8 2EJ Lead Inspector Belinda Heginworth Unannounced Inspection 10th October 2005 09:20 The Lawns, Exmouth DS0000062003.V252392.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 The Lawns, Exmouth DS0000062003.V252392.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. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Lawns, Exmouth Address 52 Salterton Road Exmouth Devon EX8 2EJ 01823 331712 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) Voyage Ltd Barbara Elizabeth Greenslade Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager must obtain the Registered Manager’s Award by November 2006 24th May 2005 Date of last inspection Brief Description of the Service: The Lawns provides personal and supportive care for 10 residents with learning and physical disabilities. The house is a detached three storey building in a residential area of Exmouth. All bedrooms are single with en-suite facilities. There is a large lounge, dining room and kitchen. Additional communal rooms are provided for games and relaxation. There are pleasant secure gardens to the front and rear of the property including level patio areas. The home has been adaptated to meet the needs of residents with physical disabilities. The providers, Voyage Ltd is a large organisation with a number of registered homes throughout the region. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3 hours with one of the deputy managers being present throughout. The Lawns currently has 9 residents living in the home. The majority of residents have limited verbal communication skills. Although seven residents currently living there were seen and spoken with, not all were able to express an understanding about life at the home. However all residents seemed happy and the relationships between staff and residents appeared good. Five staff including the deputy manager were consulted and their views on the home were discussed. The inspector looked around parts of the home and some records were inspected. What the service does well: What has improved since the last inspection? What they could do better: The home needs to develop a method of recording how residents’ daily care plans goals are being met to ensure that achievement of goals, or work carried The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 6 out towards them are recorded on a daily basis. This will provide key workers with a tool to evaluate residents’ care plans goals. Restrictions on choice or freedom should be discussed, agreed and recorded with other professionals - for example a Good Practice Committee. The home should develop a shift system that is designed to meet the social needs of residents in the evenings. The deputy manager’s should be allocated some time for admin type duties. 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 Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 Not inspected on this occasion. EVIDENCE: The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&7 Care plans and risk assessments provide staff with the information they require to meet residents’ needs safely. Improvements are needed in relation to decision-making arrangements. This is particularly important given that some residents have limited capacity to contribute to plans and decisions. EVIDENCE: Residents have limited communication skills and have a limited understanding of care plans and are therefore unable to easily contribute to their formulation or reviews. It was clear through observations made that the staff team work hard to meet residents’ needs. Care staff demonstrated a good knowledge and understanding of the care plans and any associated risks. Care plans provide good information about residents’ needs but additional information is needed in relation to decision-making on behalf of residents. For example, many of the doors in the home are locked; this includes the front door and the communal toilet. The kitchen is also kept locked which means residents are unable to access it if they chose. Due to some complex behaviours of some residents it could be unsafe to have the doors unlocked. The staff team want to ensure they meet their responsibilities under their duty of care by keeping residents safe. However, the decision to carry out these The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 10 “restrictive practices” has not been discussed and agreed within a multidisciplinary setting. Individual care plans, risk assessments or the home’s Statement of Purpose and Service User Guide do not reflect the reasons for any restrictions or who was involved in the decisions. It was recommended during the last inspection that any practices that are restrictive should be discussed and agreed within a multi-disciplinary setting. This remains the same. It was highlighted during the last inspection that daily records were to be reviewed to ensure that achievement of goals or works carried out towards them are recorded on a daily basis. This would provide key workers with a tool to evaluate residents’ care plans goals. This work has not been completed. The deputy manager agreed that the current method of recording daily events does not take into account the goals and care highlighted in care plans. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 & 16 Links with the community are good and staff support service users’ social and educational opportunities during the day. The home needs to improve such opportunities in the evenings. EVIDENCE: It was clear through observations made during the inspection that relationships between staff and residents is caring and respectful. On the day of the inspection residents and staff were using the home’s sensory room for art and crafts, listening to music and relaxing in the soft play area. The atmosphere was warm, friendly and relaxed. Residents use the local and surrounding facilities for swimming, shopping and walks. The home employs art, aroma and music therapists to come to the home for sessions with the residents. The majority of activities take place during the day apart from planned evening activities. For example staff took residents to the local carnival recently. However, because the day shift ends at 8.30pm when two night staff The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 12 start duty residents do not have the opportunity to go out on ad hoc evening activities. The majority of residents require a minimum of two staff when out of the house, therefore after 8.30pm there is not enough staff on duty. It was recommended during the last inspection that the shift system was reviewed to ensure that there are enough staff on duty at all times of the day to meet residents’ needs, including social needs. (See section 31 – 36) Residents are supported to maintain good contacts and relationships with families. Many residents go home for visits and weekend stays. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents benefit by receiving personal support in the way they prefer. EVIDENCE: Personal care and support is provided by staff. Care plans describe preferences, likes and dislikes. Staff, in the last inspection demonstrated a good knowledge and understanding of the information in the care plans. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Residents benefit from a good complaint’s procedure. EVIDENCE: Voyage Ltd produce the policies and procedures for the home. The complaint’s procedure is clear. Staff had a good awareness of the policy and knew what to do if they were not happy. The current residents living in the home are unable to understand written words or pictorial formats. It is staffs’ observations and knowledge of residents that make them aware that a resident is unhappy. The deputy manager intends to display the complaint’s procedure for relatives to see. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Residents benefit from a clean and hygienic home. EVIDENCE: The Lawns is very homely and clean throughout. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 33 Residents benefit from a competent and effective team of staff. Some improvements are needed in relation to meeting residents’ social needs in the evenings. EVIDENCE: The deputy manager said that 28 of staff have achieved NVQ level 2 and above and 30 are in the process of completing the qualifications. Staff receive an in depth induction training linked to the Learning Disability Award (LDAF). In addition staff attend courses such as epilepsy awareness, communication skills, abuse awareness and many more. The training and qualifications ensures that residents are protected by suitably trained staff. Staffing arrangements during the day appear to meet the needs of the residents. Wide and varied activities take place, in and out of the home, because there is a good ratio of staff. Voyage’s rota policy is a set shift system. The Operational Manager said during the last inspection that it was a flexible system that can be changed to meet the changing needs of residents. However the current shift pattern does not take into account residents’ social needs in the evening. Day shifts end at 8.30pm when three staff take over for the night shift. Due to the complex needs of the residents, unplanned social and leisure pursuits cannot be provided outside of the home with three staff. This was discussed with the The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 17 Operational Manager and the home’s Manager during the last inspection. It was agreed in May 2005 that the shift system should be reviewed to take into account social needs beyond 8.30pm. The shift system remains the same. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 18 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 The home is managed well with systems in place that monitor the quality of service offered. Some improvements are needed to the time allocated to the deputy managers for admin type duties. Residents’ health & safety is well protected. EVIDENCE: The registered manager is currently on extended leave that was agreed with the CSCI. The home has two deputy managers who are “acting” up in the manager’s absence. The deputy managers are also part of the numbers of staff required to meet the needs of the residents each day. This means that no time has been set aside for them to complete admin type work. For example staff supervision, care plan reviews, monitoring of records and so on. Although the deputies are managing well, the work is being completed by them staying on after their shift has ended or while they should be caring for residents. Management time should be included in their working week to ensure residents have the staff they require to meet their needs. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 19 The home has good systems for monitoring the quality of care delivered to residents. These range from care plan reviews, staff training and supervision, visits from the providers and so on. Voyage Ltd have produced a quality monitoring tool that will assess all aspects of service, including satisfaction surveys to residents, staff, relatives and outside stake holders. The monitoring tool has not been completed yet as the home only opened in January 2005. The deputy manager said it should be completed by the end of December 2005. Some doors in the home that lead to the outside are locked by a coded keypad. (See section 6-10) These are to prevent residents leaving the house unescorted. The residents living at the home could be at many risks without staff to guide them. The inspector was told that all but the front door are overridden when the fire alarm goes off. This means that staff and residents would be able to release the means of escape doors without having to use the coded keypad. The fire logbook showed that fire tests and staff training were completed and up to date. The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 20 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 X X X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 2 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Lawns, Exmouth Score 3 X X X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 3 X DS0000062003.V252392.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA6 YA7 Good Practice Recommendations Residents’ daily monitoring sheets should record information relating to care plan goals. Residents rights to make decisions is limited only through the assessment process, involving the resident and as recorded in the individual residents care plan. Any decisions made by others should be recorded, including the reasons why and involving a mulitidisciplinary approach. The registered person should review staffing shifts to ensure the home is able to meet social needs at all times of the day and evening. The duputy managers should be allocated some admin time to be able complete admin type duties without infringing on the time spent with residents. 3 4 YA33 YA37 The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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. Extracts may not be used or reproduced without the express permission of CSCI The Lawns, Exmouth DS0000062003.V252392.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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