Inspection on 19/09/08 for Warrington Community Living - Lucklaw

This inspection was carried out on 19th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Warrington Community Living -... 23/08/06

Warrington Community Living -... 07/12/05

Warrington Community Living -... 04/05/05

Warrington Community Living -... 09/12/04

Warrington Community Living -... 03/09/04

Warrington Community Living -... 27/01/04

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Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Vitalise Sandpipers Centre

Sue Ryder Care Birchley Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 20/12/2008.

CARE HOME ADULTS 18-65 Warrington Community Living - Lucklaw Lucklaw Burtonwood Road Great Sankey Warrington Cheshire WA3 3AN Lead Inspector David Jones Key Unannounced Inspection 19 and 22 September 2008 12:50 Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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 Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warrington Community Living - Lucklaw Address 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) Lucklaw Burtonwood Road Great Sankey Warrington Cheshire WA3 3AN 01925 230474 Warrington Community Living Care Home 4 Category(ies) of Physical disability (4) registration, with number of places Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category of service only: Care home only – Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability – Code PD The maximum number of service users who can be accommodated is: 4 Date of last inspection 20 December 2007 Brief Description of the Service: Lucklaw is a care home registered to provide personal care and accommodation for four adults with physical disabilities. It is a domestic four-bedroom bungalow in a residential area of Warrington and blends in with neighbouring properties. The premises have been adapted to accommodate the needs of people with a disability. There is level access throughout the bungalow with low gradient ramps to the front door and gardens. People who live at the home have their own specially adapted transport enabling them to go out for day trips and to the local community. Information about Lucklaw including copies of the most recent inspection report is made available to each resident and their representatives and can be acquired by contacting Warrington Community Living on 01925 246870. Fees range according to the needs of the individual. Contact Warrington Community Living on 01925 246870 for further information. There are no additional charges other than transport costs shared between the four people who live at the home. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes This key inspection was unannounced. The visit to the home took place over two days and took 10 hours and 20 minutes in total. It started at 12:50 pm on the first day. This visit was just one part of the inspection. Before the visit took place we asked the manager to complete a document called Annual Quality Assurance Assessment or AQAA for short. We ask all services to complete this document once a year. It gives us information about how the home is meeting the needs of the people who use the service and includes future plans for further development. We made our questionnaires available for the people who use the service, their relatives and the staff and their views about the home have been taken into account. We also looked at the information that we already had about the service and this with the information from the AQAA helped us to form our inspection plan. We looked at the care records of two of the people who live at the home to see the care they receive. Some people were spoken with and their views taken into account. We also visited Warrington Community Living offices in Warrington Town Centre so we could check staff recruitment records. Some of the home’s policies and procedures were also checked to see if these were up to date and provided staff with appropriate guidance. What the service does well: Lucklaw is home to a group of people who have lived together for a number of years. As they have communication difficulties, we were not able to talk with them so we sent survey questionnaires to their relatives for their views. They told us that the home continues to meet the needs of their relatives and some made positive comments. For example, one relative told us their relative “has the best support living in their home. All their needs are met and I feel they are well looked after”. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 6 There are good procedures for introducing new people to the home. They have their needs assessed so they know the home will be suitable for them and they are encouraged to make a number of visits to the home before they move in so they can make an informed decision about living there. The home is well maintained and the needs and preferences of the people who live there have been taken into account in the decoration and furnishing of the home so it meets their needs and reflects their personalities. What has improved since the last inspection? What they could do better: The statement of purpose and service users guide should be made available in a range of easy read formats so people with a learning disability are helped to understand it. The people who live at the home should be provided with a document that confirms terms and conditions so they and their representatives know their rights and responsibilities in relation to the services they receive. Care plans need to be reviewed with the person who lives at the home and their representatives including health and social care professionals. This will help to make sure that arrangements for care are made in the best interests of the person and that they always receive care in the way they would prefer. General reviews should be arranged where appropriate and each person’s family members and other representatives should be invited to attend. This will provide the people who live at the home with the support they need to make decisions about the way they receive care and plans for future development. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 7 Managers must make sure that proper provision is made to ensure the safety and well being of the individual at all times. This means a sufficient number of suitably qualified, competent and experienced persons must always be working at the care home to make sure that the needs of the people who live there are met. Risk assessments must be carried out and, where necessary, risk management plans must be put in place for all possible hazards so people who live at the home are safe and protected from accidents and injury. Plans to improve and provide appropriate bathroom facilities must be put into practice so all people who live at the home have the facilities they need. All new staff must receive the training they need so they have appropriate skills and knowledge to meet the needs of people who live at the home before they are allowed to work with them in an unsupervised capacity. Quality assurance systems need to be put in place to make sure the home is run in the best interests of the people who live there. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service have their needs assessed so they receive the care and support they need. EVIDENCE: The people who live at the home have lived together for a long tome and no new people had moved in for a long time. However, information provided in the AQAA showed us that there are good procedures for introducing new people to the home. These help the person and their representatives to make an informed choice about the home. The manager and support staff would work closely with the person and their representatives including family members, health and social care professionals to make sure that the person’s needs are assessed before they move in. Care plans would be drawn up with the individual so appropriate arrangements can be made to meet their needs in the way they would prefer. People interested in living at the home are encouraged to make a number of visits so they can see the home and meet and get to know the other people who live there. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 10 There is a statement of purpose that sets out the objectives and philosophy of the home and a service users guide, which provides information on facilities and services provided. The manager is looking at ways of making these documents available in a range of formats including using photographs and illustrations to make the information easier to understand. The service users guide needs development to include a standard form of contract. This will ensure that the people who live at the home and their representatives have written information about terms and conditions so they know their rights and responsibilities. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live at the home do not always get the support they need to help them make important decisions so their rights are not adequately protected. Risks were not assessed and staff did not have some of the guidance and support they needed to make sure risks were minimised so some people were not safe. EVIDENCE: Information provided in the AQAA told us that the home has put risk assessments in place so people are safe in their daily lives and activities. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 12 However in two care files we looked at we found that risk assessments were missing or were out of date. For example, one person’s file did not contain a risk assessment on the use of rectal diazepam and staff were not fully aware of all the dangers associated with this important procedure. This meant that this person was potentially at risk of personal injury and harm. The risk assessments on another person’s file were out of date. They related to a holiday the person went on in 2006 and were irrelevant to the current day-today hazards for that person. For example, there was no risk assessment on the use of bed rails that had been put in place to prevent the person falling out of bed. However, there are hazards associated with the use of bed rails, which had not been assessed or recorded. This showed us that the home had not made sure that risks to health and safety of the people who live there have been identified and as far as possible eliminated. Care plans have been revised since our last inspection and some had been improved. They covered a wider range of personal care needs and included more personal preferences so people received care in the way they preferred. For example, each person’s care plan had a new section on how they would prefer to receive affection from their care workers. This shows us that staff were sensitive to each individuals’ changing needs. None of the care plans we saw had been signed or agreed by the person’s representatives. This is important because the people who live at the home do not have capacity to agree their own care plans so they need the support of their representatives to help them make appropriate decisions in their best interests. One of the care plans we saw stated that the person should not be left in the home with only one member of staff during the day. This contradicted another part of their care plan, which stated, “When they are at home with one staff member they must sit or lie on their bed in case rectal diazepam needs to be given”. Senior staff explained that the person is put on their bed in the interests of their safety because they need two staff to give them their medication if they are sitting in their chair or wheelchair. They told us they do this because of staff shortages to allow other people who live at the home to go out with other staff. This decision does not reflect the person’s best interests. The rights and freedom of movement of one person should not be restricted to enable other people to go out. Information in the AQAA told us that the manager and the staff recognise the right of people who live at the home to take control of their lives and to make their own decisions. There was evidence of good practice where two people had received the right level of support to help them with their decision-making when they exchanged rooms to meet their individual needs. General reviews do not take place regularly so people who live at the home and their representatives have not always had opportunity to review their care. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 13 For example, a relative of one of the people who lived at the home told us they were dissatisfied with the review process. They said family members had attended a review in 2007 but felt their views were not taken seriously, or acted upon. They told us that there was no manager or senior person at the review and they did not receive minutes of the review meeting so they did not know how the issues they raised were to be addressed. They also told us they were concerned that the family had not been consulted about important issues including a financial decision. They told us that their relative did not have capacity to make complicated financial decisions and they were concerned that the home had entered their relative into a financial arrangement without consulting their representatives. Senior staff told us that a mini bus had been leased using the financial resources of the people who live at the home but there was no record on the care files we read of the decision making process. There was no assessment of each person’s capacity to make such a decision or enter into a financial agreement. Where there is any doubt about a person’s ability to make a decision an assessment of the person’s capacity to make the decision must be done. The decision making process must determine the level of support the individual needs to make the decision, including who needs to be consulted on their behalf. The decision making process must be recorded. This needs to be done to safeguard and promote the individual’s rights and is a legal obligation under the Mental Capacity Act. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. A lack of available staff and inadequate planning has meant that some people do not always have sufficient opportunities for leisure, recreation and social interaction. EVIDENCE: As the people who live at the home have communication difficulties, we were not able to talk with them so we asked their family members for their views about the home and these have been taken into consideration. We also observed what people do during the day and looked at their activity records to see what activities they had done in the last month. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 15 Most of the relatives who responded to our survey told us that the people who live at the home received the right level of support but one family told us they were concerned that things had changed and there was a lack of suitable activities and opportunities for social interaction. Records showed us that some people had not always had opportunity to take part in appropriate activities. For example, the activities records for one person showed that they rarely leave the house to go into the local community and the activities they were offered in the house were limited to having a hand or back massage, sitting in the garden, listening to music or the TV and observing staff cleaning their rooms and cooking meals. Records show that on some days the person did not do any activities including a nine-day period when no entries were made in their activities records. Staff told us that they do their best but reduced staffing levels had meant that opportunities to take people out were usually restricted to early afternoons when shifts overlapped. The activities records for another person showed that they go out more often but there were long periods where no activities were recorded. One person is blind but the only activity recorded for them on some days was observing staff preparing food or doing other jobs around the house. Staff told us that this type of activity offers little stimulation for the person. We observed that the atmosphere in the home was relaxed, welcoming and sociable. When shifts overlapped staff worked with people on a one to one basis. Whilst we were visiting, one staff member took one person out for a walk and another staff member helped another person bake a cake. However there were no clear plans as to what staff could do to keep all people suitably occupied and some people became disengaged and appeared isolated at times. Staff told us each person has an activities programme in their personal files but these were not being followed. They said they were trying to develop new, more suitable activities programmes but were having difficulty identifying what could be done with available resources. We observed support staff preparing meals and helping people who needed assistance with their meals. Staff were sensitive to the needs of each person and provided them with the support they needed, at a suitable pace. We saw that people were offered well-balanced, appetising meals that they enjoyed. Records of meals served need to include everything on the menu including vegetables so a full assessment of each person’s diet can be made. Links with family members are supported and relatives told us they are always or usually kept informed of significant events in the home. Most relatives told us they were satisfied with the standard of care facilities and services provided but one family told us that they were not always made to feel welcome and communication between them and the home had not been as reliable as they would wish. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. Proper provision is not always made to ensure the health and well-being of people who live at the home. Support staff do not always have the knowledge, skills and guidance they need to make sure people’s health care needs are met. EVIDENCE: The aims and objectives of the home reinforce the importance of treating people with respect. Personal support is provided in private and individual preferences are recognised and usually met. However, discussion with staff and records showed us that proper provision has not always been made to ensure the well being of one of the people who lives at the home. A recently recruited staff member, who was inexperienced and untrained, had been left on their own, unsupervised, to provide care for one person who had complex health and personal care needs. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 17 Assessments showed that this person needed two staff to help them with their mobility and with the administration of vital rescue medication if they had an epileptic seizure. The staff member had not received training in the administration of medication or moving and handling but had received one hour’s training on the administration of rectal diazepam. Discussion with the manager and the staff member showed that the training they had received on rectal diazepam did not equip them with the skills and knowledge they would need to ensure the procedure would be carried out effectively or safely. This meant that this health and welfare of the person the staff member was being asked to provide support for was put at risk. We observed how staff provided care for the people who lived at the home. All care interventions were done well with attention to detail by making sure the individual was at ease and the care plan followed. Each person’s health care needs were recorded in their respective care plans along with guidance for staff on how they are to be met. Health care needs were monitored; potential problems and indications were identified and dealt with at an early stage. Health care records for one person were not up to date. They did not include recent visits to the dentist and GP but staff were able to fill in the gaps. “Anticipatory Care Calendars” had been introduced to help staff monitor each person’s health and well-being so they know when to make contact with health professionals so the person’s health care needs are met. Relatives who responded to our survey told us that staff at the home meet the needs of the people who live there and some made positive comments about the standard of care provided. For example, one relative told us their relative “has the best support living in the home. All their needs are met and I feel they are well looked after. The staff I feel have the skills and knowledge to provide excellent care”. Another family told us that the facilities were good but they got the impression that staff lack training in caring for people like their relative although they think the staff do their best. They told us that they “value the service but staff need more training so they know what to do for the best”. Arrangements for the storage, recording and administration of medicines were satisfactory in the main. All staff, with the exception of two new recruits, had received training in the administration of medication and all staff had received some training on the administration of rectal diazepam. The manager told us that the standard form of training given for staff on the administration of rectal diazepam was a video followed by a question and answer session. There was no formal training and no form of practical or theoretical assessment of the individual’s competence to make sure they have the required skills to carry out the procedure safely. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home has a complaints procedure and thorough adult safeguarding procedures so the people who live at the home are able to express their concerns, are listened to and safeguarded from abuse and neglect. EVIDENCE: No complaints about the home had been received since our last inspection. The home’s complaints procedure provides appropriate guidance on making a complaint but is only available in a standard format. This should be made available in a format that is suitable and more accessible for the people who live at the home and their representatives. Various methods of communication should be explored including using illustrations and possibly audiovisual media. Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing so that staff know they can highlight poor practice if needed. Training records we saw show that most support staff had received training and guidance on adult safeguarding procedures so they know what to do in the event of any suspicion or evidence of abuse. One adult safeguarding referral had been made to the local authority since the last inspection. Managers and staff had worked in partnership with the police and the local authority to make sure that vulnerable people were protected. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 29 and 30 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well maintained so the people who live there have comfortable, bright and cheerful accommodation of a design and layout that generally meets their needs. EVIDENCE: Lucklaw is a bungalow located in a residential area of Warrington. The home looks like other houses in the area so it does not stand out. It provides spacious, comfortable, bright and cheerful accommodation. Interior decoration, furniture, fixtures and fittings are good and each person’s bedroom reflects their individual needs and personality. Relatives of the people who live at the home told us that the home provides excellent accommodation. Changes have been made to the home over time to meet the needs of people who live there, including fitting overhead hoist tracking and alterations have been made to make it easier for people to use the back garden. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 20 The main bathroom has a toilet in it. Unfortunately, the only other toilets in the home are those located in two people’s en-suite bathrooms. This means that staff and the people who do not have en-suite facilities have to use the toilets in other people’s bedrooms when the main bathroom is engaged. This is inappropriate because it compromises the privacy and rights of the people who live at the home. An assessment previously carried out by a suitably trained member of staff had indicated that the bath is too low and this may present dangers to staff who are helping people to bathe. Requirements made to improve bathroom and toilet facilities had not yet been met in full. The manager wrote to us after this visit and confirmed further development was planned to improve bathroom and toilet facilities in the near future. Although there is no sluice in the home, appropriate arrangements are made for the handling and disposal of waste and infection control. The home is clean and well presented throughout. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are not always enough qualified, competent and experienced staff to meet the health and social care needs of the people who live at the home. EVIDENCE: The manager told us that two staff had left and one was on long-term leave. Existing staff had worked additional hours but had not been able to cover all vacant shifts. There were a number of bank staff employed by Warrington Community Living but they had not been available in sufficient numbers. This meant that there has been times when there was not enough staff to meet the health and social needs of the people who live at the home. For example, one staff member told us that there had been a number of occasions when they had been on their own in the home with all four people who lived there. On another occasion a recently recruited staff member who was inexperienced and insufficiently trained had been left on their own, unsupervised, to provide care for one person who had complex care needs. This person was assessed as needing two people to assist them with mobility and other essential care needs. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 22 Failure to provide sufficiently qualified and experienced staff in appropriate numbers meant that this person’s health and welfare was put at risk. We checked the recruitment files for two new staff who had started work at the home since our last inspection and we discussed recruitment procedures with the assistant manager and some staff. Records show that the home’s recruitment procedures were thorough so people who live at the home were safeguarded from harm and abuse. We talked to the assistant manager and some staff about staff training opportunities and we looked at staff training records. These show that more than 70 of the staff have or are working towards National Vocational Qualifications at level 2 or 3 in care. Staff files contained certificates for a range of relevant training and development subjects including medication and health care procedures, administration of rectal diazepam, health and safety at work, food hygiene, protection of vulnerable adults, moving and handling, fire safety training, sensory awareness and other specialised topics including PEG feeding systems. All staff have an annual appraisal which helps them and their managers to identify further training needs to make sure they continue to have the skills and knowledge to provide care for the people who live at the home. However training records showed that two new recruits had not received induction training even though they had been working as care workers in the home for more than ten weeks. Both staff members had been booked on an appropriate training course with the local authority but this was not to take place until twelve weeks after they started work. All new staff should receive structured induction training that meets “Skills for Care” common induction standards within six weeks of them starting work in the home. This needs to be done so new care workers know how to work safely and effectively. All care staff were helpful, friendly and cheerful. They told us they received regular supervision from the manager but did not see her or the assistant manager often. The assistant manager told us that she had not been able to spend as much time in the home as she would have liked because she had to work as a hands-on care worker at another home operated by Warrington Community Living. Staff told us that in the absence of a senior member of staff on duty they often took their lead from some of the more experienced care workers. They said they were happy with this and felt well supported as a staff team. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The manager and assistant manager have the necessary experience and skills to manage the home but need be at the home more to ensure that the needs of people who live at the home are planned for and met so their well-being is assured. EVIDENCE: Since our last inspection the previous manager of Lucklaw has moved to another job with Warrington Community Living. The former assistant manager was appointed as manager of Lucklaw on 31 March 2008 and a new assistant manager has since been appointed. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 24 The new manager has not made applied for registration with us (the commission) because of some unforeseen complications. They told us that they expect to resolve these problems and will put in an application for registration in the near future. The management structure is suitable for the home’s stated purpose and includes the manager, assistant manager and eleven support staff posts. Both the manager and the assistant manager are registered nurses in learning disabilities. The manager is experienced in the field of learning disabilities but does not hold a management qualification so is working towards the Registered manager’s award. It is important that the manager completes this qualification so they can demonstrate that they have the necessary skills to manage the home effectively and ensure all the needs of the people who live there are met. Information provided in the AQAA and discussion with the manager shows us that the manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The manager told us that she has tried to promote person centred care planning. She said she wants to make sure people are involved in the development of their care plans and where necessary receive support from their relatives and other representatives when required. In this way each person’s diverse needs will be recognised and recorded so care staff are given the guidance they need to provide care in the way the individual prefers. Unfortunately the manager’s plans have not worked out as she would have wanted. Four of the five requirements we made following our last inspection of the home in 2006 had not been met in full. Work on reviewing and revising care plans had not been completed and general reviews had not been organised. Important risk assessments were missing from people’s case records and in some instances care plans needed revising so staff have the guidance they need to carry out their work safely and in the best interests of the individual. The assistant manager had been asked to complete much of this work but had been unable to because she had to work as a care worker at another home. The assistant manager, who is responsible for staff rotas, had to deal with severe staff shortages over the summer. On occasion there were not enough staff to cover all vacant shifts, which resulted in the needs of the people who lived at the home not being met. The home does not have sufficient bank staff available to cover vacant posts and there are no current arrangements to use agency staff to provide cover when required. The manager needs to ensure that proper provision is always made for the welfare of the people who live at the home. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 25 Warrington Community Living revised quality assurance procedures for its care homes in 2007 but this work had not been put into practice at Lucklaw. There had been no recent survey of the views of the people who use the service and staff were not aware of the home’s quality assurance system. The new manager told us after the inspection that a suitable quality assurance system will be introduced based on seeking the views of the people who live at the home and their representatives. A report on quality issues will be published so people will know their views are taken seriously and acted upon. Information provided indicates that fire precautions are in place and routine maintenance checks of gas and electrical systems, hoist, electrical appliances, lift, fire alarms, extinguishers and emergency lighting systems are undertaken and are up to date. Some risk assessments were missing and there was not enough evidence that action had been taken to identify and minimise risks to the health and safety of the people who live and work at the home. Staff told us they had not received any specific training on equality and diversity; however some had covered it on NVQ training and had an understanding of the issues. They were aware that the home aimed to meet each person’s diverse needs through person centred planning. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 2 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 3 25 X 26 X 27 2 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X 2 2 X Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes The registered persons must provide appropriate bathing facilities as in accordance with residents’ assessed needs to ensure a safe environment. Previous time scale 01.04.05, 25/08/05 and 01/04/06 not met) 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 1 YA6 15(2)(b), Following consultation with the 30/11/08 (c) & (d) person who lives at the home and their representatives, the person’s care plan must be reviewed and revised as necessary. This will help to make sure that arrangements for care are made in the best interests of the individual and they receive care in the way they would prefer. 2 YA9 13(4)(c) Risk assessments must be 30/09/08 carried out and, where necessary, risk management plans must be implemented for all identified potential hazards including use of bed rails, the administration of rectal diazepam and environmental hazards, to make sure that the people who live at the home are safe. Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 28 3 YA19 12(1)(b) 4 YA20 19(5)(b) 5 YA33 18(1)(a) 6 YA39 24(1) Proper provision for the care, treatment and supervision of people who live in the home must be made so their needs are met in the way they prefer and they are not subjected to inappropriate restrictions on choice and freedom of movement. Training for staff on the administration of rectal diazepam must sufficient to give them the skills and knowledge they need to ensure the health, safety and well being of the people who live at the home. There must be enough suitably qualified, competent and experienced persons working at the care home to make sure the needs of the people living there are met and their wellbeing is assured. A system for reviewing the quality of care provided at the home must be established, and a report on this provided to the commission, to make sure that the home is being run in the best interests of the people who live there. (Previous timescale 29/02/08 not met.) 30/09/08 30/11/08 30/09/08 15/12/08 Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 29 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 YA1 YA5 Good Practice Recommendations The service user’s guide and statement of purpose for the home should be available in formats that are easier for the people who live there to understand. The service user’s guide should include a standard form of contract or provide a statement of terms and conditions so people know their rights and responsibilities relating to the service provided. Reviews of people’s care plans should be done regularly and where appropriate each person’s family members and other representatives should be involved in the review so the person receives the assistance they need to evaluate the care provided and agree plans for their care and future development. Where there is any doubt about a person’s ability to make a decision an assessment of the person’s capacity to make the decision should be made. The decision making process must determine the level of support the individual needs to make the decision including who needs to be consulted on their behalf. The decision making process must be recorded. This needs to be done to safeguard and promote the individual’s rights and is a legal obligation under the Mental Capacity Act. A range of suitable activities should be developed so people who live at the home have opportunities for recreation, leisure and social interaction in the home and local community. The health care records of people who live in the home should be kept up to date so they receive the health care they need and benefit from regular health checks. Plans to improve and provide appropriate bathroom facilities must be put into practice so all people who live at the home have the facilities they need. New staff should receive induction training that reflects Skills for Care induction criteria within six weeks of them starting work at the home so they know how to work safely and effectively. 3 YA6 4 YA7 5 YA12 6 7 8. YA19 YA27 YA35 Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North West Region Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Warrington Community Living - Lucklaw DS0000027018.V366403.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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