CARE HOME ADULTS 18-65
LUCKLAW Burtonwood Road Great Sankey Warington WA5 3AN Lead Inspector
David Jones 4 and 6
th th Unannounced May 2005 13:20 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 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 Stationary 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. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Lucklaw Address Butonwood Road Great Sankey Warrington Cheshire WA1 1SR 01925-230474 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Warrington Community Living Les Whittle (proposed) Care Home 4 Category(ies) of PD - Physical Disability (4) registration, with number of places LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 09.12.04 Brief Description of the Service: Lucklaw is a care home registered with the Commission for Social Care Inspection to provide personal care and accommodation for four adults with physical disabilities. The establishment is a domestic four-bedroom bungalow set within 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. Preparations were being made at the time of the inspection to provide additional bathroom, toilet and sluice facilities. Service users have specially adapted transport enabling them to access the local community. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was a routine unannounced inspection carried out as part of the Commission for Social Care Inspection’s duties. The inspection took place over two days for a duration of 10 hours and 50 minutes. Seven members of staff, the manager and the Chief Executive were spoken with during the inspection. All four service users were also spoken with but discussion was limited due to communication difficulties. The inspector observed staff interacting with and supporting service users. The gardens and some parts of the building were looked at, as were some records including the case notes of three service users. What the service does well:
The home provides comfortable, spacious and well-equipped accommodation, which is decorated and furnished in accordance with service users’ personal needs and characters. The home is clean and free of malodours. Service users, who were at ease in the home’s environment, were able to make their needs known. Staff help service users to explore and take advantage of opportunities presented them by the community at large and help them take part in a range of activities inside and outside of the care home. Service users are helped to make choices and maintain family links. Staff maintain contact with service users health and social care professionals to make sure that each individual’s health care needs are met. Service users are protected from harm. Staff receive guidance on the implementation of adult protection procedures and a copy of the local authority’s policy and procedures document is available in the home for staff and any other interested parties. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The home was not being managed properly at the time of the inspection. A large number of requirements and recommendations made after the last inspection of the home had not been met. Some of the care plans had not been updated in over one year. Staff were unfamiliar with the content of service users’ care plans and there was evidence of confusion as to how service users’ needs were to be met. There was a lack of assessment and staff training in relation to moving and handling and without appropriate guidance staff had developed and used inappropriate practices, which put themselves and a service user at risk. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 7 The manager is responsible for the management of two homes conducted by Warrington Community Living (WCL). It was evident that the manager did not have sufficient time to manage both homes. Arrangements to manage the home must be improved and the manager must be provided with the resources necessary to ensure that staff are appropriately, supervised and supported. (It is acknowledged that the Chief Executive of WCL took action immediately after the inspection to strengthen the management structure and address outstanding requirements. A Senior Support worker was to be employed by the 16th May 2005 to assist the manager in the day-to-day conduct of the home.) Management must ensure that care staff are aware of the content of care plans and are clear as to how service users needs are to be met. Care practice must be monitored, evaluated and reviewed on an ongoing basis to ensure that care is provided in accordance with the agreed care plan and the needs of service users. General review meetings or Individual Personal Planning meetings (IPPs) that involve the service users and his/her representative should be held at least once in any 12-month period. Assessments including risk assessments and care plans must be reviewed and updated to make sure that service users needs are known and appropriate arrangements must be made to make sure needs are met. Stock records of all medicines received into the home were not maintained and 18 tablets were found to be missing. Arrangements must be made to ensure that medicines are stored and administered appropriately. Stock records must be made of any medicine entering the home and management must conduct regular medication checks to ensure medicines are given according to the advice of the respective service users’ doctor. Staff had taken action to protect a service user from harm by erecting a gate to restrict him from entering the kitchen when it was in use. There was no written evidence that would indicate that these actions had been risk assessed, agreed or confirmed within the care plan for the guidance of staff. Where such restrictions on service users freedom of movement have been put in place the registered persons must ensure these are recorded and agreed with the individual’s family members and other representatives. Staff must be given appropriate training in moving and handling to make sure that service users and themselves are as safe as is reasonably possible. Appropriate bathing, toilet and sluicing facilities must be provided in accordance with service users’ assessed needs and the home’s electrical wiring systems must be checked by an appropriately qualified electrician. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 8 The registered persons must introduce a system for asking service users; their family members and other representatives about the quality of care provided in the home and must produce a report that confirms how quality issues have been addressed. A Statement of Purpose and a Service Users’ Guide must be made available to all service users and their representatives to ensure that they have all the information about the home they are entitled to. 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. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, and 5. Some progress had been made to address a previous requirement regarding the home’s Statement of Purpose and Service Users Guide which require further development and publication. Without this information prospective and current service users and their advocates are disadvantaged when making decisions about the home. Insufficient progress had been made to address previous requirements to implement appropriate assessment, risk assessment and care planning processes to ensure that service users’ developing needs are identified and met. Service users had not been provided with terms and conditions relating to their placement at the home. Without this document service users and their advocates do not have confirmation of the service users rights and responsibilities. EVIDENCE: The manager of the home had developed a draft Statement of Purpose and a draft Service Users Guide. Both of which were in the process of being finalised for publication at the time of the inspection. See requirement 1. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 11 Reading of service users’ case records indicated that the home’s assessment, risk assessment and care planning processes required further development to incorporate all aspects of need detailed in the National Minimum Standards and presented by service users. This requirement had been identified on previous inspections. Information provided by the manager subsequent to the two previous inspections indicated that the home’s assessment and care planning systems were to be extensively reviewed to include risk assessment and person centred planning processes. Staff spoken with advised that the manager had asked key-working staff to complete new assessment documentation which sought to address the holistic needs of the service user. This work had not been completed at the time of the inspection and none of the findings had been incorporated in service users’ care planning documentation. The case records relating to three of the four service users were seen as part of a case tracking exercise. Two of the three care plans seen had not been updated since February 2004. Two of the staff spoken with during the inspection advised that they were not familiar with the content of care plans and another indicated that the care plans were out of date and the information in them was unreliable. See requirements 2 and 4. Perusal of case records indicated that a service user had suffered an accident and hurt her eye in April 2005. This incident occurred when the service user grabbed hold of the hoist frame when being mobilised by staff and had pulled her self forward catching her eye on the frame in the process. The accident record indicated that the hazard had been removed. However, there was no indication as to how the hazard had been identified and removed and there was no subsequent entry in the care plan to confirm arrangements to prevent a reoccurrence of the incident. Staff spoken with during the inspection advised that the service user has a propensity to grab hold of the hoist frame during manoeuvring procedures, especially when the frame is tilted forward to position her correctly for lowering on to her chair. Concerns were expressed by staff as to the service users’ safety, should she trap or bang her head again. There was no risk assessment in place to identify an appropriate strategy to control or limit these hazards and provide an agreed strategy by which staff could protect the service user from further harm. Different staff gave differing accounts as to how they seek to protect the service user from injury in this regard. In some instances staff hold the service user’s wrist down so that she is unable to grab the bar. Others said they stood from behind and held her arm down and another advised that she reclines the chair back, which prevents the need to tilt the hoist frame forward, and therefore the service user does not grab the bar. The registered persons must ensure that these potential hazards are risk assessed and that appropriate specialists are consulted regarding the difficulties encountered. Staff must be appropriately trained in moving and handling and clear guidance must be confirmed in the care plan and disseminated amongst all staff. See requirements 2, 4, and 6. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 12 It was noted that the care plan relating to another service user advocated methodologies to assist the individual with mobility and the use of equipment, which had not been used for some considerable time. This issue was highlighted subsequent to the previous inspection and two requirements were made relating to the assessment of service users needs and the development of an appropriate plan of care. No progress had been made to address these requirements. Staff spoken with advised that circumstances had changed and the service user would not weightbear on occasion. Further discussion with staff and observation indicated that they were inappropriately assisting the service user to mobilise in a way, which put themselves and the service user at risk of harm. There was no risk assessment available regarding this activity and the care plan was inaccurate and out of date. See requirements 2, 4, 6 and 7. Service users were not provided with documents confirming terms and conditions of residence. At feedback to the inspection the manager advised such documents were in draft and being finalised. See requirement 3. No progress had been made since the previous inspection to explore and implement methodologies to facilitate communication with service users. Assessments completed by the previous manager had not been reviewed or put into practice or confirmed in care plans as agreed strategies. Without this documentation the staff will not achieve a consensus on approach to communication, to the detriment of service users. See recommendation 1. Good practice was noted in that the home’s new assessment documentation was designed to identify service users’ aspirations within a comprehensive assessment framework. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 6, 7 and 9. Insufficient progress had been made to address previous requirements to implement appropriate assessment, risk assessment and care planning processes to ensure that service users’ developing care needs are identified and met. Due to inadequacies in the home’s care planning processes there was a lack of consistency in approach to care and service users were at risk of harm. Service users are enabled to make decisions about their lives but limited progress had been made to ensure the adequate recording of limitations on freedom of movement put in place in the interests of health and safety. Without such limitations being confirmed in writing and agreed with service users’ advocates service users are not afforded the full protection that the home must provide. EVIDENCE: As identified during the previous inspection staff were able to demonstrate how individual choices had been made and daily diaries recorded these instances, as appropriate. It was again noted via observation and discussion with staff that limitations of freedom of movement had been implemented in the interest of a particular service user’s safety. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 14 However, there was no risk assessment made in this respect and there was no confirmation of the resulting limitation or the associated decision making rationale within the respective individual’s case records. See requirement 5. Two of the three care plans seen had not been updated since February 2004. Two of the staff spoken with during the inspection advised that they were not familiar with the content of care plans and one other indicated that the care plans were out of date and the information in them was unreliable. Staff were unaware of the content of care plans resulting in confusion over the administration of PRN medication and a service user being put at risk. The service user in question suffered from epilepsy and constipation with evidence that there was a correlation between the frequency of him experiencing seizures and being constipated. The care plan relating to the administration of a laxative was very precise and well-detailed in that it stated clearly that the laxative must be administered with the evening medication of the third successive day without evidence of a bowel movement. Staff maintained detailed records of this service user’s bowel movements, in accordance with good practice, and associated entries were made at the top of the page in the service user’s daily diary and on an analysis sheet. Perusal of these records confirmed that the medication was being routinely administered on the fourth day of no bowel movement contrary to the instructions confirmed in the care plan. In an isolated incident it was evident that there had been an occasion when five successive days had passed when the service user had not had a bowel movement and the medication was not administered until the sixth day contrary to the instruction in the care plan. See requirements 4 and 8. The same service user was prescribed rectal diazepam to be administered according to the care plan if a seizure lasted for more than 2 minutes or if the service user experienced a seizure with a duration of under two minutes but then had another seizure within the same day. Staff routinely recorded when the service user had a seizure and the information was collated on an analysis sheet, in accordance with good practice. Discussion with staff and reading of the home’s record systems indicated that there was confusion as to when rectal diazepam should be administered. The analysis sheet indicated that on several occasions the service user had experienced two or more seizures in one day and medication had not been administered. On one occasion the service user had six seizures before the medication had been administered. See requirement 4 and 8. It was evident that prior to the administration of rectal diazepam the staff were required to consult the manager. Given that all staff had training in the administration of rectal diazepam, consideration should be given as to whether this precaution is appropriate. It builds in a delay that may be unnecessary and avoidable. See recommendation 2. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 15 One member of staff advised that she was of the view that the care plan relating to the administration of rectal diazepam for this service user was inappropriate because if it was followed the service user would, in her view, be subject to being sedated by the medication on a regular basis. This is a valid observation that should be taken up with the service user’s heath care professionals. The care plan had not been reviewed since February 2004. See requirements 4 and 9. As identified during the previous inspection, reading of service users’ case records confirmed that the home’s risk assessment processes required further development. There was no evidence that appropriate action had been taken in this regard. The most recent and available client handling assessments were several years old and had not been routinely updated. A comprehensive risk assessment had been seen on a previous inspection that was the subject of an outstanding requirement. It had identified that staff required training in moving and handling. Staff present during the inspection advised the inspector that they had not had the benefit of training in moving and handling. See requirements 6 and 7. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 11,12, 13 and 14. Staff engage service users in a range of activities both inside the home and in the local community. These provide service users with opportunities for leisure, personal development and social inclusion. EVIDENCE: Perusal of daily diaries, discussion with staff and observation confirmed that staff seek to engage service users in the day to day domestic routines associated with running the home including cleaning and tidying the house and making shopping trips to the local community. In addition service users are escorted on outings for leisure and recreation with regular drives out in the mini bus and visits to cafes and other places of interest. Staff were seen to interact with service users on a frequent basis engaging them in two-way communication. It was positive to observe a service user participate in singing along with staff to “Beatles” songs known to be a favourite of hers. Staff spoken with during the inspection were keen to further develop the range of activities that are currently on offer. Information provided indicated that staff use to take service users swimming but had not done so recently due to current staff not having the appropriate training. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 17 Discussion with the manager subsequent to the inspection indicated that the home’s new care planning systems are designed to facilitate service users choice and challenge barriers that may prevent the service user from achieving personal goals. It is envisaged that the home’s care planning systems will be central to the continued development of a fulfilled life style for each respective service user. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 18 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 standard(s) 18, 19, and 20. Care, including the administration of medication, was not provided consistently with guidance detailed in service users’ care plans. As a consequence of this service users were at risk of harm. The service users are unable to express their views verbally and unless arrangements for their care are confirmed in a plan of care that has been agreed by their advocates and representatives there are no assurances that care and support is provided in a way the service user prefers. Records of the stocks of loose medicines received into the home were not routinely maintained, medication was missing and therefore service users were not adequately protected. EVIDENCE: It was noted that a care plan relating to a service user advocated methodologies to assist the individual with mobility which had not been used for some considerable time. It was evident that in the absence of a satisfactory care plan staff had not achieved a consensus of approach to assisting the service user with her mobility. Staff demonstrated inappropriate methods of assisting the service user to mobilise that put themselves and the service user at risk of harm. See section of this report titled “Choice of Home” and requirements 2, 4 and 6 for further details. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 19 Staff were unaware of the content of care plans resulting in confusion over the administration of PRN medication and a service user being put at risk. See the section of this report titled “Individual Needs and Choices” and requirements 4 and 8 for further details. Discussion with staff confirmed that affection was given to service users based on a foundation of mutual regard. How affection is expressed and reciprocated should be entered on respective service users care plans to ensure that staff are provided with guidelines in the interests of protection, monitoring and review. See recommendation 3. A medications check identified that stock records relating to loose medicines entering the home were not made and 18 tablets were missing and unaccounted for. See requirement 10. Reading of records and discussion with staff indicated that service users’ health care needs are monitored and contact is maintained with health and social care professionals on an ongoing basis, in accordance with good practice. All service users are registered with a local GP. Records of visits to and from health care professionals were recorded in each service user’s daily diary along with information about other daily events. Whilst this provided a comprehensive record analysis and review would be better facilitated if separate health care records were maintained. Information provided by the manager subsequent to the previous inspection indicated that illustrated “personal health records” would be introduced. These were not being used in the home at the time of the inspection. See recommendation 4. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 20 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 standard(s) 23. Satisfactory Adult Protection Procedures are in place to protect service users from abuse, neglect and self harm. EVIDENCE: An allegation of misconduct had been made against a member of staff employed at the home. The local authority’s Adult Protection Procedures had been instigated and the member of staff concerned had been suspended without prejudice in the interest of the protection of vulnerable adults, whilst an investigation is being carried out. Staff confirmed that they had received guidance on the implementation of adult protection procedures and a copy of the local authority’s policy and procedures document was available in the home for the guidance of staff. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 21 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 standard(s) 24, 25, 26, 27,29 and 30.The premises provide comfortable, bright and cheerful accommodation of a design and layout that reflects the needs and preferences of the services users. Some progress had been made to address previous requirements regarding the provision of appropriate bathing, toilet and sluice facilities. This work must be completed to ensure the safety of staff and the privacy and dignity of service users . EVIDENCE: The premises are in keeping with the local community, and provide comfortable, bright and cheerful accommodation that reflects the needs and preferences of the services users. Adaptations have been made to the premises over time to accommodate changing needs of service users, including the provision of overhead hoist tracking and to facilitate access to the home and the back garden. An assessment previously conducted by a suitably trained member of staff had indicated that the bath is too low and the health and safety of staff assisting service users to bathe may be jeopardised. The main bathroom is equipped with a WC. Unfortunately, the only other WC’s in the home are those located in service users’ en-suite facilities. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 22 This means that staff and a service user who does not have en-suite facilities are required to use the WC’s in other service users’ bedrooms when the main bathroom is engaged. The registered persons must provide appropriate toilet facilities to ensure the privacy and dignity of service users. The home is not provided with a sluice facility, which is necessary as the majority of the service users present with double incontinence. The provision of appropriate toilet, bathing and sluice facilities are the subject of three previous requirements. The manager advised that plans had been draw up and work was expected to commence once funding had been identified. See requirements 11, 12 and 13. Service users’ bedrooms were designed, equipped, decorated and furnished to meet the individual’s assessed needs and personal preferences. The home was clean and well presented throughout. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 23 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, and 36. Limited progress had been made to ensure that the staff team are appropriately supervised in the day-to-day care and support of service users. This had resulted in an uncoordinated approach to care with evidence of differing approaches to care tasks and confusion as to the content of care plans. This along with unaddressed training needs adversely affected the staff group’s ability to meet the needs of service users. EVIDENCE: Staff spoken with during the inspection were aware of the main aims and values of the home and each advised that they had been provided with a job description detailing the role and responsibilities of a support worker. The NVQ training programme was well advanced with 5 of the home’s 12 staff having achieved an NVQ level 2 in care or above and a number of others applying for registration for the qualification in the near future. See recommendation 5. Staff rosters seen during the inspection indicated that staff were employed in numbers sufficient for the well being of service users. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 24 The manager is the manager of two homes run by Warrington Community Living. Staff confirmed that the manager made regular visits to the home but could not be specific about the duration or frequency of the visits. No action had been taken to address a previous recommendation to make sure that the manger’s input is confirmed on the staff roster. See recommendation 6. With all support staff being of equal grade and no designated “Shift Senior System” there is no structure in the staff team. In the absence of the manager no one individual is responsible for the supervision and conduct of the staff group on a day-day basis. Staff spoken with indicated that morale in the home had improved and there was more evidence of team working but it was still difficult to achieve agreement and common ground as to how service users needs should be met. Limited progress had been made to address issues raised at previous inspections regarding a lack of structured care planning and necessary levels of managerial and supervisory input. Staff training needs in moving and handling identified at the previous inspection had not been addressed and some care plans had not been reviewed since February 2004. Some care staff spoken with advised that they were not familiar with the content of care plans and it was apparent that there was an element of confusion and a lack of clarity as to how service users’ needs were to be met, as evidenced in previous sections of this report. Information provided by the manager and Chief Executive at feedback to the inspection indicated arrangements had been made to appoint an appropriately experienced senior support worker to address the identified management deficiencies. The respective individual would be confirmed in post in the very near future. See requirements 4, 9 and 14. Staff advised that the manager had instigated scheduled supervision and monthly house meetings. Records seen indicated that one member of staff had not had supervision since October 2004 and another advised that her last supervision had taken place approximately two months ago but was not recorded and prior to that she had not had supervision since February 2004. The last recorded house meeting was held on the 20th December 2004. See recommendations 7 and 8. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 25 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41 and 42. The home was not being managed properly at the time of the visit. Management arrangements were inadequate to ensure that staff were approriately supervised and that care was delivered in accordance with service users’ identified needs as detailed in care plans. Care practice was not being appropriately monitored and evaluated and identified staff training needs in moving and handling were not being addressed. EVIDENCE: The recently appointed manager is a Registered Nurse Learning Disabilities and an experienced manager and practitioner in the field of learning disabilities with many years of experience. He had made an application to register with the Commission for Social Care Inspection and is pursuing qualification in care management to NVQ level 4. See recommendation 9. Fourteen of the seventeen requirements and eight of the eleven recommendations arising out of the last inspection conducted on the 9th of
LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 26 December 2004 had not been satisfactorily addressed. (Thirteen of these requirements and eight of these recommendations had been reiterated from previous inspections). As detailed in previous sections of this report the home’s medication procedures, assessment including risk assessment, care planning monitoring and review procedures, staff training and staff supervision arrangements require further development to ensure that service users’ needs are met, their rights are protected and promoted and proper provision is made for their health and welfare. See requirements 1-16. It was evident that the manger had been unable to communicate a clear sense of direction and leadership to staff due to the fact that his time in the home had been limited. General review meetings had not been convened on behalf of service users in over one year. See recommendation 11. Staff scheduled supervision had not been offered at the appropriate frequencies. See recommendation 7. House meetings had not been convened on a regular monthly basis. See recommendation 8. No progress had been made to implement team building for the staff team as recommended subsequent to the previous inspection. See recommendation 10. At feedback to the inspection The Chief Executive of WCL explained that circumstances and resource limitations had impacted on the manager’s capacity to manage the home. To address these deficiencies assurances were given that the management structure would be strengthened with the deployment of a full time senior support worker. See requirement 14. The home did not employ a structured quality assurance system. Information provided indicated that the home had previously deployed quality audit mechanisms and methods of implementing effective quality assurance mechanisms were under review. See requirement 15. The service users do not communicate verbally and ascertaining their views presents challenges to the staff and management. Good practice was identified in relation to the new assessment, care planning and health care monitoring documentation that the manager was in the process of introducing at the time of the visit. It was noted that this reflected an holistic approach to care of the individual. The documentation is also illustrated with pictograms as an aid to communication and understanding. Visits to the home were made by the Chief Executive of WCL on a monthly basis, in accordance with the requirements of regulation 26. Some progress had been made in reviewing the home’s policy and procedures documents, in that an up-to-date Adult protection policy had been made available to staff. Some of the home’s policies had not been updated since 1995. The manager confirmed that these were under review. See recommendation 12.
LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 27 Inspection of the premises, perusal of the care home’s record systems and discussion with management and staff indicated there was no evidence that an appropriately qualified individual had checked the home’s electrical wiring systems. See requirement 16. Information provided by the manager subsequent to the inspection indicated that all staff had had fire training and an appropriately qualified individual had tested the home’s portable electrical appliances. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 28 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 2 2 2 x 2 Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 1 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 2 x 2 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score 3 1 1 x 2 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
LUCKLAW Score 2 3 1 x Standard No 37 38 39 40 41 42 43 Score 1 2 2 2 2 2 x F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 29 yes 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 1 Regulation 4 and 5. Requirement Timescale for action 30/06/05 2. 2, 3, 18 and 19. 14 and 13. 3. 5 5 4. 2, 3, 6, 18, and 19. 15 The registered persons must produce a statement of purpose in accordance with Regulation 4 and a Service Users Guide in accordance with Regulation 5 and as detailed in the National Minimum Standards 1.1 to 1.3.(Previous time scale 01.03.05 not met) The registered persons must 30/06/05 ensure that the home’s assessment, risk assessment and care planning processes incorporate all aspects of need detailed in the National Minimum Standards and presented by service users.(Previous time scale 01.03.05 not met) The registered persons must 30/06/05 provide each service user with a standard form of contract or statement of terms and conditions.(Previous time scale 01.03.05 not met) The registered persons must 30/06/05 provide each service user with a plan of care that confirms how their needs will be met.(Previous time scale 01.03.05 not met) LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 30 5. 7 15 and 17 6. 2, 3, 9, 18, 19 and 42 13 7. 9, 20, and 42. 18 8. 6, 18, 19. and 20. 12, 13 and 15. The registered persons must maintain a record of any limitations agreed with a service user, or his/her representative, as to the service user’s freedom of choice, liberty of movement and power to make decisions is appropriately recorded along with details of the agreement and the decision making rationale.(Previous time scale 0103.05 not met) The registered persons must review risk assessments and respond to and act upon recommendations made subsequent to the home’s moving and handling assessments.(Previous time scale 01.03.05 not met) The registered persons must ensure that staff have received training in moving and handling appropriate to their individual duties and responsibilities.(Previous time scale 01.03.05 not met) The registered persons must conduct the home so as to promote and make proper provision for the health and welfare of service users and ensure that PRN medication is administered in accordance with the prescription and guidance confirmed within the care plan. The registered persons must liaise with a service user’s health care professionals regarding issues raised by staff regarding guidance for the administration of rectal diazepam as detailed within the service user’s care plan and subsequently update the care plan and disseminate information amongst the staff team. 30/06/05 30/06/05 25/08/05 06/05/05 9. 19 and 20. 12 and 13. 30/06/05 LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 31 10. 20 13 and 17. 11. 24 23 12. 23 24, 27 and 29. 13. 23 30. 14. 18 and 33. 18. 15. 39 24 16. 42 23 The registered persons must ensure that medicines entering the home are appropriately recorded (Previous time scale 0103.05 not met) The registered persons must provide appropriate bathing facilities as in accordance with service users assessed needs to ensure a safe environment.(Previous time scale 01.04.05 not met) The registered persons must provide appropriate toilet facilities and when these are in place staff should not routinely use service users’ private facilities.(Previous time scale 01.04.05 not met) The registered persons must provide a sluicing facility, in accordance with service users’ needs.(Previous time scale 01.04.05 not met) The registered persons must ensure that staff are appropriately supervised.(Previous time scale 01.04.05 not met) The registered persons must implement and maintain an effective quality assurance system for reviewing and improving the quality of care provided.(Previous time scale 01.03.05 not met) The registered persons must ensure that the home’s electrical wiring systems are checked and serviced by an appropriately qualified person.(Previous time scale 01.01.05 not met) 30/06/05 25/08/05 25/08/05 25/08/05 30/06/05 25/08/05 25/08/05 LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 32 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 3 6, 19 and 20. Good Practice Recommendations The registered persons should explore and implement methodologies to facilitate communication with service users. The registered persons should consider whether the precaution to consult the manager prior to the administration of rectal diazepam is appropriate in that all staff have been trained in this regard an it builds in a delay that may be unnecessary. The registered persons should ensure that service users’ needs for affection are detailed in the care plans with guidelines for staff as to appropriate responses. The registered persons should maintain separate records of services users’ visits to and from health and social care professionals to aid analysis and review and ensure that each service user is offered an annual health check. The registered persons should ensure that at least 50 of the staff team achieve NVQ level 2 or above by 2005. The registered persons should ensure that managerial input into the home is confirmed on the staff roster. The registered persons should ensure that staff receive scheduled supervision in accordance with the National Minimum Standards. The registered persons should hold “House meetings” on a regular basis to provide a forum for the exchange of information and another means to provide guidance to staff. The registered persons should ensure that the manager achieves a qualification in care management at NVQ level 4 or above. The registered persons should instigate team-building exercises to enable staff to better deal with change. The registered persons should ensure that IPP meetings or general reviews are convened at least once in any 12month period. 3. 4. 3 and 18 19 5. 6. 7. 8. 32 33 36 36 9. 10. 11. 37 38 38 LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 33 12. 40. The registered persons should ensure that the homes policies and procedure are reviewed and updated as required and that the full range of policies and procedures are made available to staff in accordance with the list in appendix 3 of the National Minimum Standards. LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 34 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 LUCKLAW F51 F01 S27018 Lucklaw V224473 040505 Stage 4.doc Version 1.30 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
