Inspection on 07/12/05 for Warrington Community Living - Lucklaw

This inspection was carried out on 7th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Warrington Community Living -... 19/09/08

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

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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The Good Companions

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Cuerden Grange Rest Home

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Vitalise Sandpipers Centre

Sue Ryder Care Birchley Hall

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

CARE HOME ADULTS 18-65 Warrington Community Living - Lucklaw Lucklaw Burtonwood Road Great Sankey Warrington Cheshire WA5 3AN Lead Inspector David Jones Unannounced Inspection 7th December 2005 10:00 Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 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.V276695.R01.S.doc Version 5.1 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.V276695.R01.S.doc Version 5.1 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 WA5 3AN 01925 230474 9999 Warrington Community Living Leslie Andrew Whittle Care Home 4 Category(ies) of Physical disability (4) registration, with number of places Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 4 service users accommodated in the category physical disability (PD) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidelines that may be issued through the Commission for Social Care Inspection. The registered provider must ensure that Mr Leslie Whittle achieves the Registered Manager’s Award by 1st November 2006 4th May 2005 3. 4. Date of last inspection 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 are being made to provide additional bathroom, toilet and sluice facilities. Residents have specially adapted transport enabling them to access the local community. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 7th and 16th December and a feedback meeting was held on the 20th December 2005 to complete the inspection. In addition to the manager four members of staff, were spoken with during the inspection. Three of the four residents were also spoken with but discussion was limited due to communication difficulties. The inspector observed staff interacting with and supporting residents. The gardens and some parts of the building were looked at, as were some records including the case notes of three residents. What the service does well: What has improved since the last inspection? The manager has produced a statement of purpose and service users guide in draft and after some further development of the service users guide he intends to make both documents available to residents, their represenatives and the commision. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 6 A senior support worker is employed and scheduled supervision is offered to staff at appropriate frequencies. This has improved staffs’ understanding of their roles and responsibilities in relation to care planning, monitoring and review but further development is needed to ensure residents needs are consistenly met. Staff meetings are held on a regular basis. There are improvements in some aspects of the home’s assessments and care planning procedures. Assessments and care plans generally provide more detailed information and guidance as to how each residents’ identified needs are to be met. A resident’s relatives have been consulted on limitations on freedom of movement put in place in the interst of the individulas safety. Communication is addressed in the revised care plans and the manager is in the process of contacting health care professionals to arrange for speech therapy assessments to develop communication with residents. Records of visits to and from health care professionals are recorded in each resident’s daily diary and in illustrated “personal health records” that have recently been introduced. These provide an overview of each resident’s health care needs and arrangements to address them. Arrangements for the administration of medicines are much improved. The precaution to consult the manager prior to the administration of rectal diazepam has been reconsidered. All staff have been trained in this regard and are now instructed to provide the medication in accordance with the prescription without any unnecessary delay. Scheduled supervision is offered to staff at appropriate frequencies and all staff have received training in moving and handling, first aid, administration of medication and rectal diazepam and training in the use of the PEG feeding device. Training on continence management and first aid has been arranged. An appropriately qualified engineer has serviced the home’s electrical wiring installations . What they could do better: The home is not being managed properly. Care practice is not appropriately monitored, evaluated and adult protection procedures have not been implemented in the interests of the protection of vulnerable adults. Action must be taken to make sure that the home is managed with sufficient care competence and skill to ensure the health and well being of residents. These matters have been raised with the Chief Executive of Warrington Community Living who is taking action to address these issues. The manger must finalise his work on the statement of purpose and service users guide and make these documents available to residents. Without this information residents are disadvantaged when making decisions about the home. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 7 Assessments including risk assessments and care plans must be reviewed and updated to make sure that residents needs are known and appropriate arrangements must be made to make sure needs are met. 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. Staff must receive training in adult protection procedures and action must be taken to ensure that the Commission for Social care Inspection and relevant social services departments are informed of significant events. The home’s medication systems have been improved but they need to be audited on a regular basis to ensure residents’ needs are appropriately met. Appropriate bathing, toilet and sluicing facilities must be provided in accordance with residents’ assessed needs. Staff recruitment procedures must be followed to ensure that residents are appropriately protected. Quality assurance systems require further development to ensure that residents, aided by their representatives, are consulted on quality issues and action is taken to address matters raised. 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. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 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.V276695.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. The statement of purpose and service users guide needs further development. Without this information new and existing residents are disadvantaged when making decisions about the home. Assessment, risk assessment and care planning processes need further development to make sure that the documents are accurate and residents changing needs are identified and planned for. Residents have not been provided with terms and conditions relating to their placement at the home. Without this document residents and their representatives do not have confirmation of the their rights and responsibilities. EVIDENCE: The manager of the home has redrafted the statement of purpose and service guide. These documents were not read at the time of the inspection but discussion with the manager indicates that the service users guide needs further development to ensure it incorporates a standard form of contract. Both these documents must be made available to residents and their representatives and copies should be sent to the Commission for Social Care Inspection. See requirement 1. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 10 Reading of case records and discussion with staff identified significant improvements in some aspects of the home’s assessments and care planning procedures. Assessments and care plans generally provide more detailed information and guidance as to how each residents’ identified needs are to be met. Communication is addressed in the revised care plans. The manager is in the process of liaising with health care professionals to arrange for speech therapy assessments and involvement of a speech therapist to further develop means of communication with residents. He reports that a speech therapist is not currently available in the area but will continue to explore how these needs can be addressed. See recommendation 1. However, observation and further reading of case records identified deficiencies and inaccuracies in the home’s assessment, risk assessment, care planning, monitoring and review systems and the manager was unable to demonstrate that all arrangement for care are based on good practice and reflect clinical guidance. A resident sustained an unexplained injury to his right hand on the 08/12/05, bruising his hand and fracturing his finger. Staff referred the resident for medical attention, but no action was taken to review the assessment or risk assessment to prevent further injury or investigate how he may have sustained these injuries. Staff said that the consultant attending to the residents fracture at hospital had difficulty applying a splint and bandages to the fractured finger and had asked staff to accomplish this task. This information was recorded in the daily diary but not in the care plan. On the 16/12/05 the splint and bandages had not been applied. Staff said that they did not know how to accomplish this and the resident was reluctant to allow them to touch his injured hand and he withdrew it when they attempted to apply the splint and bandage. Staff said that they had not consulted the hospital, GP or District Nurse regarding these problems. See requirements, 2, 3, 4 and 5 and the following section of this titled “Individual Choices and Needs” for further information. Residents and their representatives are not provided with documents confirming terms and conditions of residence. See recommendation 2. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Insufficient progress has been made to address the previous requirement to implement appropriate assessment, risk assessment and care planning processes and ensure that residents developing care needs are identified and met. Care practice is not appropriately managed, monitored and evaluated to ensure residents well being. A resident’s relatives have been consulted on limitations on freedom of movement put in place in the interst of the individulas safety. EVIDENCE: Management procedures to review care plans are unsatisfactory. A residents care plan had been reviewed by the manager on the 13/12/05 and the manager had signed and dated the care plan accordingly. This would indicate that the care plan is up-to date, but this is incorrect. Reading of the care plan and discussion with staff confirms that the care plan is inaccurate. It does not reflect changes in the resident’s medication, which had been made at least three weeks prior to the 13/12/05 including changes to the laxative and the type of rescue medication used for epilepsy. See requirement 4. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 12 Care practice is not adequately monitored and risk assessed to ensure the well-being of residents. A resident suffered an accident during the inspection. Staff had left her unsupervised in her bedroom strapped into her shower chair/commode, which toppled over. Staff advised a screen had been put around her whilst she used the commode and they had left her alone in the interests of privacy and dignity. Staff advised that they routinely left this resident sat strapped into her shower chair or commode as in accordance with the risk assessment. The risk assessment identified that the resident was at risk of falling from the shower chair and commode. Steps to minimise the risk of this centred on the use of waist straps and it stated that these are to be used at all times when the commode is in use. Discussion with staff indicated that the resident waves her arm around and moves her upper body from side to side. The risk assessment did not adequately address the identified hazard. The use of waist traps is not inappropriate in these circumstances but alone they do not provide adequate protection against the potential hazards encountered. The risk assessment does not stipulate that the resident must never be left unsupervised whilst using the shower chair and there is no evidence that an occupational therapist has been consulted regarding the problems encountered and how they may be safely managed. See requirement 3, 5 and 6. The Chief Executive of Warrington Community Living took immediate action to address these issues. Staff are instructed to supervise the resident at all times whilst using the shower chair and commode until such time as appropriate and safe measures are implemented that ensure the safety of the resident and preserve her dignity and privacy at the optimum levels. A risk assessment had been developed to address the manual handling needs of a resident who is hoisted and the potential hazards of her becoming aggressive during the procedure. This risk assessment required further development as although it indicates that two staff may be required it does not stipulate what action staff should take to control and limit the potential hazards of the resident injuring herself. See requirement 5. As noted above in the previous section of this report some aspects of the home’s assessment and care planning arrangements have improved. Assessments and care plans generally provide more detailed information and guidance as to how each residents’ identified needs are to be met and each of the care plans have been further developed with the provision of an overview of the respective persons needs. It is recommended that this overview is dated to facilitate review. Limitations on the freedom of movement of a resident who would be at risk when staff are undertaking hazardous activities in the kitchen have been discussed and agreed with his next of kin, as appropriate. A wooden gate prevents this resident from gaining access to the cooking and food preparation areas of the kitchen. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 13 The manager advised that staff have been instructed only to close the wooden gate at times when it is absolutely necessary to do so. One of the residents is Nil by mouth and is fed by a PEG feeding device. A risk assessment has been developed by staff to address the possible hazards associated with reflux. Discussion with staff indicates that the possibility of reflux is more likely when this resident is chesty. This observation should be shared with the Dietician and the Stoma Nurse and if appropriate the risk assessment should be further developed to reflect this. Staff provide food and fluids according to the advice and guidance of the dietician and stoma nurse and all staff have received training from the stoma nurse on the use of the P.E.G feeding device. There was no written guidance in the care plan as to the precise amount of fluids to be provided. However, this was rectified by the 16/12/05 the second day of the inspection. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 16 and 17. Residents are supported to maintain family links and daily routines promote individual choice and freedom of movement. Residents are offered a varied and nutritious diet. EVIDENCE: Staff support residents to maintain family links and help them to correspond with relatives who receive Christmas cards and are informed of significant events in the home. Visiting relatives indicate satisfaction with the standard of care, facilities and services provided. Communication is said to be good and they are made welcome when visiting the home. The atmosphere in the home is relaxed, welcoming and sociable. Discussion with staff and observation confirms that staff engage residents 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. Residents greet all visitors at the front door and staff interact with residents on a frequent basis engaging them in two-way communication. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 15 Reading of records and discussion with staff confirms that a health varied and nutritious diet is on offer. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Care practice is not appropriately managed, monitored and evaluated to ensure residents’ well being and that their needs are met in a consistent way. Action must be taken to ensure that residents receive support and advice from appropriate clinicians including occupational therapists and general practitioners as required. Arrangements for the administration of medicines are much improved. Action must be taken to ensure that medication audits are carried out on a regular basis. EVIDENCE: Residents’ preferences and needs about how they are assisted, moved and supported are detailed in revised care plans. However, issues identified during the inspection and confirmed in previous section of this report confirm that care practice is not appropriately managed, monitored and evaluated to ensure that residents needs are met in a consistent way and in accordance with advice from appropriate health care professionals. Where complications providing a resident with treatment as advised by their health care professionals is encountered, as in the case where staff did not know how to apply the splint and bandages to a resident’s broken finger, immediate action must be taken to refer the matter back to the appropriate professional for further advice or alternative treatment. Where other problems are encountered with risks associated with the use of equipment, as in the case with the resident who is Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 17 at risk of falling out of her commode and shower chair, the occupational therapist or other appropriately qualified person must be consulted and appropriate strategies agreed and implemented. See requirements 3, 5 and 6. The residents are unable to express their views and unless arrangements for their care and support are confirmed in appropriately detailed and accurate assessments and care plans that have been shared and agreed with their representatives there are no assurances the that care and support is provided in a way the resident prefers. See requirements 2 and 4. Arrangements for care and plans for the future have previously been developed and agreed via “Individual Personal Planning” meetings known as IPPs, which aim to involve the resident, their family members and other representatives. There have been no IPPs or general review meetings any of the residents in over a year. See recommendation 3. Records of visits to and from health care professionals are recorded in each resident’s daily diary and in illustrated “personal health records” that have recently been introduced. These provide an overview of health care needs and arrangements to address them. Discussion with staff and observation confirms that affection is given to residents based on a foundation of mutual regard. How affection is expressed and reciprocated should be entered on respective resident’s care plan to ensure that staff are provided with guidelines in the interests of protection, monitoring and review. See recommendation 4. A medications check found that medicines are stored, recorded and administered appropriately in the main. The stock records of one medication where incorrect but this could be traced back to an error previously made. This error should have been identified during medication audit by simply checking the record of reducing balances of medication against the stock. It is noted that medication audits are not routinely undertaken at least once a month. See requirement 7. Its is positive to note that the precaution to consult the manager prior to the administration of rectal diazepam as identified at the last inspection has been reconsidered. All staff have been trained in this regard and are now instructed to provide the medication in accordance with the prescription without any unnecessary delay. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Appropriate arrangements are in place for making complaints. Procedures are in place for the protection of vulnerable adults but these are not used effectively. EVIDENCE: No formal complaints have been received since the last inspection. The home’s complaints procedure provides appropriate guidance and information as to how to make a complaint. Procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998, but these are not used effectively. A resident sustained an unexplained injury to his right hand on the 08/12/05, that caused bruising and a fractured finger. No action was taken to: • • • Instigate adult protection procedures in the interests of the protection of vulnerable adults. Notify the Commission for Social Care Inspection in accordance with the requirements of the regulations. Report the matter to the Local Authority Environmental Health Officer as in accordance with RIDDOR, in the interests of Health and Safety. See requirements 8, 9 and recommendation 5. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 19 Information provided by the manager confirms that all staff have received guidance in the implementation of adult protection procedures but none have received formal training. The registered persons must ensure that all staff members’ identified training needs are addressed. See requirement 8. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. The home provides comfortable, bright and cheerful accommodation of a design and layout that reflects the needs and preferences of residents. Some further progress has been made to address previous requirements regarding the provision of appropriate, bathing, toilet and sluice facilities. This work must be accomplished to ensure the safety of staff and the privacy and dignity of residents. EVIDENCE: The premises are in keeping with the local community, and provide spacious, comfortable, bright and cheerful accommodation that reflects the needs and preferences of the residents. Adaptations have been made to the premises over time to accommodate changing needs of residents, including the provision of overhead hoist tracking and alterations have been made 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. See requirement 10. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 21 The main bathroom is equipped with a WC. Unfortunately, the only other WC’s in the home are those located in two residents’ en-suite facilities. This means that staff and a resident who do not have en-suite facilities are required to use the WC’s in other residents’ bedrooms when the main bathroom is engaged. The registered persons must provide appropriate toilet facilities to ensure the privacy and dignity of residents. See requirement 11. The home is not provided with a sluice facility, which is necessary as the majority of the residents present with double incontinence. See requirement 13. The manager advised that plans have been drawn up to provide appropriate toilet, bathing and sluice facilities that should be implemented early in the New Year. Residents’ bedrooms are designed, equipped, decorated and furnished to meet the individual’s assessed needs and personal preferences. The home is clean and well presented throughout. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. A senior support worker is employed and scheduled supervision is offered to staff at appropriate frequencies. This has improved staffs’ understanding of their roles and responsibilities in relation to care planning, monitoring and review but further development is needed to ensure residents needs are consistenly met.There are occassions when staffing levels are insufficent to ensure that residents needs are met. Residents have not had the full protection of the organisation’s staff recruitment procedures. Significant progress has been made in staff training but all saff require training in adult protection to ensure the protection of vulnearble residents. EVIDENCE: Staff conduct their work with care, good humour and evidence of affection for the residents. They advised that morale is improving and they said they are appropriately supervised and supported by the new senior support worker and the manager. Staff meetings are held on a regular basis. Information provided by staff confirms that all members of the staff team have received training in moving and handling, first aid, administration of medications and rectal diazepam and training in the use of the PEG feeding device. Training on continence management has been arranged and all have received training in first aid but seven require updates, which are also being arranged. None of the staff have received formal training in adult protection procedures other than guidance from the manager. These procedures were not implemented when a resident presented with a serious unexplained injury. See requirement 8. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 23 Information provided by the manager indicates that the NVQ training programme is well advanced with 50 of the home’s staff having achieved an NVQ level 2 in care or above and a number of others but not all staff pursuing the qualification in the near future. See recommendation 6. A minimum of two members of staff are required during the day time period to ensure that residents’ needs are met and their safety and well being is assured. Staffing rosters are designed to ensure that staffing levels vary from two to four or five members of staff on duty during peak times when demand on resources is higher. Reading of worked rotas indicates that there were a number of times in December when there was only one member of staff on duty during the day time period. A staff member advised that on one of these occasions she had no option other than to put one of the residents to bed during the day in the interest of her safety. Staff advised that the number of staff available is inadequate to cover absences due to annual leave, sickness and staff training. The registered persons must develop appropriate contingency arrangements to ensure that a sufficient number of staff are on duty to ensure residents’ well being and needs met. See requirement 13. Reading of staff recruitment files provided by the manager indicated that one member of staff had commenced employment without receipt of a reference from her previous employer and there is no written confirmation that a POVA First check or Enhanced Criminal Records Bureau certificate had been received. It is also noted that there was an apparent gap in the individual’s employment history and there is no record of this being explored or accounted for. See requirement 14. Scheduled supervision is offered to staff at appropriate frequencies but two staff members advised that they are not clear about their responsibilities in entering and updating care plans. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42. New management arrangements have been made to make sure that staff are appropriately supervised. However, the home is not being managed properly. Care practice is not appropriately monitored, evaluated and adult protection procedures have not been implemented in the interests of the protection of vulnerable adults. Quality assurance systems require further development to ensure that residents, aided by their representatives, are consulted on quality issues and action is taken to address matters raised. Electrical installations have been serviced as appropriate. EVIDENCE: The registered manager is a Registered Nurse Learning Disabilities and an experienced manager and practitioner in the field of learning disabilities with many years experience. He does not have an appropriate management qualification and is pursuing a “registered manager’s award” as in accordance with a condition of registration. See requirement 15. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 25 As noted at the last inspection the home’s management structure has been strengthened with the appointment of a Senior Support Worker. Information provided by the manager indicates that these arrangements are to continue. It is difficult to ascertain how much time the registered manager spends in the home, as there is no written record of his visits. Adult protection procedures have not been implemented in the interests of the protection of vulnerable adults, and as detailed in this report there is evidence that care practice is not adequately monitored and evaluated by the manager. A programme of scheduled supervision has been introduced but further action must be taken to make sure that staff are aware of their roles and responsibilities regarding the maintenance and development of assessments and care plans. See recommendation 7 and requirement 16. Information provided by the manager confirms that no further progress has been made to introduce effective quality assurance processes in the home. The manager had introduced a “residents’, relatives” and other interested parties satisfaction questionnaire prior to the last inspection. Information from the returned questionnaires has not been collated and a report identifying quality matters and any action taken to address issues raised has not been produced. See requirement 19. Information provided by the manager indicates that the home’s electrical wiring installations have been serviced by an appropriately qualified engineer and all staff have received training in health and safety issues including fire prevention and safe moving and handling. As noted previously in this report action must be taken to review risk assessments and provide appropriate equipment where required and to ensure the health safety of residents and staff. See requirements 5 and 10. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 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 1 3 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 1 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 2 3 X 2 X Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 27 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 YA1 Regulation 4 (2) and 5 (2) Requirement The registered persons must develop the service users guide to ensure it includes a standard form of contract and supply a copy of the statement of purpose and service users guide to the Commission and make a copy of these available on request for inspection by every resident and any representative of the residents. The registered persons must ensure that assessments of the residents’ needs are kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. The registered persons must ensure that the home is conducted so as to promote and make proper provision for the health, welfare and where appropriate treatment of the resident. Timescale for action 31/01/06 2. YA18YA2 14 (2) 31/01/06 3. YA3 12 (1) 31/01/06 Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 28 4 YA18YA6 15 (2) 5 YA9 13 (4) (b) The registered persons must keep residents’ care plans under review and revise each plan as required in accordance with changing circumstances and needs. The registered persons must ensure potential hazards are analysed and risks are assessed to ensure that any activity in which a residents participates is free from avoidable risk, as far as reasonably possible. The registered persons must review the use of restraining waist straps as a method to prevent a resident from injuring herself. The resident’s representatives (including health and social care professionals) must be consulted in this regard, where it is practical to do so and restraint must only be used if it is the only practicable means of securing the residents welfare. 31/01/06 31/01/06 6 YA6YA9 13 (4) (b) 13 (7) 31/01/06 7 YA20 13 (2) 8 YA33YA32YA23 13 (6) The registered persons must 31/01/06 make appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines including regular audits. The registered persons must 31/01/06 take appropriate measures to ensure the protection of residents including the training of staff and instigation of adult protection procedures in the event of any unexplained injury or suspicion of abuse. DS0000027018.V276695.R01.S.doc Version 5.1 Page 29 Warrington Community Living - Lucklaw 9 YA23 37 The registered persons must notify the Commission without delay of any serious injury to a resident. 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 and 25/08/05 not met) The registered persons must provide appropriate toilet facilities and when these are in place staff should not routinely use residents’ private facilities.(Previous time scale 01.04.05 not met) 25/08/05 The registered persons must provide a sluicing facility, in accordance with residents’ needs.(Previous time scale 01.04.05 not met) 25/08/05 The registered persons must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers sufficient for the health and welfare of residents. The registered persons must not employ a person to work at the home unless the requirements of regulation 19 are met and all appropriate documentation is in place. The manager must achieve the registered managers award by 31/11/06 16/12/05 10 YA24YA27 23 (2) (j) 01/04/06 11 YA24YA27 23 (2) (j) 01/04/06 12 YA24YA30 23 (2) (k) 01/04/06 13 YA33 18 (1) (a) 31/01/06 14 YA34 19 (1) 31/01/06 15 YA37 9 30/11/06 Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 30 16 YA38 10 The registered persons must, having regard to the size of the care home, the statement of purpose; and the number and needs of residents manage the home with sufficient care competence and skill as to assure the health, safety and well-being of residents. The registered persons must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home and shall supply to the Commission a report on any such review of the quality of care provided. 16/12/05 17 YA39 24 (1) 27/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA3 YA5 YA18 Good Practice Recommendations The registered persons should ensure methods of communication with residents are devloped in accordance with advice and recommendation of the speech therapist. . The registered persons should provide each service user with a written “terms and conditions document”. The registered persons should convene general review meeting or IPPs involving residents, their families and other representatives in a review of arrangements for care and plans for future development 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. 4 YA18 Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 31 5 YA23 6 YA32 7 YA37 The registered persons should report the incident where a resident fractured his finger to the Local Authority Environmental Health Officer as in accordance with the registered persons responsibilities under Reporting Injuries Diseases and Dangerous Occurrences Regulations (RIDDOR), in the interests of Health and Safety. The registered persons should ensure that care staff hold a care NVQ 2 or ; are working toward the qualification by an agreed date or the registered manager can demonstrate that through past work experience staff meet the standard. The registered persons should ensure that the manager confirms in writing on the staff rota the time he spends in the home. Warrington Community Living - Lucklaw DS0000027018.V276695.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Northwich Local Office 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. 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