Care Home: Ladybank - Robinia Care

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What the care home does well The staff team have worked well together and provided peer support when responding to situations that have been challenging to the service provision. Since the arrival of the temporary manager the standards at the home have improved, and the staff team have been receiving the supervision and leadership required in order to meet the service users needs. What has improved since the last inspection? None applicable as this is the first inspection. What the care home could do better: The home would benefit from a permanent manager who is experienced in supporting the service user group at the home. The staff would benefit from ongoing supervision, and team meetings, in order to develop and fulfil their roles and responsibilities. Training which is specific to the needs of the service users accommodated at the home would be beneficial for all the staff team. CARE HOME ADULTS 18-65 Ladybank - Robinia Care 356 Ladybank Road Mickleover Derby DE3 0TN Lead Inspector Claire Williams Unannounced Inspection 19 April 2005 12.30pm 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. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Ladybank - Robinia Care Address 356 Ladybank Road, Mickleover, Derby DE3 0TN 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) 01332 512233 The Robinia Care Group PLC, Carriage Court, 25 Circus Mews, Bath BA1 2PW Vacant Care Home 4 Category(ies) of LD - Learning Disability registration, with number of places Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection None Brief Description of the Service: 356 Ladybank Road is a small care home owned by Robina Care. It was registered with the Commission for Social Care in December 2004 and became operational on the 31st December. The Care home provides personal care and accommodation for up to 4 adults with learning disabilities, aged between 18 and 65 years. The house have been furbished to reflect the style of a family home. All bedrooms are of single occupancy and service users have access to two small garden areas. The care home is close to the centre of Mickleover with easy access to local facilities. At the time of the inspection there was two service users living in the home. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the Care Home since it was registered, and it took place over 6 hours and was undertaken by two inspectors. The inspectors examined care files and records, and a tour of the building was undertaken. The inspectors spoke with the staff on duty and observed staff practices with the service users who have complex support needs. Due to these complex needs the service users were not able to contribute directly to the inspection process. A complaint was received by the Commission for Social Care Inspection, which was investigated by the inspectors during this unannounced inspection visit. A couple of weeks prior to this visit the registered manager had resigned from her position. This inspection was undertaken with the assistance of a manager from another home owed by Robinia Care, who had agreed to cover the managerial role at the home and provide support and assistant to the staff and the service users on a temporary basis. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 6 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 Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 7 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 4. Service users were provided with pre-admission assessments of need that enabled the staff team to be fully aware of the individual’s support needs before they moved into the home. The Statement of Purpose did not contain up to date information. EVIDENCE: Both service user files had assessments of need, which were completed prior to their admission to the home. These were completed by their respective Care managers and a representative from Robinia Care. Additional information had been provided by other agencies involved in the service users care. Introduction visits took place by the service users to the home, and the staff visited the service users previous placements in order to collect appropriate information to enable them to provide appropriate care and support in meeting the service users needs. The Statement of Purpose available at the home is out of date and does not reflect the current status of the home and needs to be updated now the home is operational. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 8 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 Individual plans are now in place for each service user and reflected their support needs and personal goals. Management of risk areas were fully identified, and strategies implemented to minimise any risks to the service users. The staff team assist and make decisions on service users behalf in accordance with their preferred lifestyle. EVIDENCE: Two files examined contained plans of care individual to each service user. The plans covered all of the areas as required by the National Minimum Standards. There was insufficient records maintained for one service user, but these have now been implemented by the arrival of the stand-in experienced manager. Comprehensive risk assessments have now been implemented covering key areas of concern, and action required by the staff in order to minimise or eliminate these risks. Both service users currently residing in the home have communication difficulties. The staff team have devised methods of communication for example Makaton, symbols and simple sentences tailored to meet the needs of each individual service user. The staff team make decisions on behalf of the service users in accordance with their plans of care and through positive interventions. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 9 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, 14,15, and 16 Although service users have access to varied opportunities, and life experiences in order to develop independent living skills, records of activities and daily routines were not available for one service user. Opportunities were tailored to individual interests and abilities and where possible risks had been identified and managed. Service users were encouraged to maintain contact with families and individual routines within the home were respected. Service users living at this home are unable to access employment or full time education. EVIDENCE: The service users living at this home have learning disabilities and behaviours that can be challenging. The service users do not attend any daytime activities, at present, but this is something that the staff team hope to organise in the future. Service users have access to in-house activities and opportunities to develop their independent living skills. A sensory room is available but not currently in use. Although activities are facilitated on a daily basis there were insufficient records maintained in relation to structured weekly activity Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 10 programmes. The temporary manager stated that these are currently being developed. Service users are supported to access local community facilities, and this is assisted by the provision of a car, which is provided by the organisation responsible for the home. Activity risk assessments are completed in order to prevent and minimise any potential risks to the service users and staff whilst undertaking community based activities. Information in the daily records confirmed that the service users are supported to maintain contact with their family and friends. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 11 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, and 19 Service users receive support in personal care tasks in a manner, which promotes their dignity and in accordance with individual support plans. Service users health is monitored and access to healthcare facilities is supported. EVIDENCE: Service users files now contain individual routines and preferences on how the service users like to be supported in personal care tasks. The temporary manager has implemented a comprehensive management plan for one service user, which contains details on how the service user must be supported in order to minimise any behaviours, which could be challenging during these interventions. Observations of the staff supporting the service users confirmed that support is provided in a manner that respects and promotes individual dignity and privacy when undertaking personal care tasks. Access to healthcare provisions is facilitated and records maintained. Both service users are registered with a local GP. The temporary manager has requested the support of a psychiatrist in order to develop plans and strategies in supporting one of the service users. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 12 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) 22, and 23 A Complaint procedure was in place but the recording of complaints needs to be improved. The complaint received by the Commission for Social Care Inspection was investigated, and in response to this strategies and training need to be implemented to protect service users from harm. EVIDENCE: A complaints procedure was in place, which was clear and included the stages and timescales that complaints would be responded to. The care home has received three complaints concerning the parking of staff cars. These complaints were recorded in the complaints book, but there was insufficient detail concerning the action and outcome of these complaints. The Commission for Social Care Inspection received a complaint concerning the staff practices when supporting a service user whose behaviour is complex and challenging towards the staff and the service. The staff members were witnessed using inappropriate restraining techniques when the service user’s behaviour was challenging. The investigation highlighted that the staff team did not receive appropriate guidance and supervision from the previous manager in dealing with complex situations were the service users behaviour was challenging and harmful. Since the arrival of the temporary manager a behaviour management plan and risk assessments have been implemented to support the staff team in dealing with complex and challenging situations. Some of the staff have received training provided by Securicare, which focuses on conflict management including techniques to defuse verbal and aggressive behaviour in adults with a learning disability. However these techniques have not always been successful in protecting the service user from harm. All incidents have been recorded on ‘incident forms’ and in the service users files. The temporary manager has Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 13 begun to contact professionals qualified in restraining techniques and arrangements have been made for an initial visit from a company specialising in this area. This visit will help the staff team to develop positive interventions and strategies, which will be specific to the service users, support needs. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 14 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, 28, 29 and 30. The Home is equipped, furnished and maintained to a satisfactory standard and offers homely and spacious facilities for Service Users to enjoy. EVIDENCE: The premises provided a safe, comfortable, bright, and clean environment for Service Users. It was free from offensive odours, and provided sufficient light heat and ventilation. The local amenities were easily accessed, with the help of the Home’s transport and staff cars. The Home was also in keeping with the surrounding housing in the area, and the furnishings and fittings were all domestic in character. The premises meet the requirements of the local Fire Service and Environmental Health Dept. The Home was provided with a sensory room, which was unused and needed attention to bring it into an operational state. The Home was able to provide single bedrooms to all Service Users. Appropriate furniture and fitting were provided for both Service Users currently living in the Home. Some of the communal areas had been reduced to the bare minimum of furniture leaving them looking very stark. However, this was Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 15 due to the difficulties of one Service User, who was having difficulties settling into the Home. It is to be hoped that once the Service User is more settled the décor in the Home will improve. The two bedrooms currently occupied were well provided with items belonging to each Service User, which made the bedroom their own. The bedroom windows on the first floor were guarded to prevent Service Users from falling from an open window. Each Service User could lock their bedroom door, if this were applicable. The Home provided sufficient lockable toilets and bathrooms to meet the necessary requirements. The kitchen and laundry were domestic in scale and appropriate to a Home of this size. Staff were provided with an office/sleep-in room and their own toilet, should they choose to use it. During the inspection a handyman called to make repairs to the Home, ensuring that it was maintained to a safe standard. The Home was seen to be clean, hygienic and free from offensive odours. Laundry facilities were sited so that laundry did not have to be carried through the kitchen or dining areas of the Home. The laundry floor was found to be impermeable and the walls were readily cleanable. The laundry was also washed in a washing machine at appropriate temperatures. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34,35, and 36 The Home was found to be staffed with a mixture of experienced, skilled and knowledgeable people, and new staff with little or no experience of assisting the Service Users currently living at the Home. Although training was provided additional training is required which is specific to the needs of the service users who currently live in the home. The staff team have not previously received adequate support and supervision in order to meet the service users needs. EVIDENCE: Staff were observed to be accessible and supportive to Service Users and to be interested, motivated and committed to Service User care. It was judged that between the staff they had the skills and knowledge to meet Service Users needs. However, one Service User’s behaviour was difficult to manage and has resulted in bruising to the arms, legs and occasionally bodies of staff. Staff spoken to felt that addition training would be beneficial in assisting them in providing more appropriate care. Staff spoken to informed the inspectors that they had not previously received adequate support and direction from the previous manager in supporting a service user’s complex needs, and felt that their concerns were not acknowledged. Staff confirmed that conditions at the home have improved since the arrival of the temporary manager and appropriate support and guidance is now provided. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 17 The numbers and skill mix of staff on duty have been increased by the temporary manager to ensure appropriate support and supervision is provided and to meet the overall management of the Home. Specialist services are needed to enable staff to meet the needs of the Service Users. The records of two staff were examined during the inspection. It was found that two written references had been obtained for both staff. A photograph was also found in each file, as was evidence of Criminal Records Bureau findings. However, only one member of staff had provided a full employment history and neither had provided sufficient evidence of the qualifications they had obtained. Neither member of staff had provided evidence of their mental or physical wellbeing to carry out their work. There was limited information in the files to support the training received by the staff team. Recently employed staff did not commence at the home by completing an induction programme and all staff have not received all of the required mandatory training. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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 and 38 The arrival of the temporary manager has improved the overall management and leadership approach of the home. EVIDENCE: The registered manager’s position at the home is currently vacant due to the previous manager resigning from her role. During discussions with the staff team it was highlighted that inadequate support and leadership was provided previously, which resulted in the staff team feeling isolated and unsupported. A member of staff contacted a Human resource manager, of the organisation, to inform them of their concerns, but the staff member felt that “she wasn’t listened to”, and her concerns “were not acknowledged”. An experienced manager from another home owned by Robinia has agreed to provide temporary managerial support to the staff and service users. The staff team have commented positively about the arrival of this manager and improvements made in the overall running of the home. Staff feel supported and felt that the manger’s approach has created an open positive and inclusive atmosphere. Positive relationships were also observed between the manager Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 19 and the service users. The temporary manager has started to audit some of the paperwork at the home, and has commenced in implementing records and organising training required by the staff. The organisation responsible for the home intends to advertise the manager’s position, and are now aware of the issues related to the home. Support and assistance is now being provided to the staff and the temporary manager, in order to improve the standards at the home. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 2 3 2 3 3 x Standard No 31 32 33 34 35 36 Score x 2 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ladybank - Robinia Care Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 2 x x x x x D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 21 NA 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. 2. 3. Standard 1 12 4 Regulation 4 (1) 16 (2) (n) 16 (2) (m) 22(8) Requirement An up to date statement of purpose must be available at the home. Programmes of stuctured activities must be devloped. Records of service users social interests and preferred activities must be recorded in their care plan. The recording of complaints must include information about the action taken, timescales of response and the outcome. All staff in the Home must receive training in restraint, managing challenging behaviour and Autism to meet the needs of Service Users, and in stress management to meet the needs of the staff. The Registered Providers must check, and hold documentary evidence, that all staff employed in the Home from April 2002, have satisfied the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended in 2004. The assistance of specialist workers and Timescale for action 31st June 2005 31st July 2005 31st July 4. 22 31st May 2005 31st August 2005 5. 23 and 32 18(1) (a) (c ) (i) 6. 34 19(1)(a) to (c), & 19(4) & (5) 31ST July 2005 7. 35 18(1)(c) (i) 31ST May 2005 Page 22 Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 8. 9. 10. 11. 12. 35 35 35 37 36 and 38 18 (1) (a) psychologists/psychiatrists must be obtained to ensure that staff are able to meet the needs of all Service Users in the Home. All staff members must receive mandatory training. 18 (1) (c ) New staff must commence on an (i) induction programm. 18 (1) (c ) Training records and a training (i) programme must be devloped for all of the staff team. 8 (1) (a) The Registered Providers must appoint an indivdual to manage the care home. 18 (2) All staff must be appropriately supervised and supported. 31ST August 2005 31st May 2005 31st June 2005 31st July 2005 31st June 2005 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. Refer to Standard 24 Good Practice Recommendations The sensory room should be reorganised, completed and brought in to use as soon as possible. Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection South Point, Cardinal Square Nottingham Road Derby DE1 3AT 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 Ladybank - Robinia Care D52-C02 S60830 Ladybank V221450 190405 Stage 4.doc Version 1.20 Page 24 - 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. 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