Care Home: Lammas Lodge

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What the care home does well The home only offers a place to someone if they judge they can meet their needs. They will be given a three month trial stay. For the second year no one has left or moved in, so the home has a settled group living there. They are supported to have their health and physical care needs met in the way they prefer. They have health checks each year. Each man is supported to have their own chosen daily routines and take part in activities they enjoy and benefit from. They are supported to stay in close touch with their families. The house and garden are spacious, homely, comfortable and safe. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 The men have nice bedrooms and they are supported to keep lots of their own things. They have their own toilet and bathing facilities. They enjoy the meals and they are offered a choice. Enough staff are on duty each day to support the men the way they prefer. Staff support the men in a consistent way and this helps reduce the number of times people become upset or angry. What has improved since the last inspection? There is now visual information to help new people understand about the home. More activities are being offered in the house, grounds and local community. There are more drivers to help people get out into the community. The men are all developing their personal abilities. People have open access to more of the rooms in the house. There is visual information to help the men understand things better, such as healthy living and how to complain. Parts of the home have been made more homely and comfortable. Staff are better trained in important areas such as autism, protection and medication. They are also better supervised and are working together as a team to provide a good service. The team is more balanced between male and female staff. Less staff have left so the men know them well and they are better trained. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 The staff are more confident in helping the men if they become upset or angry. More things are in place to help control infections. What the care home could do better: New staff should not start work until all the rights checks have been carried out and their background explored. The care records and review could better show how the men are developing and what their goals are currently and for the future. The men could be further helped to understand things and make choices with communication aids. The house could be assessed by a specialist to see if improvements can be made for the people with visual impairments. Key inspection report CARE HOME ADULTS 18-65 Lammas Lodge Lugwardine Hereford Herefordshire HR1 4DS Lead Inspector Jean Littler Key Unannounced Inspection 23rd September 2009 10:30 Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Lammas Lodge Address Lugwardine Hereford Herefordshire HR1 4DS 01432 853185 01432 851468 lammas.lodge@craegmoor.co.uk Craegmore.co.uk Parkcare Homes Ltd 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) Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 6 The maximum number of service users who can be accommodated is: 6 25th September 2008 Date of last inspection Brief Description of the Service: Lammas Lodge offers 6 places to younger adults who have a learning disability and needs associated with Autism Spectrum Disorder. The Home is situated on the outskirts of Lugwardine village, which is three miles from Hereford. The house is set in large grounds with an area for activities and a sensory garden. The house is large and is divided into three areas. There is a self-contained one bedroom flat, the main house that provides one ground floor and four first floor en-suite bedrooms, and a staff office and meeting area. Two unmarked vehicles are provided to facilitate community access. The providers state that a high staffing ratio will be provided to meet the assessed support and supervision needs of people with complex needs. The providers have written information about the service that can be sent out to interested parties or is available on their website. The most recent inspection report is on display in the visitors’ area of the Home. The weekly fee is included in the Service User’s Guide. It starts at £2552 and may be increased depending on the assessed needs of the individual. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. We, the Commission, carried out this inspection over eight hours. We looked around the house and spoke with two of the staff. One man let us see his bedroom and we saw the separate flat. The support in place for two men was looked at in more detail. Some records about them were looked at such as care plans and medication. The new manager, Mr Cuggy, was on duty and helped with the inspection. He had sent us information about the service before the visit. Surveys were sent out before the visit. Four were returned from residents, five from their relatives, nine from staff and three from professionals. Overall these were very positive. What the service does well: The home only offers a place to someone if they judge they can meet their needs. They will be given a three month trial stay. For the second year no one has left or moved in, so the home has a settled group living there. They are supported to have their health and physical care needs met in the way they prefer. They have health checks each year. Each man is supported to have their own chosen daily routines and take part in activities they enjoy and benefit from. They are supported to stay in close touch with their families. The house and garden are spacious, homely, comfortable and safe. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 6 The men have nice bedrooms and they are supported to keep lots of their own things. They have their own toilet and bathing facilities. They enjoy the meals and they are offered a choice. Enough staff are on duty each day to support the men the way they prefer. Staff support the men in a consistent way and this helps reduce the number of times people become upset or angry. What has improved since the last inspection? There is now visual information to help new people understand about the home. More activities are being offered in the house, grounds and local community. There are more drivers to help people get out into the community. The men are all developing their personal abilities. People have open access to more of the rooms in the house. There is visual information to help the men understand things better, such as healthy living and how to complain. Parts of the home have been made more homely and comfortable. Staff are better trained in important areas such as autism, protection and medication. They are also better supervised and are working together as a team to provide a good service. The team is more balanced between male and female staff. Less staff have left so the men know them well and they are better trained. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 7 The staff are more confident in helping the men if they become upset or angry. More things are in place to help control infections. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 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 Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents would be given information to help them make a decision about where to live. They would have their needs assessed and be given the opportunity to trial the service. EVIDENCE: The information available to any prospective new resident has been improved. It is now in an Easy Read format with photographs and other visual prompts to help people understand about the home and the service. Mr Cuggy plans to develop an easy read contract. An Easy Read residents agreement was seen on display with photographs. There have not been any changes in the resident group for over two years. The company has an admissions policy. Mr Cuggy did not refer to this in the AQAA but did say that any new person would be given a three month trial stay. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men’s needs are included in their care plans and these are kept under review. The men are being assisted to make decisions about their lives and take reasonable risks on a daily basis. Some areas for improvement were identified. EVIDENCE: The personal records of two of the men were sampled. These showed that their needs have been assessed and reflected in care plans to guide staff. The plans have been written in a person centred way showing that each person has individual needs that need to be met consistently. The information included areas such as a daily life summary, a detailed picture of specific needs in each area such as social interaction, preferred daily plan, activities and a life history. The information had been reviewed in the last six months, however, in some cases it contradicted guidance in the file from specialist health Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 11 professionals reports, for example, whether it was safe for someone to eat crisps or not. The plans are not in a format the men would understand. However, Mr Cuggy said the company are looking at this issue, and he has arranged for some information to be developed into a visual format. It is positive that plans directed staff to promote the men’s independence, choice making, privacy and dignity. The plans contained aims and some goals but these could be made clearer to better show the development that staff and families describe. In most cases guidance is in place about how staff should respond to specific behaviours, such as, becoming aggressive whilst in a vehicle. One man still does not have clear guidance about his behaviours. This was raised at the last inspection. Mr Cuggy said the behaviour therapist has not focused on his needs due to him having different funding arrangements. There was lots of evidence to show that he is developing well, however, clear in house guidance needs to be written if the therapist is not involved. Risk assessments are included in the plans. The Multi-disciplinary Team of professionals who meet at the home regularly, are involved in writing and reviewing some of these. Their minutes showed they had reviewed the arrangements for one man after an incident where he ran into traffic during an outing. However, three risk assessments were in his file about this issue with different instructions for staff. Mr Cuggy needs to ensure that staff are aware of the current guidance and old information is promptly removed to avoid confusion. Records also need to show who has been involved with the decision to meet the requirements of the Mental Capacity Act. This person is again going out next to roads with only one worker. The professionals may think this is an appropriate risk, but there was no evidence that his family had agreed or if any efforts had been made to discuss the matter with the person. Mr Cuggy reported that Key workers are now expected to meet with their key resident and complete monthly reviews of their needs and wishes. Monthly summaries are also completed, however, these could be better used to track the men’s wellbeing and better demonstrate development in areas such as behaviour, communication, social inclusion and independence. Review meetings with the men’s representatives have been held, however, in some cases Mr Cuggy is waiting for social workers to lead on this process, instead of planning them routinely and preparing clear keyworker reports on issues, progress and the future for each person. These meetings can be used as person centred action planning meetings as well as reviewing the other areas of someone’s life and needs. Staff reported that the men are supported to make decisions at a level that they can cope with. Examples given included food choices, the colour of new Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 12 clothes, their next planned outing. It was clear work has now started to provide visual communication aids. One man also has an electronic communication aid. Mr Cuggy said some staff have also now attended signing training and a holistic approach to communication is being promoted. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Positive arrangements are in place to provide the men with active and enjoyable experiences each day that they have some choice and control over. They receive a very personalised service and are encouraged to develop their life skills and self-confidence. Good efforts are being made to maintain links with families. Mealtime arrangements offer choice whilst encouraging a healthy diet and social interaction. EVIDENCE: A structure is an important part of each man’s daily routine because of their Autism, but a flexible approach is also taken so individual’s wishes and frame of mind can be taken into account. Existing hobbies and interests have been supported following admission such as listening to music or playing computer games. Each man is at a different stage of being able to take part in social Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 14 activities and access community facilities so the arrangements are very personalised with at least one-to-one staffing is provided. Two vehicles are provided to facilitate outings. Some staff felt that a 3rd vehicle would be beneficial as most of the men prefer or need to travel just with staff. Staff feedback about this area was positive, comments included, ‘We work well to enrich peoples’ lives, by trying to access different activities and experiences. Staff are flexible with working hours to enable this to happen; The house is improving visually inside and there are new different activities for people to take part in; I believe our residents are very happy; We provide good support and enable people to develop and learn new skills, provide access to new tasks and activities that people are interested in’. All the men have different activity plans that have been developed based around their assessed needs and interests. Mr Cuggy reported that a great effort has been made over the last year to find new suitable activities for them and to increase their involvement in the community. One man is having a massage every two weeks. He was going to the Forest of Dean the next weekend and he visits his family monthly. Some college courses are accessed along with other day opportunity services such as Ryefields and SCORE. All the men have been on, or are planning to go on a holiday. Three went to France and because this was such a success another visit in planned. Another man is getting out much more as his behaviour is much more settled. Staff said he is enjoying Yam Jam music sessions in Hereford and Trampolining every week. Swimming sessions are being accessed at the pool at another company Care Home. Walks in Malvern Hills have taken place, sessions at Worcester Snoozlen, and day trips to the beach. One man enjoyed the experience of going in the bumper cars at the fair. Mr Cuggy said this was a great achievement for him and an expression of trust to the staff he sat in with. Everyone now has a rail card and companion bus passes. One man had been on a bus trip to Tenbury Wells recently. Mr Cuggy said evening activities are being arranged now and the staffs’ shifts are extended to accommodate this 5-6 times a month. He gave examples of evening activities, Irish nights at the social club, line dancing, karaoke at the Yew Tree pub, Country and Western nights and the monthly ECHO disco. A summer fete had been held, that was open to the local community, with stalls and games. Mr Cuggy said it was a success and the families were very supportive. Money was raised that will go towards new equipment and activities. The sensory room is used for watching DVDs. The activities area has been refitted with sports equipment. The garden now houses ducks and Guinea pigs that some residents are taking a particular interest in caring for. Records confirmed what staff said about people being encouraged more to do their own laundry, cleaning and food preparation. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 15 The speech and language therapist supports the development of communication skills. Positive outcomes were reported such as one man’s use of an electronic communication aid. It is positive that at least good effort is being made to provide people with visual information. All of the men are being supported to stay in regular contact and/or visit their families. One man was on holiday with his family. One is supported to stay over night with his family and also visit for lunch monthly. Overnights did not happen prior to this placement. Another person was supported to visit their brother recently. In the past the brother has come to the home, so this is a positive development. The staff are guided by the specialist team about how to support the men to develop emotional skills and how to respond to them expressing their sexuality. Because of their condition the men have difficulty developing close friendships with each other, however, Mr Cuggy said four men will engage at times with one of their peers. The group seems relatively compatible within the highly individualised service. Food is purchased locally every few days and staff prepare the meals. The men are encouraged to take part where possible. Several make their own drinks, breakfast and snacks. Healthy food is being promoted. One man was having a cooked breakfast daily, now he has to be motivated to cook this himself if he wants it. A choice is offered and the men’s preferences are known. The records showed a varied diet is being provided. One man has had very successful results from being on a dairy free diet. Mr Cuggy said a dietician has given menu advice. One worker now takes the lead with planning meals and spending the budget. He said she was being creative and was seeking feedback from the men and staff in a comments book. Theme nights have been started to encourage the men to have new experiences in music and food. German and Hungarian have been tried so far. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men are being well supported with their personal and physical health care needs. Effective systems are in place to help them manage their emotional health needs. Medication is being safely managed on their behalf. EVIDENCE: The care plans contained detailed guidance showing how the person prefers to be supported. Details included how staff should encourage independence with washing and how to care for specific areas Records showed people are having baths or showers at least daily. The men looked smart and they had their own style. Staff confirmed that the men are encouraged to buy and choose their own clothes and the staffing ratio allows them to be supported to follow their own daily routine. The care plans sampled showed that arrangements are in place to meet current physical health needs such as chiropody and dental checks. External professionals are being involved when specialist needs arise. Records are being Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 17 made following health appointments were clear. Mr Cuggy reported that everyone has an up to date Health Action Plans and annual health checks. He is currently not getting any information about what is being checked during this process. For example, one man has a weakness for ear infections, but it was not known if his ears were examined during the health check. Feedback from one family alerted him to the fact that well man checks had not been arranged, so this has now been rectified. He said the support from community health professionals has improved, for example, a dentist came to the home several times to build trust with one man. This resulted in the man eventually showing the dentist his teeth. The staff spoken with reported that health needs are taken seriously and that health professionals’ input is valued. The company provides some health support, for example speech and language therapy and psychology. A team of specialists attends the Home and meet every 4-6 weeks to give advice. A worker spoken with said the behavioural therapist does not spend much time with the men observing them but that the behavioural guidance is clear and practical and staff are able to implement it. Positive examples were given for improvement in peoples’ behaviours and emotional state and two men have had their medication reduced. The feedback from health specialists who are regularly involved was positive. ‘Staff seek and act on the advice of the consultant. In the last year the team has become more stable and able to support the residents to access a whole range of activities and experiences. A good home to work with; This is a warm, caring, personal service to individuals. The flat provides privacy and individual care for my client. There is good medical care. He has been much happier at this placement and his behaviours have almost disappeared. There is good contact with his parents; The service manages people with complex needs in a person centred way. Appropriate staff training and leadership has ensured that the quality of care is very good. There are regular multi disciplinary meetings and carers and family are involved in decisions’. Areas for suggested improvement were, ‘The service needs to improve staff retention, but the situation is better than it was last year; The last review was less well prepared than other ones; Management continuity has not been good over the year; There needs to be more visual communication aids used to support routines’. The medication is stored appropriately inside a locked room and the keys are being held securely. Staff do not administer medication until they have been formally judged as competent. Accredited training is also being provided and most staff have attended this. The administration and returns records were in order and contained the relevant details. It is positive that medicines are being kept under monthly review with the health professionals involved with each man. Additional ‘as needed’ medication is rarely used. The guidance for this could not be found, which was concerning. However, Mr Cuggy established that it had been with the GP who has now signed to give official approval. Controlled Drugs (CD) are in stock and these are being safely managed. A CD register is used to keep a running balance and two staff are always involved in Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 18 administrating these medicines. One man is prescribed emergency medication for epilepsy. Staff are now being appropriately trained by a professional before being permitted to administer this. Homely medication guidance was in place that had been reviewed in July 09. One administration error had occurred recently. Mr Cuggy was not aware that he should have reported this to us; however, he had taken appropriate steps to try and prevent a reoccurrence. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men’s representatives know how to make complaints and feel any concerns are taken seriously. The men are being supported to express their views. A framework is in place to help safeguard the men and they are supported to express their emotions in a constructive way. EVIDENCE: The men’s representatives know how to make complaints and feel any concerns are taken seriously. The men are being supported to express their views. A framework is in place to help safeguard the men and they are supported to express their emotions in a constructive way. A company complaints procedure is in place. There is an Easy Read version more suitable for people with learning disabilities. This is now displayed in the activities area. All the men are likely to need support to raise a concern formally. Staff would usually become aware that they were unhappy about something from changes in their behaviour, which is monitored each day. The new residents’ meetings and keyworker support should help to give people the opportunity to express their views, if they are able to. Mr Cuggy had reported in the AQAA that two complaints have been made in the last year, however, these were issues between staff that were resolved Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 20 internally. The five relatives who returned surveys said they know how to raise a concern and that they have confidence that their views would be listened to. The owner’s ‘Your Voice’ initiative aims to promote self-advocacy. It is difficult for the men to engage in decisions about the service they receive, however one person is attending the Your Voice meetings and others are benefiting from activities that are being arranged as a result of this initiative. The two staff spoken with were clear they would report any concerns promptly. Mr Cuggy reported that all staff have attended the local authority’s training on Safeguarding vulnerable adults in the last year. Protection is also covered during the induction process. There are policies and procedures in place to give guidance about raising concerns and managing allegations of abuse. Staff have to sign to show they have read these. No such concerns have been raised in the last year. Guidance is in place and staff are trained in how to respond positively to the men’s complex behaviours. As reported earlier positive outcomes are being seen from the staff working consistently in line with the care plan guidance. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in a spacious, comfortable, clean and safe home and they have personalised bedrooms. There are now less restrictions in place so people have more freedom of movement in their home. EVIDENCE: The Home was refurbished in 2004 and re-opened specifically for people with Autism. The building is fitted with appropriate fire prevention and fire fighting equipment. Safety features are fitted such as hot water valves and window restrictors. In the main house there are five bedrooms that are a reasonable size and have en-suite bath or shower facilities. The communal areas are spacious and include a large lounge, a small room with a computer, communal toilets and bathroom, a dining area, sensory/movie room, a kitchen, a laundry, an activities area and a sensory garden. The layout of the accommodation allows the men to have personal space inside and outside. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 22 The sixth man is accommodated in a self-contained flat at the rear of the house. This has its own entrance and is made up of a bedroom, kitchen/diner, lounge and shower room. To try to lessen the impact on residents of the operational side of the service the office and meeting area are in a separate section with its own entrance. The grounds were in reasonable order. Some men have their own trampolines on the large lawn and one man has his own summerhouse. A new swing was erected recently. The wooden structures in the sensory garden have been repainted and the gravel changed for wood chippings. Mr Cuggy reported that there are plans to make better use of the grounds in the next year. He said a real effort has been made to improve the environment. Some areas have been redecorated and recarpeted. The activities area has been made much more homely. New games equipment has been set up for the winter and this is proving popular e.g. darts, pool and table football. Two of the bedrooms seen were personalised and homely. It was clear that people are encouraged to have lots of personal possessions and hobby items. A solution has been found to one man’s difficulty accepting standard designs of bedroom furniture. Staff confirmed that his room now looks much nicer. Two people are now holding their own bedroom door keys and Mr Cuggy hopes that one other will be able to develop this skill. The home has been adapted to meet peoples’ special needs. Great effort has been made in the last year to enable visual information to be displayed for the men in a way that prevents this from being removed or damaged. It is positive that people are being restricted from less areas of their home. The movie room is now unlocked and most people now have unsupervised access to the kitchen. Two men have visual impairments but no specialist input has been provided in relation to these needs and how their environment could be better adapted to meet these needs. A handy-person is employed to manage the grounds and deal with minor repairs. Mr Cuggy reported that this arrangement is sufficient as long as improvements are planned ahead and organised. He gave dates in the AQAA to show that equipment has been routinely serviced. The Home was found to be generally clean and tidy. Staff carry out these duties and the men are encouraged to get involved in domestic tasks. There are cleaning schedules for staff and the residents. One resident takes the daily fridge and freezer temperatures. The laundry is a suitably sized room and all the equipment was working. Infection control systems are in place and these have been improved in response to the swine flu threat. There has not been an Environmental Health inspection in recent years. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 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 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men are being supported by staff they like and know well. There are enough staff and the team is functioning well. Staff feel well trained, supported and led, which is having positive outcomes for the men. The residents are still not being fully protected by the Home’s recruitment practices. EVIDENCE: All men need a lot of verbal support from staff to carry out daily tasks. Some also need physical support in some areas and the support of one or two staff to access the community. The interactions observed during the day between staff and the men were appropriate. Staff showed great patience while helping one man make the transition, over half an hour, from home into the car for an outing. They were successful and the outing went ahead. Feedback from residents and their families was positive about staff numbers and their attitude. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 24 Care staff also clean, shop and cook. There is usually a shift leader and six or seven support workers on duty. Feedback from Mr Cuggy said the correct staffing levels are being provided and a sample of rota confirmed this. Two staff said in their surveys that more staff are needed each day. One felt that help from a cleaner would free up carers time. Staff turnover has been low with only one permanent worker leaving in the last year. Of the team of 27 staff 12 are male. This balance allows one person to have the two male staff needed to support him both during the day and at night. There is a senior structure and staff work in separate teams who rotate in a set pattern. Staff feedback indicated that handovers are given and communication is usually effective. Two felt communication between shifts and teams could be improved. Mr Cuggy reported that shifts can now end at 10pm rather than 8pm to better enable evening activities to be arranged. Staff said this does not happen very often and that the men are in a routine that revolves around early nights. Two examples were given by staff. One was that when people go to the pub they come home by 8pm now, when the shifts ended later they would come back at 9pm. Another said one man used to get ready for bed at 9pm, he now goes up to change at 8pm. Mr Cuggy said people may get changed but they are not encouraged to go to bed early. The long shifts do have some benefits for the men as outings are not set up around staff having to end a morning shift at 3pm and shift changeover can cause additional anxiety. He should also closely monitor how tired staff become working 12 or 14 hr shifts. The men in this service have complex needs that require staff to be functioning at their best at all times. Staff said discussions take place occasionally about having shorter shifts but it is then dismissed again. Mr Cuggy should review the situation with staff and try to further develop the rota so all these needs can be met. Staff feedback was overall very positive. Some comments included, ‘We have a wide variety of training and supervision so we can carry out our duties. There has been management changes but since Jan 09 the new manager has been enthusiastic and has made a positive impact on residents and staff. Residents are being offered more activities and being included. We are good at ensuring their views are listened to and they are enabled to make choices; Training is always kept up to date, we have a great staff team, it is a positive environment to live and work. We go out into the community every day and give the residents loads of fun as well as everyday elements of life. I have been here for some years, in the last year there have been positive changes largely due to our new manager and a more positive staff team. Evidence showed that training arrangements have been improved, for example, all staff have attended Food Hygiene and Infection Control courses. Mental Capacity Act and Safeguarding Adults briefings have been prioritised. Mr Cuggy showed the training plan and courses are being held regularly. He Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 25 reported that the basic Autism awareness course the company provide is being followed by staff attending the Local Authority course on Autism. The majority of staff have also attended a course on Autism and Sexuality to build up their knowledge. Some staff still felt like they needed more training on Autism. Mr Cuggy said staff are now being given two hours a month personal development time and Autism will be one area they will be encouraged to focus their research time on. Eight staff have completed the Learning Disability Qualification and it is hoped more will gain this award. NVQ awards are being promoted. All either have or are working towards level 2 and five staff either have level 3 or are working on this. The Clerk is completed an Admin NVQ. Mr Cuggy should evidence that suitable induction and mentoring systems are now in place for new staff. The staff spoken with were positive about the training provided. They also felt more supported now supervision sessions were being carried out regularly again. One confirmed that she has always been very well supported by colleagues and senior staff when she has been involved in incidents that have been very challenging. The recruitment records for two staff were sampled. Both workers started when there was no manager in place. The files showed that in one case not all the appropriate pre employment checks had been carried out prior to them taking up post. There were significant gaps in the person’s past education and employment history. There was no evidence of who had authorised the person starting before their CRB was retuned even though they had disclosed a past conviction. Supervision information indicated that the person had been supervised until the CRB was returned but this was anecdotal rather than a formal record of the arrangements. Shortfalls of this kind were found it the last inspection, so the company needs to review how recruitment is managed when there are no registered managers in place in their services and consider retraining staff in the HR department. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men have benefited from a service that is being run in their best interests. EVIDENCE: There has not been a registered manager in post since May 2007. The current manager was appointed in September 07 and resigned in August 08, without applying for registration. There was then a period when there was no manager and the team leaders were sharing responsibility. Mr Cuggy was one of these team leaders and he was confirmed in post in February 2009. He has applied for registration and is waiting for an interview date. He has a relevant qualification and has attended recent training to update his knowledge and help him fulfil his role. Some gaps in his knowledge were found, such as the introduction of the Independent Safeguarding Authority. He needs to ensure Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 27 he has all the information he needs for his role and keeps up to date with professional developments. Mr Cuggy completed the AQAA well and showed he has a good understanding of the improvements that have been made and those still needed. The findings detailed in this report show that the changes he has made are having positive outcomes for the residents and staff. It is positive that he aims to work towards the service gaining accreditation with the National Autistic Society. He reported that he has been supported by senior staff in the organisation and he has received private supervision. Record keeping systems are being improved. Mr Cuggy is supported with the administration tasks by the full time Clerk who has been in post for several years. Some incidents have been correctly reported to us; however, some others have not. Mr Cuggy said he had reported them all to senior staff on the company Critical Incident forms, but this form does not prompt him to also report to us. The company may want to consider helping managers by adding a prompt. A sample of records relating to residents’ personal finances were seen. These showed a suitable system is in place. Two staff sign record books and the balance in peoples’ tins is checked weekly. People were spending money on appropriate items and when valuable these had been logged into their inventory, for example, one person had purchased a DAB radio. People are being encouraged to hold some of their own money either in their bedrooms or when they go out. A tuck shop runs in the home to provide experience of purchasing items. Feedback from surveys has been positive about the way Mr Cuggy is managing the service. Some comments frpm relatives includes, ‘My son enjoys living in his flat, he is well and happy, he goes out a lot to different activities such as shopping and eating out, music and trampolining; They offer our son a high quality of care and after some difficulties at the start they now are meeting his needs; They have provided our son with a safe and happy place to live. He is assisted by good staff who always try to find new ways to improve his quality of life. His health and general wellbeing has improved greatly since he moved in. He has even come off a medication he has been on for many years; Our son has been in the home for 2 years, they are the best 2 years the family have known since he left school. I could not be more thankful to the staff’. There is a company formal Quality Assurance system that involves a series of audits being carried out. Mr Cuggy said the last full review resulted in the service being rated as 3 star. The audit process had not identified that there were shortfalls in the recruitment practices or that some incidents had not been appropriately reported under Regulation 37. The providers may wish to consider if changes can be made to improve monitoring of these areas. The QA process also includes surveys for residents and their families, but not professionals. It would be positive if professionals were invited to give feedback at least annually. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 28 Policies are in place and the AQAA showed these have been reviewed by the organisation over the last three years. Mr Cuggy said the company is developing these into accessible formats. The AQAA showed that safety and maintenance checks have been carried out. Mr Cuggy has developed an emergency plan and six copies of this are placed around the house. Fire checks were up to date and the latest drill was held in June 09. Training evacuations has also been held recently. Staff reported that health and safety is well managed. There is a culture of completing risk assessments as part of daily work because of the nature of the service provided. It is positive that the maintenance budgets is increasing next year so work to improve the premises can continue. Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 29 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 3 2 3 3 x 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 4 26 3 27 4 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 x 3 3 3 3 2 3 x Version 5.3 Page 30 Lammas Lodge DS0000024739.V378002.R01.S.doc Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Develop clearer goals for each person through Person Centred Planning and report on progress in the monthly summaries. All residents should have clear strategies in place to guide staff about how to respond to their predicted behaviour patterns. 2. YA7 Develop recording systems to better demonstrate how decisions are being made in line with the requirements of the Mental Capacity Act. Risk assessment information should be clear, and any out of date information removed promptly, to avoid any staff confusion. Continue work to develop the use of visual communication aids for residents. DS0000024739.V378002.R01.S.doc Version 5.3 Page 31 3. YA9 4. YA16 Lammas Lodge 5. YA19 Develop a way of establishing what examinations are carried out as part of the annual health check process. The care plans should reflect the advice from professionals unless it is shown that the advice is out of date and not valid. If this is the case the professionals report should be removed or a record attached to it to explain the change. 6. 7. YA29 YA33 Seek input from a specialist in visual impairments about possible adaptations to the environment. Continue to develop a more flexible rota planning system to meet the men’s needs and reduce the length of staff shifts. Ensure recruitment procedures are followed carefully to better safeguard people. Offer professionals the opportunity to give feedback as part of the Quality Assurance process. Ensure all relevant incidents are report to CQC in line with regulation 37. 8. 9. 10. YA34 YA39 YA41 Lammas Lodge DS0000024739.V378002.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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