Care Home: Lampton Court

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What the care home does well Lampton Court provides individuals with a structured weekly programme that includes one to one counselling, group therapies and physical activities. Individuals we spoke to said ` I have been in and out of prison all my adult life and have never had any help before I got here, it`s brilliant` `This place has saved me, if I had not come here I would be dead` `Weekend activities are something else, they are brilliant` Surveys returned prior to this inspection taking place also included many positive comments about what the service did well. `There is quite a good structure in place, with activities etc. I am relatively new and have just gone through detox so it may not be fair to comment.` `CBT therapy, counseling, Reiki and work therapy.` `Lampton provides me with the safe environment that I require at the moment in my life. It also provides with all the help and counselling I need.` `It provides help, advice, security and a chance of a better lifestyle once I leave.` Lampton Court provides people with a good choice and range of meals. They have a new chef who is trying out new ideas and menus. Individuals are encouraged to take part in meal preparations and this is an expected part of their learning and development. The home has developed good systems of ensuring that the views of people who use the service is heard and a robust complaints procedure with written documentation how how all complaints have been investigated and resolved. What the care home could do better: Stocks of prescription only medicines must not be kept in the home if it is no longer registered to provide nursing care. Arrangements must be made for the safe disposal of any remaining stocks of prescription only medicines. Since this inspection the home have written to us with a suitable action plan on how they intend to address this. Abbreviations should not be used when writing the dose of medicines on the administration record sheets because this may increase the risk of mistakes being made.If a medicine prescribed to be given regularly is not given, the reason for this must be recorded. All medicines must be kept securely, within a locked medicine cupboard. The medicine fridge should be locked and the temperature recorded daily to make sure it is in the safe range for storing medicines.If medicines are prescribed to be given "when required", information available for staff should include the reason for giving them. If the dose is variable guidance should be available on how to choose the dose to give. This is to make sure that these medicines are given consistently and appropriately. Random inspection report Care homes for adults (18-65 years) Name: Address: Lampton Court Lampton Court Littleham Bideford North Devon EX39 5HT two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Joanne Walsh Date: 2 1 0 4 2 0 1 0 Information about the care home Name of care home: Address: Lampton Court Lampton Court Littleham Bideford North Devon EX39 5HT 01237470280 01237425040 admissions@lamptoncourt.com www.lamptoncourt.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Linda Fletcher Type of registration: Number of places registered: Conditions of registration: Category(ies) : Health & Care Partnership Limited care home 32 Number of places (if applicable): Under 65 Over 65 0 0 past or present alcohol dependence past or present drug dependence Conditions of registration: 32 32 A suitably qualified and experienced clinical lead be in place for as long as Mrs Fletcher is the registered manager for this service. The maximum number of service users who can be accommodated is 32. The registered person may provide the following category of service only: Care home with Personal Care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Past or present alcohol dependence (Code A) Past or present drug dependence (Code D) The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Past or present alcohol Care Homes for Adults (18-65 years) Page 2 of 12 dependence (Code A) Past or present drug dependence (Code D) Date of last inspection Brief description of the care home Lampton Court provides 24-hour care for 32 younger adults aged 18 to 65 years with past or present alcohol andor drug dependencies. The home is registered as a care home. The service is run in a large detached house standing in its own extensive landscaped grounds and is a short drive away from the North Devon town of Bideford. There are two separate units within the main house, one for detoxification, where all rooms are shared occupancy and the other unit is for people undergoing the therapeutic programme to help them with their drug or alcohol dependency The service runs a programme that provides group work, and an activity programme. The programme also provides an experience of community living and day programme. The fees charged can be obtained by contacting the service; additional charges are made for personal items such as toiletries, magazines and newspapers. Copies of previous inspection reports are available in the office at Lampton Court. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: This random inspection was completed on a week day in April by a team of inspectors including a regulation inspector, a pharmacist inspector and an expert by experience. This is someone who has experience of using services and is able to understand the needs of the people for whom the service is aimed at. We decided to complete a random inspection to look at some targeted areas as we had received a number of concerns and we wanted to be assured that the service was still providing quality outcomes for people. We had also received an application from the home to vary their conditions as they no longer want to offer detoxification facilities and therefore do not wish to continue with the nursing home part of their registration category. The inspection team spent 5 hours speaking to staff, to people who are currently living at the home and to the registered manager. We looked at some of their key documents to help us decide how well the home is running. These include medication records and storage, plans of care, staff recruitment and training records. We spent time talking to people who are currently using the service for rehabilitation. We sat in on a relapse prevention group session. We talked to two cousellors, a support worker, the housekeeper and the registered manager. We saw that the home no longer has any people who have been admitted for detoxification. We saw that the home had written to all commissioning services to explain that they no longer provide a detox service and to request written confirmation that the current people at the home do not have nursing needs. The pharmacist inspector looked at the handling of medicines in the home. Since the closure of the detoxification unit, one nurse is employed to be the clinical lead for Lampton Court. The nurse and some support staff are now responsible for giving medicines. The clinical lead told us that support staff have received medicines training from the pharmacy and that he has also provided one to one training and assessment to ensure that staff are safe to give medicines. We saw that there is a medicine policy in place and flow charts designed to help staff follow safe procedures for giving medicines. People using this service are registered with a local doctor. One doctor visits Lampton Court on a weekly basis and will see people using the service as needed. Staff said that people can also choose to go and see a different doctor if they wish to. Medicines are supplied to Lampton Court using private prescriptions, which are dispensed by a local pharmacy. Whilst the home has been registered to provide nursing care a number of frequently used medicines, including prescription only medicines, have been kept as stock and given according to the doctors prescription. Care homes which are not registered to provide nursing care cannot keep stocks of prescription only medicines and an immediate requirement has been made in relation to this. People using the service may look after their own inhalers or some creams but all other Care Homes for Adults (18-65 years) Page 4 of 12 medicines are looked after by staff. We discussed the need to ensure that if people look after their own inhalers they are responsible for keeping them safely and using them appropriately. Staff said that they have arranged to discuss a suitable homely remedies policy with the visiting doctor, for treatment of minor ailments. Prescription only medicines must not be used as homely remedies. The clinical lead told us that they encourage people living in the home to be independent and expect them to come and ask for their medicines within set times.We saw two gaps on one persons medicines administration record and were told that they had not come and asked for the medicine. If a medicine prescribed to be given regularly by staff is not given, a reason must be recorded. For some medicines, missing doses may have important consequences for the person and should be discussed with the GP. Records are kept of the medicines administered by staff. These are handwritten by staff and signed by the doctor. Most of the dosage instructions have been written using common Latin abbreviations. The clinical lead told us that staff giving medicines had received training about the meaning of these. However using abbreviations can increase the risk of mistakes being made, so dosage instructions should always be written in full. When a medicine is prescribed with a variable dose, the amount given is recorded. Some medicines are prescribed to be given when required. These have clear dosage instructions and a maximum daily dose but no explanation about what the medicine is for. Some of these medicines have a variable dose but it is not clear how staff choose which dose to give. Action should be taken to make sure that this information is available for staff, so that medicines are given appropriately and consistently. Records are kept of the receipt of medicines and the disposal of unwanted medicines. Records allow staff to audit some medicines very easily and show they have been used appropriately. Other medicines would be more difficult to check and we discussed how it might be made easier to audit these medicines. Secure storage is available for medicines, within a locked room. At the time of the inspection a few items were not kept in the medicine cupboard. Staff should ensure that all medicines are kept in the locked cupboard. A medicine fridge is available but no records are kept of the temperature. A minimum/maximum thermometer is needed and daily records kept of the fridge temperature to ensure that it is in the safe range for storing medicines.Suitable storage and records are available for medicines needing additional security. The expert by experience reported: During our unannounced visit I had the opportunity to observe a relapse prevention group in which residents were completing life maps. This involved mapping their life from birth to present day using significant events and examining factors that may have led to their substance misuse. At the end of the life mapping exercise which they presented to the rest of the group they were asked if they could have changed anything. This was an intensive session for the majority of the residents and the worker who was facilitating the group ensured that the session ended on a high with a game. This was one session of a rolling 12 week group work programme. Some residents had the option of attending the group work programme twice, dependent on the length of their stay at Lampton Court. Relapse prevention and overdose Care Homes for Adults (18-65 years) Page 5 of 12 prevention sessions are held on a weekly basis. Residents days are structured. The day starts at 7am with breakfast followed by practical duties such as cleaning. Therapeutic group work begins at 10am and lasts between 45 minutes and 1 hour followed by a 15 minute break. A further 45 minute group session follows. Lunch is served between 1pm and 1.30pm and is cooked by a chef. Residents have a washing up rota. All residents begin working to a care plan within 2 days of their arrival at Lampton Court. The care plan is reviewed weekly and has a high level of service user input. All residents attend a goal setting group. Goal setting is integral to care planning and residents are encouraged to input to each others planned goals. Rights Respected and Responsibilities Recognised. Residents are able to wash their clothes in a washing machine during weekly allocated time slots. Relationships are respected. Visits with family and friends are encouraged. During the initial stage of treatment visits can only take place on site. Once a resident has engaged with the programme for 8 weeks visits may take place in town. Residents may be required to undertake drug and or alcohol testing on their return from external visits. There is a payphone at Lampton Court which is available for residents use after morning group work sessions and up until 10pm. All rooms are of a good standard. They are of a good size and contain sinks and 2 have en-suite shower and bathrooms. Communal toilets are situated on every landing. Beds are partitioned to give a degree of privacy. No music is allowed in rooms, ipods and radios have to be handed to staff by 10.30pm. Lampton Court has 2 television rooms with DVDs, books and board games available. Medication is distributed at a regular time daily. A doctor visits once a week and community GP visits are also available to residents. A blood-borne virus nurse visits weekly. The lunch I observed was of very good standard and is cooked by a chef. Evening meals are cooked on a rota basis by residents. Weekly food shopping is undertaken by staff. One person commented The food is excellent, I have put on loads of weight in the last 5 weeks Residents have access to complementary therapies including Tai Chi and Reiki delivered by external therapists. There is an outdoor swimming pool, five a side football pitch and an inside gym all of which are of a good standard. Art materials are available to residents. Residents are able to attend places of worship. Lampton Court owns a mini-bus used for transport to activities, including outdoor activities such as climbing, abseiling, walking and bike-riding. Four computers are available to residents with restricted internet access. Care Homes for Adults (18-65 years) Page 6 of 12 Residents are given their full benefit monies and it is their responsibility to pay Lampton Court for board and lodging. What the care home does well: What they could do better: Stocks of prescription only medicines must not be kept in the home if it is no longer registered to provide nursing care. Arrangements must be made for the safe disposal of any remaining stocks of prescription only medicines. Since this inspection the home have written to us with a suitable action plan on how they intend to address this. Abbreviations should not be used when writing the dose of medicines on the administration record sheets because this may increase the risk of mistakes being made.If a medicine prescribed to be given regularly is not given, the reason for this must be recorded. All medicines must be kept securely, within a locked medicine cupboard. The medicine fridge should be locked and the temperature recorded daily to make sure it is in the safe range for storing medicines. Care Homes for Adults (18-65 years) Page 7 of 12 If medicines are prescribed to be given when required, information available for staff should include the reason for giving them. If the dose is variable guidance should be available on how to choose the dose to give. This is to make sure that these medicines are given consistently and appropriately. 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 set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered manager 30/04/2010 must ensure that prescription only medicines held in the home are supplied for individual service users. Arrangements must be made for the safe disposal of current stocks. Immediate requirement. to ensure that the medication system is robust Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered manager 25/05/2010 must ensure that clear accurate medicines administration records are kept: Dosage instructions must be written in full. If regular medicine is not given a reason must be recorded. to ensure that there is a robust audit trail for all medicines 2 20 13 The temperature of the 25/05/2010 medicine fridge must be monitored daily to ensure that it is in the safe range for storing medicines. to ensure that medicines are Care Homes for Adults (18-65 years) Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action stored correctly Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended that when medicines are prescribed to be given when required, information available to staff should include the reason for giving the medicine and if the dose is variable, guidance about which dose to give. To enable them to give the medicine appropriately and consistently. Care Homes for Adults (18-65 years) Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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