Care Home: Lanrick Cottage

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What the care home does well We received extremely positive comments from relatives about the service. These included: `Each client is given care according to their individual needs. They are not treated the same way. Excellent`. `Treat clients with respect`, `This is an excellent care home for autistic adults`. `Keep up the good work`. The service provides people with individualised care. Support plans are person centred being based on each person`s specific needs with actions shown to meet the desired outcomes. Relatives told us that they felt the service treated their relative as individuals. Comments included: `keep on tailoring care to each individual client` and `[my relative] is treated as an individual and all the staff understand his personality and need for routines`. People are supported to have the lifestyle they wish recognising each person`s individual differences and their preferences. For example one person likes to go to college, others enjoy going out to play snooker and another enjoys horse riding. Two people are supported to have their spiritual needs met. Everyone has the chance to go on holiday. The service is aware of each person`s specific communication needs and supports people to make decisions about their lives including such things as deciding what to eat, what to wear and how to spend their time. The service promotes people to keep in touch with their family through for example supporting the use of the telephone, by email and through supporting people to visit relatives. One relative said `Liaison between us is excellent`. People`s health care needs are being met and they receive regular health checks. The service supports people to receive specialist health care treatment. The staff receive training to meet people`s needs and staff are very knowledgeable about each person`s needs. One relative said `They recognise and exceed all areas of care`. What has improved since the last inspection? Since the last inspection the service has been registered to provide for a fourth person living there. The service has had double glazing replaced and the service decorated. This has improved the environment for the people that live there. A vegetable garden has been created giving people the opportunity to take part in growing their own food. What the care home could do better: We did not make any requirements at this inspection. However we made recommendations on how the service could improve its service to people. We feel that the service can further develop its support plans and introduce Health Action Plans. This will make documents more accessible. Although people are supported to take part in activities we feel that there is scope for this area of the service to be developed. This would allow people to have a fuller lifestyle. We also recommended that the service consider providing staff with training in behaviour management. This may help staff to be more confident when responding to behavioural incidents. We have also written to the Registered Provider to remind them of their responsibility to visits the service at least monthly. These visits are a legalrequirement and are made to satisfy the provider that the service is being run properly in the interests of the people that live there. CARE HOME ADULTS 18-65 Lanrick Cottage 41 Wolseley Road Rugeley Staffordshire WS15 2QJ Lead Inspector Jane Capron Unannounced Inspection 9th September 2008 09:15 Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lanrick Cottage Address 41 Wolseley Road Rugeley Staffordshire WS15 2QJ 01889 585262 F/P 01889 585262 lanrickcottage@aol.com 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) Care Services (UK) Ltd Maureen Elizabeth Holcombe Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation (without nursing) for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 4 The maximum number of service users to be acommodated is 4 2. Date of last inspection 24th April 2007 Brief Description of the Service: Lanrick Cottage is a four bedded care service for people with autism/severe learning disability who also have specialist communication needs. The service is situated on a main road leading into Rugeley. It is set back from the road with parking for a number of cars at the front. There is an attractive garden at the front and a secure garden at the rear providing opportunities for service users to use the garden. The service is completely in keeping with the surrounding residential properties. It is well located to access the town centre resources and public transport. The service has its own transport. The accommodation is well maintained and attractively decorated. The home currently comprises of a lounge, dining room, conservatory, toilet and kitchen and two bedrooms with ensuite downstairs and two bedrooms and bathroom upstairs. The service supports people to undertake a range of independent living tasks such as helping in the house and undertaking shopping. The service has links with local colleges and also provides people that live there with a range of leisure activities both in and out of the service. People living there have the chance to go on holiday and out for day trips. The service user guide does not give information about the fee level. People may wish to obtain up to date information from the service. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 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 This inspection took place over a six hour period and the service did not know we were visiting. This information used as part of this inspection included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Three surveys provided by relatives of people living at the service. • Information from health care staff that support people living at the service. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • Discussions with staff and the manager • Observation of people living at the service • Observation of staff supporting people • An examination of records What the service does well: We received extremely positive comments from relatives about the service. These included: ‘Each client is given care according to their individual needs. They are not treated the same way. Excellent’. ‘Treat clients with respect’, ‘This is an excellent care home for autistic adults’. ‘Keep up the good work’. The service provides people with individualised care. Support plans are person centred being based on each person’s specific needs with actions shown to meet the desired outcomes. Relatives told us that they felt the service treated their relative as individuals. Comments included: ‘keep on tailoring care to each individual client’ and ‘[my relative] is treated as an individual and all the staff understand his personality and need for routines’. People are supported to have the lifestyle they wish recognising each person’s individual differences and their preferences. For example one person likes to Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 6 go to college, others enjoy going out to play snooker and another enjoys horse riding. Two people are supported to have their spiritual needs met. Everyone has the chance to go on holiday. The service is aware of each person’s specific communication needs and supports people to make decisions about their lives including such things as deciding what to eat, what to wear and how to spend their time. The service promotes people to keep in touch with their family through for example supporting the use of the telephone, by email and through supporting people to visit relatives. One relative said ‘Liaison between us is excellent’. People’s health care needs are being met and they receive regular health checks. The service supports people to receive specialist health care treatment. The staff receive training to meet people’s needs and staff are very knowledgeable about each person’s needs. One relative said ‘They recognise and exceed all areas of care’. What has improved since the last inspection? What they could do better: We did not make any requirements at this inspection. However we made recommendations on how the service could improve its service to people. We feel that the service can further develop its support plans and introduce Health Action Plans. This will make documents more accessible. Although people are supported to take part in activities we feel that there is scope for this area of the service to be developed. This would allow people to have a fuller lifestyle. We also recommended that the service consider providing staff with training in behaviour management. This may help staff to be more confident when responding to behavioural incidents. We have also written to the Registered Provider to remind them of their responsibility to visits the service at least monthly. These visits are a legal Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 7 requirement and are made to satisfy the provider that the service is being run properly in the interests of the people that live there. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 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 Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good An assessment is completed before people move to the service. This makes sure that the service understands people’s needs and can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service’s Annual Quality Assurance Assessment (AQAA) told us that the service undertakes an assessment of people’s individual needs and desires by talking with them and their family/carers. They also said that after the initial assessment they offer a flexible three day assessment to give the prospective service user the opportunity to see what they offer. When we looked at the documents relating to the person admitted earlier this year we saw that the service had completed an assessment. This covered the person’s health, personal care, communication needs, spiritual needs, activities, likes and dislikes and family relationships. We also saw that comprehensive information had been provided by health care professionals and by the local authority. When we spoke to the manager and a staff member they confirmed that as part of the assessment they have visited the person where they were living. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good People living at the service are involved in planning their care and in making decisions and choices about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service’s AQAA states that the people living at the service have a person centred plan that meets their individual needs and is reviewed every three months. It also states that each person’s individual communication needs are recognised and signs and symbols used where needed. When we looked at a sample of support plans we saw that these were in a person centred format although we feel that they could be developed into a more user friendly format. The plans included all areas of care including health and personal care, social activities, spiritual needs, dietary needs, Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 11 domestic activities, financial support and communication. The plans showed the support people needed to ensure that the desired outcomes were met. Plans were based on encouraging people’s independence for example where one person needed support with bathing it identified that they would run the water and in another instance one person could complete some domestic tasks but needed unobtrusive observation. Where people had specialist communication needs these were well described. For example one plan showed that the person used verbal communication with a combination of makaton and gestures. Support plans also identified people’s preferences for example with meals and activities and gave information about each person’s preferred daily routine. We saw that the service had developed behavioural support plans. These were based on diversion techniques and promoting positive behaviour. Plans followed observation and experience of knowing the person. For example in one case the service had a plan based on ignoring certain behaviours and this had led to the behaviour lessening. We also saw that the service had involved health professionals to provide advice over managing behaviour. When we spoke to staff they knew people’s needs and were aware of the management strategies and were able to describe how they would respond. The service’s AQAA states that individual risk assessments were in place, and these show that staff supervision is used, rather than not allowing the people to undertake activities. Our examination of records confirmed that individual risk assessments were in place. These covered such areas as self-harming behaviour, bathing, going into the community and the use of household equipment. These assessments were, as described in the AQAA, based on providing staff support to enable people to undertake activities rather than preventing activities taking place. For example one person had spent some time working in a charity shop and the service had provided one to one support to enable this to occur. Other people took part in activities such as making drinks and laundry and did this with staff support and supervision. We looked at how the service supported people to make decisions and choices. The three surveys from relatives all stated that the service supports people to live the life they choose. One relative commented ‘[my relative] is given choice and supported in the choices [they] make’. Another relative said ‘[my relative] is able to express his likes and dislikes regarding food/ leisure activities etc’. Another comment was ‘considering X’s inability to communicate well the staff have always managed to understand and meet his needs/ preferences’. A survey we received from a health care professional was positive about people being able to choose to live the life they wanted. When we spoke to staff they told us how each person made choices about their lives. They told us the people living at the service helped to choose meals and to choose the food to put on the shopping list. Due to people’s specialist communication needs the service uses specific communication Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 12 techniques. For example the shopping list is put together using symbols on cards and taken to the supermarket. When a product is put in the shopping trolley the appropriate card is removed. Staff told us people choose when to go to bed and get up and they could tell us each persons preferred bedtime routine. We spoke to the key worker of one person and she was able to describe the support this person needed to make choices. She told us that the person can choose clothes from a small selection of items or will point to the clothes they want to wear. In respect of food they will not eat it if they don’t want it. Another example of the service supporting choice was positively responding to one person’s wish for a rabbit. This was provided and a plan put in place to support the person to look after it. Whilst we were at the service we saw staff supporting people to make choices for example about how and where they spent their time. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 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): 12, 13, 14,15,16,17 Quality in this outcome area is good People that live at the service are supported make choices about how they live and have the opportunity to take part in activities of their choice. People are supported to maintain and develop relationships. This enables people to live the life they choose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service’s AQAA states ‘We support and encourage Service users to make choices in a range of activities, both in and out of Lanrick Cottage’. The AQAA states that this included regular visits to a local pub to play snooker, one service user attending college 3 days per week, another going riding weekly and two others going to the local gym. We saw that the supports plans identified people’s activities they enjoyed and Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 14 took part in. Each person also had a weekly schedule. This was provided in a pictorial format. Within the service everyone was supported to take part in household tasks such as doing their laundry, helping with meal preparation and cleaning and tidying their bedrooms. While we were there we saw one person helping to do their laundry and another one helping to make lunch. The service also supported people to undertake a weekly newspaper delivery round. The money raised was used to fund people’ s holidays. Activities in and out of the service were based on people’s individual preferences and included the activities identified above as well as trips out, meals out, shopping and going to the hairdressers. We did feel there may be more scope for people to take part in activities. All the people living there had been on holiday and another weekend break was due to take place shortly after we visited. Two of the people living at the service were of Christian faith and the service provided support to meet these needs. One person was supported to go to church and the relative of the other told us in their survey ‘[our relative] is a committed Christian, this is recognised by the staff and [they] get to watch their favourite programme Songs of Praise.’ People are supported to maintain relationships with their family. One person’s relative had visited the previous weekend and another person was being supported by staff to visit their family on the day of our inspection. Relative surveys confirm good relationships and one commented ‘ [service] keeps in touch with family (always made to feel welcome)’ and another said ‘we feel Lanrick is an extension of our family.’ Routines within the home are based around each person’s individual needs. Due to the conditions of some of people living there their individual routines were important to them and they like to do tasks in a specific order or in specific way. Therefore the service responds to these needs within an overall flexible routine having no for example no set times for meals or for activities. Comments from relative surveys included ‘keep on tailoring care to each individual client’ and ‘[my relative] is treated as an individual and all the staff understand his personality and need for routine’. The AQAA told us that the service ‘offers homemade, nutritious, healthy meals, prepared by staff supporting service users, in the domestic style kitchen. We meet the dietary needs of one person whose health needs require them to have a special diet.’ We saw a record of the meals provided and these showed that people have a varied menu. We observed one person getting their own breakfast- going to the cereal cupboard and making their choice of cereal. We joined people for lunch and observed that staff and the people living there eat together. One person chose to eat alone at a separate table. The mealtime was relaxed and people were encouraged to serve themselves and to have second helpings if they wanted. The service is supporting one person to have a specialist diet and records confirmed that this was being provided. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good The services supports people to have their health, medication and personal care needs met in a way that promotes their dignity, privacy and independence This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA provided by the service told us that everyone living at the service had a person centred plan that showed how each individual liked their personal needs to be met. It also stated that everyone had access to a General Practitioner, dentist and optician and that people had the input from specialist health care staff for example the Epilepsy nurse, Cystic Fibrosis nurse and relevant consultants. The service also told us that a Speech and Language therapist visited the service monthly. Our examination of a sample of files confirmed that people’s individual health and personal care needs were identified. We would recommend that these were in the Health Action Plan format. People received health care checks ups Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 16 including having dental and eye tests. Where these were refused it was documented. Files evidenced that when people felt ill the service contacted the GP. For example one person experienced swelling and pain and was referred to the GP. When this persisted the service sought medical advice and in response supported the person to attend the hospital. This resulted in the person having specific health care treatment. The survey of the relative of this person told us of the good support and care their relative had received during this time. They commented ‘They recognise, meet and exceed all areas of care’. We also saw that the service involved specialist health care staff when necessary. For example a specialist nurse was involved in supporting staff to work with one person’s health care and behavioural needs. In the survey we received they commented ‘I was satisfied by how the service and staff managed [their] health needs and understand the complexity of their care’. We saw that people were having their personal care needs met in an individualised manner. Their preferred routines were identified in support plans. People were dressed in age appropriate clothing. We saw that people were being supported to have their hair and nail care attended to. We also observed people being treated with respect and their privacy promoted. For example we observed staff knocking on bedroom and bathroom doors and personal care being attended to in private. Surveys told us that relatives felt that their relative received care that met their needs. Comments included ‘ ‘excellent individualised attention’, ‘each client given care according to their individualised needs’. The service told us that they had developed new procedures for the administration of medication. When we looked at the arrangements for meeting people’s medication needs we saw that the service was using a ‘bottle to person’ method of administration. Medication was being kept securely in a locked cabinet in a locked room. The records showed us that all staff administering medication had received relevant training and when we spoke to a staff member she was aware of the medication procedures. We case tracked two people’s medication and saw that the service was keeping accurate records. There were no gaps in the medication administration records (MAR) and the service had an effective system for recording and accounting for medication. One person was having medication with food but records were in place to support this method and this was the way the person chose to take their medication. The service did keep some antibiotics in stock for urgent use. This was with medical agreement, recorded on the MAR sheet and the service was aware of the need to check for expiry dates. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good The service has procedures and practices in place to ensure that people are listened to and concerns acted upon. People living at the service are being protected by the service’s safeguarding procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service’s AQAA stated ‘We respond to the views of those that use the service and their relatives. We have a complaints procedure.’ We saw that the service had a complaints procedure that was in both written and pictorial form. The service had received no formal complaints but we saw that the manager had responded to a concern that had been raised by a relative. The people living in the service would not be able to utilise the complaints procedure so rely on the staff to identify any concerns. When we spoke to staff they were aware of how people expressed distress through nonverbal methods. For example if one person does not like a meal they will refuse to eat it another person will become agitated as method of expressing that they are not happy. Relatives told us they knew about the complaints procedure and were confidence t that the service would respond appropriately if they had any concerns. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 18 The AQAA told us they had a whistle blowing policy and followed the Staffordshire Interagency procedures. They also said that staff had training to make them aware of signs and symptoms of potential abuse. The training records we saw confirmed that staff had received safeguarding training and when we spoke to staff they could tell us about the possible signs and symptoms of abuse. They were clear about what they would do if they suspected any abuse was taking place. Staff were also aware that violence and aggression can be a means of communication. They could describe the plans to deal with any such incidents. We checked on the service’s procedures for managing people’s money. A support plan was in place to support people to manage their money. We checked a sample and this confirmed that the service was safeguarding people’s money. Records of expenditure were being kept that were supported by receipts. The records checked corresponded with the amount of cash held. People’s money was kept securely with each person having a lockable tin. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good The accommodation provided enables people to live a well-maintained, safe and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that ‘ Lanrick Cottage is an ordinary house, in an ordinary street. The home is indistinguishable from other houses in the road. We pride ourselves in providing a clean, warm, homely environment, in well presented surroundings, with a relaxed atmosphere, where service users and their visitors feel comfortable.’ Lanrick Cottage, as the AQAA states, is ‘an ordinary house, in an ordinary street’. We saw that the property was well maintained having had replacement double-glazing has been fitted in all rooms and all rooms in the Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 20 house redecorated. It provides good accommodation for the people that live there. All bedrooms are single with two having ensuite facilities. Two bedrooms with ensuite facilities are on the ground floor and the other two on the first floor. We looked at a sample of bedrooms and these provided good private accommodation. They were individually decorated and furnished and had been personalised. There was a bathroom with toilet upstairs that is satisfactory but space does not allow for this to be developed. There is a further toilet downstairs. The service provides suitable communal rooms, having a kitchen, dining room, lounge and conservatory. The property is well decorated in a domestic style throughout. Externally there is an enclosed rear garden suitable for sitting out in. The service has recently developed a vegetable plot. The service was seen to be clean and tidy throughout. One survey we received said that the service ‘keeps the building really clean and tidy’. Cleaning schedules were in place. The service’s told us that six of staff had completed infection control training and we saw that the manager had completed an infection control audit of the service. Staff told us that the service provided protective clothing. The service had a laundry in the garage. Washing machines had a disinfectant programme. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is good Staff are trained and knowledgeable and are provided in sufficient numbers to support the people that live at the service. The service’s recruitment procedures are safeguarding people that live at the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service’s AQAA tells us that all staff were subject to pre employment checks, that they were trained and that there were good staffing levels. When we checked a sample a staff files we confirmed that staff have pre employment checks. There was evidence of satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks as well as two references being obtained and health checks in place. When we spoke to staff they also told us that they had to have checks before they started work. We looked at the roster to check the staffing levels. This showed that there was always two staff on duty throughout the day with a third staff member on duty during the afternoon and evening. We also saw that when there were Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 22 specific activities additional staff were on duty. For example when people went to the pub additional staff were on duty to provide them with the support they needed. Training records showed that people were receiving induction training when they started work. We spoke to a recently employed staff member and he told us he was doing his induction training. Records showed us that the service provided people with training both in Health and Safety and issues relevant to their work including communication, writing with symbols and makaton. The records did not confirm that people had completed training in autism but when we spoke to the manager and staff they showed us that they did have knowledge about working with people with autism. We also saw that training materials and books relating to autism were available. Although staff we spoke to were aware of how to manage people’s behavioural needs we would recommend that the service look to provide people with training in this area. We received positive comments about the staff from our surveys. A health care professional felt that the staff had the right skills. Relative comments included; ‘They go the extra mile’, ‘Treat clients with respect’, .’The staff are sensitive to [my relative’s] needs’ ‘The staff turnover is very low, but new staff members are briefed sensitively regarding [my relative’s] needs and behaviour’. And ‘They recognise, meet and exceed all areas of care’. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good The service is being well led and providing people that live there with a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been working at the service since it opened. The AQAA states she had been working with people with a learning disability for 22 years. She is qualified and undertakes training to keep up to date with current practice. We saw she had completed training in the Mental Capacity Act and was due to attend a course of Quality Assurance. Our surveys show that relative’s have confidence in the manager. One survey stated ‘ Having known Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 24 Mrs Holcombe for many years I know she would expect high levels of care’, and another stated ‘we have complete trust and respect for the staff’. The service provided us with an Annual Quality Assurance Assessment. This was provided within the required timescales. This gave us some information but there was scope for some areas to be further developed. The service does have some systems in place to monitor the service. These include auditing medication, infection control procedures and health and safety. The service also speaks to relatives regularly about the service. We saw that the service had a development plan in place that included improvements to the accommodation, training issues and reviewing and developing the activities for people that live there. The AQAA stated that staff were trained in aspects of Health and Safety including First Aid, Food Hygiene, Fire safety and COSHH. The records we saw confirmed this and showed that the service had a programme in place to ensure people remained up to date with this training. Staff we spoke to said they had received Health and Safety Training. The service AQAA provided us with information about the safety checks that the service was undertaking. It showed that these were up to date and included checks on the boiler, electrical wiring, emergency lighting and fire alarm system. We looked at the records relating to fire safety. The service had a fire procedure in a pictorial format. We saw that there was a risk assessment in place and that the checks on the fire alarms were being completed. We also saw that evacuation practice was taking place and different times throughout the day. As part of this inspection we did notice that the Registered Provider had not been visiting the service as is required and was not completing reports on the service. This is a legal requirement and we decided that we would write to him to remind him of this obligation. Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 25 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 X 2 3 3 X 4 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X 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 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 26 NO 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. 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 For support plans to be further developed using the principles of person-centred planning to make them more assessable to the people that use the service e.g. use of photos To look at providing additional activities that may be of interest to the people that use the service To introduce Health Action Plans. This may enable people to be more involved in planning their health care. To provide people with training in behaviour management techniques. This may help staff to be better equipped to manage and respond to people’s behaviour. 2. 3. 4. YA14 YA19 YA35 Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Lanrick Cottage DS0000062392.V371796.R01.S.doc Version 5.2 Page 28 - 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. 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