Care Home: Lawrence Dene

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What the care home does well Provides an excellent standard of care for service users. Provides a safe and homely environment for service users. Supports and encourages service users to lead an independent life according to their needs and strengths and to fulfil their potential as far as possible. Service users benefit from a committed and competent staff team that ensures continuity of care. The manager and staff fully involve service users in all aspects of the running of the home. What has improved since the last inspection? Bedrooms have been redecorated for the benefit of service users. The bathroom has been refitted and enhanced the facility for service users. What the care home could do better: To continue to maintain the good standards of care for the benefit of service users. Improve the response time of the landlord to repairs and remedial work. Key inspection report Care homes for adults (18-65 years) Name: Address: Lawrence Dene Basingstoke Road Spencers Wood Reading Berkshire RG7 1AP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Sally Newman     Date: 1 6 0 9 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 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 Homes for Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Lawrence Dene Basingstoke Road Spencers Wood Reading Berkshire RG7 1AP 01189886002 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): grahamkenyon@atlas.plus.com Atlas Project Team Ltd The registered provider is responsible for running the service care home 3 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection Brief description of the care home Atlas project team are the providers for Lawrence Dene, which is a care home providing personal care and accommodation for three young adults aged 18 to 65 who have a learning disability with associated behaviour problems. The home is situated on a main road within the village of Spencers Wood and is within walking distance to the local shops and a garage. The recreational and shopping facilities within the town of Reading are within a short drive from the home, and the home has its own Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 3 Brief description of the care home unmarked vehicle. Lawrence Dene is a four-bedroom detached house. The ground floor has a large lounge, a dining room and large kitchen with patio doors that leads to the back garden. The first floor has three bedrooms one with en-suite facility, a sensory room and communal bathroom. The back garden has a summerhouse, trampoline, patio area and garden furnishings to be enjoyed by the service users in the warmer months. Off-street parking is available at the front for several vehicles. Fees range from £1782.15 to £2379.63 per week. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a routine unannounced inspection conducted over the course of 5 and a half hours duration. Time was spent in discussion with the manager, senior managers and two members of staff were spoken to in private. Observations of activities within the home were conducted and other staff were spoken to briefly. A tour of the communal areas was undertaken, and a range of documentation was seen. Information provided by the service prior to the visit has been used in the evaluation of outcomes for service users. No recommendations or requirements were made as a result of this inspection. The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, cultural and racial needs. No complaints have been received by the Commission about this service since the last inspection. Care Homes for Adults (18-65 years) Page 6 of 25 Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? 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. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 service users and their relatives and representatives can be confident that they will be provided with the information necessary to determine whether the service will meet their needs. Evidence: There have been no new admissions to the home in several years. However, there are policies and procedures in place that would be used to support an appropriately assessed and individually tailored move into the home. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual service users are fully involved in decisions about their lives, and play an active role in the care and support they receive. Evidence: All three care plans were seen. Each contained detailed information about the needs of individual service users and how these needs were to be met. There are clear and detailed behavioural guidelines that guide staff in supporting service users with their day to day routines. These guidelines are reviewed on a regular basis and are applied consistently by staff to ensure that any challenging behaviour is kept to a minimum and allows individuals to achieve their goals. All care plans are reviewed in house on a regular basis and with key stakeholders including funding authorities and relatives at least annually. The service provided is determined by the wishes, preferences and aspiration of the service users living there. They are supported to be involved with decisions affecting their lives as far as possible within their capacity and strengths. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: Risk assessment were seen to be detailed and are reviewed on a regular basis. It was clear that they are compiled and applied according to individual needs and support staff in providing opportunities for service users to achieve their full potential. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who use the service are supported to make choices about their lifestyle and are encouraged to develop their life skills. Social, educational, cultural and recreational activities are varied and offer individual choice and meet aspirations and expectations. Evidence: A range of evidence was provided by the service to demonstrate that positive outcomes for individual service users is aspired to by the manager and staff in respect of their lifestyle. This evidence included information provided prior to the visit, a range of documentation maintained within the home, together with discussions with the manager, staff and observation undertaken throughout the visit. All service users have an individual timetable of activities that is reviewed together with the service user on a regular basis. The range of activities participated in is varied and includes trampolining, arts and crafts, music, walking, films, cooking and trips to the local pub Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: and gardening. Individually tailored holidays are organised and have been enjoyed by the service users. Service users are supported to maintain family links and evidence of contact details and family information was clearly recorded within those care plans seen. The service does have access to its own vehicle and the home is situated close to local bus routes. It was clear from observations and from discussion with staff and the manager that the routines in the home are flexible and meet with individual preferences. There are no hard rules about bedtimes or meal times and service users are able to decide for themselves whether to engage in activities or not. The kitchen facilities were seen and were found to be clean and tidy. Menus are planned on a regular basis with service users. However, the manager confirmed that this was not rigidly adhered to if service users had changed timetables or collectively or individually wanted to eat an alternative. All service users had the opportunity to plan, shop and cook themselves a meal on a weekly basis. There were currently no specific dietary needs within the service user group but healthy eating and portion control was promoted. Further documentation confirmed that regular checks are undertaken on food temperatures, fridge and freezer temperatures and food dates. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 health and personal care needs of service users are met. The arrangements for medication are robust and protect service users. Evidence: The health and personal care needs of service users are clearly documented in their care plans. The range of health care professionals called upon to assist with meeting individual health care needs was provided within information made available by the service prior to the visit and included a wide range of health care professionals. This information was in evidence from examination of the 3 care plans.The plans detailed individual needs comprehensively and recorded health care contacts. The advice given was incorporated into individual plans of care and where appropriate guidelines for staff had been provided. The majority of senior management staff within the organisation are qualified Behavioural Therapists. This resource is well used to provide guidance for staff on dealing with challenging behaviour and allowing service users to participate in daily activities and achieve their goals. The medication storage facilities were seen within the staff office. An audit of the Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: medication arrangements had been undertaken by the Primary Care Trust on 23.1.09 and standards relating to the storage, disposal and administration of medication had been considered as met. An annual medication review for each service user is undertaken in conjuction with the General Practioner. All staff undertake medication training and the manager confirmed that within the service all staff are supervised and are signed off as competent before becoming administrators of medication. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that their views and concerns will be listened to and acted upon and that they are protected from abuse and neglect. Evidence: Information provided by the service prior to the visit confirmed that no complaints had been made about the service since the last inspection. The Commission has received no complaints or concerns about the service. The manager confirmed that service users are encouraged and supported to air their views both on an individual basis and within daily meetings. Due to communication difficulties issues rely upon the skill of staff to interpret the needs of service users and to recognise any problems. There is a robust complaints procedure that is made known to the representatives of service users. The manager confirmed that all staff had received instruction in the safeguarding of adults. This was confirmed by the two staff spoken to in private who demonstrated a sound understanding of the principles of safeguarding and the potential for abuse. The inter-agency policy on safeguarding adults was available in the home and the manager was clear about the action that needed to be taken should an allegation or suspicion of abuse come to her attention. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a mostly well maintained and comfortable environment that is safe, clean and hygienic. A tour of the communal areas was undertaken and all areas seen were tidy and clean. The manager confirmed that there is a rolling programme of replacement in place for furniture, fittings and decoration. Bedrooms have been redecorated whilst service users have been away on holiday. The bathroom has also been refurbished. The garden is of a good size and is used and maintained by service users with the support of staff. The home is well situated close to bus routes that provides access to the town centre and places of interest. There is a comprehensive cleaning schedule in place in which service users participate. Laundry facilities were seen and were considered to be adequate to meet the needs of the current service users. The manager confirmed that the principles for the Control of Substances Hazardous to Health are adhered to and are supported by comprehensive policies, documentation and staff training. Evidence: The home is generally well maintained. However, there have been some recent difficulties in securing the co-operation of the landlord to carry out remedial work following a leaking radiator. On the day of the inspection a Senior management staff member had travelled some distance in order to meet with the landlord to discuss progress. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the support of well trained and competent staff and are protected by the organisations policies on recruitment. Evidence: Information provided by the service indicated that all staff are subject to an extensive recruitment programme that complies with the regulations. This was confirmed by the manager who also stated that no current staff were subject to disciplinary procedures or had a criminal conviction. All prospective staff must complete an application form and are subject to written references and formal interview. Two staff files were seen and contained all documentation required by regulation. The manager confirmed that all prospective staff have a POVA 1st check undertaken prior to a full Criminal Records Bureau check. Information relating to this was held at head office. All new staff have intensive induction programmes and this was confirmed by those 2 new staff spoken to. All staff have individual training profiles and the manager confirmed that all staff had received training in core activities such as fire training, food hygiene and health and safety. The organisation has a dedicated training cocoordinator who oversees all training arrangements and ensures that updates are provided for those staff who require them. Overall the arrangements for staff training were described by those new staff spoken to as very good. Staff spoken to confirmed that the staff team work well together, are supportive of Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: each other and communicate and share the needs of service users efficiently. Staff meetings are held regularly. It was reported that staff hand-overs and the use of a communication tool within care plans ensured that important information was passed on. The manager confirmed that one to one supervision is provided on 6 weekly basis and all staff have an annual appraisal. The home currently runs with a minimum of two staff on shift. The manager confirmed that the deployment of staff is under constant review and that there are plans to fill the current vacancy as soon as possible. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well run home where their views are taken into account with regard to the development of the service. Service users are protected by the homes policies and procedures for health and safety. Evidence: The manager has been in post since May 2009 and is in the process of applying to be registered with the Commission. He is currently working towards the Registered Managers Award. It was apparent from available evidence that he is competent, well qualified and experienced in managing the home and has proved to be a valuable asset to the service. Staff found him to be supportive and approachable. The manager reported that he felt well supported by the organisation and was provided with sufficient resources to run the service and to ensure that service users needs were met. The service evaluates its effectiveness primarily through the formal annual care plan review process when feedback from interested parties is sought. All views and feedback are taken account of and internal reviews are conducted more regularly to ensure that the needs of service users are continuing to be met. Monthly management Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: audits are conducted in all aspects of the running of the home. There are robust health and safety practises within the home that are underpinned by comprehensive policies and procedures. A range of checks are undertaken and documentation was seen in respect of fire safety checks, hot water outlets and electrical appliance checks. A full evacuation fire drill was carried out on 8.8.09 and was well executed. Care Homes for Adults (18-65 years) Page 22 of 25 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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 Care Homes for Adults (18-65 years) Page 24 of 25 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. 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. Care Homes for Adults (18-65 years) Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!