Care Home: Lee Court - Leonard Cheshire Disability

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What the care home does well Customer satisfaction levels are high and people enjoy going to stay at Lee Court, viewing it as a holiday. People`s needs are assessed before they are offered a place to ensure that the service only accepts people where they are confident they can meet their needs. Guests speak highly of the staff who are supervised and supported well. As people do not live permanently at Lee Court the service has little involvement with facilitating health treatment. However although this happens infrequently, when people`s health changes during their stay it is noticed and medical attention is sought quickly. The service has also demonstrated it responds properly to allegations made, even where this is not about the service, to ensure vulnerable guests are rightfully protected. The service has received one complaint since the last inspection. It was not upheld but was taken seriously and investigated thoroughly. The outcome was reported back to the complainant in face-to-face meetings and was resolved satisfactorily. On a day-to-day basis the service is managed well. The manager has worked hard over the last year to make improvements identified as required at the last inspection and has implemented some difficult changes successfully in the interests of people who use the service. The manager has the ability to reflect on her development and learning, acknowledges and accepts responsibility for any areas of weakness in the service providing a good foundation for further improvement. What has improved since the last inspection? Most noticeably guests enjoy a greater number of activities and trips out especially on week day evenings. This has been achieved by changing the staff rota pattern to ensure a greater degree of flexibility for guests. Medication systems have also significantly improved to ensure there are tighter controls and accountability to ensure guests receive their medication as prescribed. The Manager visited a respite service locally to learn from their good practice and this has helped to improve standards and reduce risk. Lee Court provides a pleasant and homely environment for its guests to stay in. It is safe and well maintained but since the last inspection steps have been taken to reduce risks further. For example, water temperatures have been adjusted to minimise the risks of scalds to service users, bedroom doors have been fitted with battery devises which ensure guests can safely prop doors open knowing they will close in the event of fire. Also window restrictors have been fitted. The property is a bungalow. Restricted windows prevent the risk of intruders gaining access to the building helping to protect vulnerable guests and their staff. At this inspection people better know how to complain and feel that they are listened to. What the care home could do better: Although medication systems have improved, there have been two medication errors seemingly the result of human error. It is important that steps are taken to learn from this, as it would appear that the witness system designed to eliminate human error has failed on these occasions. Also these matters were not notified to us under regulation 37. The second happened when the manager was on leave and staff are not aware of the duty to report such matters to us without delay. The reporting of incidents, which affect the welfare of residents, helps us to monitor the performance of the home and any associated risks. At the last inspection we did not assess how new staff are recruited as no new staff had been appointed. We assessed it at this inspection and found practice to be poor. This does not protect vulnerable adults and has the potential to put them at risk. The process had not been sufficiently managed. However we were assured that unchecked new staff had not worked as part of the staffing ratio, were supervised at all times, did not escort guests unaccompanied and did not provide personal care to guests. The manager accepted the feedback, acknowledged her responsibility for the poor performance in this area and the following day submitted an in depth action plan to ensure immediate improvement. This includes a commitment from senior managers to monitor recruitment practice to ensure national minimum standards are achieved and that guests are protected. CARE HOME ADULTS 18-65 Lee Court Queen Street Wellington Telford Shropshire TF1 1EH Lead Inspector Deborah Sharman Key Unannounced Inspection 19th September 2008 09:00 DS0000064235.V372199.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 DS0000064235.V372199.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. DS0000064235.V372199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lee Court Address Queen Street Wellington Telford Shropshire TF1 1EH 01952 272020 01952 272050 caroline.redford@lc-uk.org www.LCDisability.org Leonard Cheshire Disability 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) Ms Caroline Redford Care Home 5 Category(ies) of Learning disability (5) registration, with number of places DS0000064235.V372199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 5 The maximum number of service users who can be accommodated is: 5 20th September 2007 Date of last inspection Brief Description of the Service: Lee Court is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and short-term care for a maximum of five adults with a learning disability at any one time. The home currently provides a service for 40 people. Referrals are made through the Joint Community Learning Disability Team based at Tan Bank, Wellington, Telford. The property is purpose built and comprises a lounge, kitchen/diner, 5 bedrooms a bathroom and level access shower room. The service provider is Leonard Cheshire Disability and was registered with the CSCI in April 2005. The Responsible Individual is Ms Margaret Street and the manager of the home is Caroline Redford. Lee Court is situated in Queen Street near the centre of Wellington, Telford and is in walking distance of local amenities and just a short journey away from Telford Shopping Centre. Leonard Cheshires mission statement is included in the homes Statement of Purpose and states To work with disabled people throughout the world, regardless of their colour, race or creed, by providing the environment necessary for each individuals physical, mental and spiritual wellbeing. DS0000064235.V372199.R01.S.doc Version 5.2 Page 5 Guests at Lee Court pay a contribution towards the weekly fee. Their contribution is means tested. The Service User Guide however does not state the services weekly fee, as it should, therefore this information should be sort directly from the Manager or the service provider, The Leonard Cheshire Disability. DS0000064235.V372199.R01.S.doc Version 5.2 Page 6 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. One Inspector carried out this unannounced key inspection over two days. On the first day 19 September 2008 when the manager was on leave, we inspected between 10.15 am and 3.30pm. We returned on the second day 1 October 2008 and inspected between 9.30 and 1.00pm. The manager was available on the second day to answer any queries arising from the first day and to receive feedback about the inspection outcome. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The manager completed this document and returned it the commission on time. Comments from the AQAA are included within this inspection report. In addition prior to inspection we sent surveys out to ten people who receive respite care at Lee Court, to five staff who work there and to two independent professionals who provide their services to the home. We received completed surveys from three people who stay there and three staff who work there. We did not receive any replies from external professionals. We are not currently sending surveys out to relatives in order to comply with data protection legislation. However, we had the opportunity to talk briefly to two relatives on the first day of inspection. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. As the registered manager was not available on the first day a senior carer along with the administrator and a manager from another home supported the DS0000064235.V372199.R01.S.doc Version 5.2 Page 7 inspection process by answering questions and locating appropriate documentation requested. Over the two days we were able to talk to staff including new staff and met and spoke to two people who stay there. We assessed in detail the care provided to two people using care documentation. Most guests were out at the time of inspection but we spoke to two other people and have used our and the service’s surveys to judge customer satisfaction. We also toured the premises and sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. All this information helped to determine a judgement about the quality of care the home provides. What the service does well: Customer satisfaction levels are high and people enjoy going to stay at Lee Court, viewing it as a holiday. People’s needs are assessed before they are offered a place to ensure that the service only accepts people where they are confident they can meet their needs. Guests speak highly of the staff who are supervised and supported well. As people do not live permanently at Lee Court the service has little involvement with facilitating health treatment. However although this happens infrequently, when people’s health changes during their stay it is noticed and medical attention is sought quickly. The service has also demonstrated it responds properly to allegations made, even where this is not about the service, to ensure vulnerable guests are rightfully protected. The service has received one complaint since the last inspection. It was not upheld but was taken seriously and investigated thoroughly. The outcome was reported back to the complainant in face-to-face meetings and was resolved satisfactorily. On a day-to-day basis the service is managed well. The manager has worked hard over the last year to make improvements identified as required at the last inspection and has implemented some difficult changes successfully in the interests of people who use the service. The manager has the ability to reflect on her development and learning, acknowledges and accepts responsibility for any areas of weakness in the service providing a good foundation for further improvement. DS0000064235.V372199.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Although medication systems have improved, there have been two medication errors seemingly the result of human error. It is important that steps are taken to learn from this, as it would appear that the witness system designed to eliminate human error has failed on these occasions. Also these matters were not notified to us under regulation 37. The second happened when the manager was on leave and staff are not aware of the duty to report such matters to us without delay. The reporting of incidents, which affect the welfare of residents, helps us to monitor the performance of the home and any associated risks. At the last inspection we did not assess how new staff are recruited as no new staff had been appointed. We assessed it at this inspection and found practice to be poor. This does not protect vulnerable adults and has the potential to put them at risk. The process had not been sufficiently managed. However we were assured that unchecked new staff had not worked as part of the staffing ratio, were supervised at all times, did not escort guests unaccompanied and did not provide personal care to guests. The manager accepted the feedback, acknowledged her responsibility for the poor performance in this area and the following day submitted an in depth action plan to ensure immediate improvement. This includes a commitment from senior managers to monitor recruitment practice to ensure national minimum standards are achieved and that guests are protected. DS0000064235.V372199.R01.S.doc Version 5.2 Page 9 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. DS0000064235.V372199.R01.S.doc Version 5.2 Page 10 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 DS0000064235.V372199.R01.S.doc Version 5.2 Page 11 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): 1, 2, 3, 4, 5. Quality in this outcome area is good. Assessments are carried out before people have respite stays at Lee Court. This assures people the service is confident it can meet their needs before they are offered a place. People are also given good information about the service before they decide to stay there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection several people have been admitted to the service for the first time for respite care. We could see that the manager talked to them and their carers about the service and asked them what support they would need. This is all documented. The manager also obtains information from Social Services to help her to make a decision about whether Lee Court is the right place for the person applying. Written guidance and risk assessments are put in place before people stay at Lee Court for the first time. This ensures that staff know what support is needed and how the person would like to be supported. Staff also told us that in addition to written guidance, that managers tell them all about the person who would be arriving for their first stay. Bookings are confirmed in writing and the fee is explained in this letter. We could also see that contracts are issued in accessible formats to ensure the new guest is aware of the rights and DS0000064235.V372199.R01.S.doc Version 5.2 Page 12 responsibilities of all parties. We have advised however that information about the weekly fee should be included in the Service User guide so that this information is available to people who may enquire at an earlier stage. Before people stay at Lee Court for the first time they are invited to visit to help them to decide whether they want to stay there. People tell us they are satisfied with how they are supported with their decision to stay at Lee court. DS0000064235.V372199.R01.S.doc Version 5.2 Page 13 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’s needs and goals are met. The home has a plan of care that tells staff how to meet people’s needs. People are able to make decisions about their stay at Lee Court. This is because the staff promote their rights and choices. People are supported to take assessed risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at two peoples care. We found care plans clearly describe people’s needs and abilities and tell staff how to provide support to meet peoples significant key needs. People’s abilities are recognised and are promoted. For example people are enabled to carry out their personal care independently and DS0000064235.V372199.R01.S.doc Version 5.2 Page 14 following an assessment, one resident has administered insulin injections herself in order to maintain skills. Plans of care are reviewed very regularly and review meetings are held with the person and people involved in their lives, including Social Workers. We can see from records that people’s choices are listened to and are respected. For example a Manchester United fan enjoyed watching her favourite team on the television, maintained routines established at home and was offered but was able to decline a shower on some occasions. These were taken when the guest chose to. We can also see that when residents have requested specific activities like a shopping trip or a visit to the pub that they have been taken that same day. Records evidence well-being as a result. For example, she ‘enjoyed her shopping, very pleased with her purchases, full of smiles’. We asked a staff member what they do if a guest does not like the available meal. The response was that the guest is asked what they would like and an alternative is prepared because they ‘try to make the guests feel as comfortable as possible’. DS0000064235.V372199.R01.S.doc Version 5.2 Page 15 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, 15, 16, 17. Quality in this outcome area is good. People choose and participate in suitable leisure activities. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the service’s AQAA the manager tells us that ‘after to listening to service users and their families we have changed staffing rotas to accommodate more flexibility - ensuring staff are available when service users want them enabling more one to one activites’. Staff have confirmed this to us. Lee Court is taking steps to assess what activities people would like to be involved in during their stay. Guests are being given a new and extensive DS0000064235.V372199.R01.S.doc Version 5.2 Page 16 pictorial activity assessment document where they can choose from a wide range of activities and indicate with a tick or a cross whether they are interested in trying the activity. Staff are then engaging residents in reviewing each activity after they have done it to help staff know whether to repeat the opportunity. Guests are enjoying the exercise and we could see that for the people whose care we looked at they had enjoyed each of the activities and wanted to be able to do them again. For one person, this included a trip to the cinema, shopping in Shrewsbury, fish and chips in a café, playing on the Wii game and going to the pub. Records show a second resident to have enjoyed a wide variety of trips out to a range of different places daily during his two week stay including: • • • • • • • • • • Wolverhampton’s waterways festival Market and had ice cream Lunch at canal boat locks Walk to the supermarket Cosford air museum and to a retail park Town centre for picnic and a walk Upon request a visit to the pub in evening on two occasions West Park in Wolverhampton Shopping upon request so taken to Shrewsbury. Cinema to see Mama Mia Other records such as guests’ expenditure sheets confirmed that the activities had taken place. Discussion with a staff member showed us that peoples dietary needs are known and acted upon. A rolling menu is followed so people know what is to eat with alternatives available if required. Guests are also involved from time to time in shopping for groceries at the very local supermarket. We spoke to a guest who told us she likes the food and has plenty of it. A staff member told us ‘we offer good care, good food and good times’. All three guests who completed surveys for us indicated maximum satisfaction with the service. One person wrote ‘I Like my respite there, I look forward to going and stay there. We go out in the mini bus at weekends and there is lots to do in the home’. The AQAA tells us the manager has plans for further improvement: These are to ‘continue to increase the range of activities available, matching service users interests to individual activities/outings. Utilising volunteers to broaden the scope of activities further’. A volunteer coordinator has been appointed to help to achieve this objective. DS0000064235.V372199.R01.S.doc Version 5.2 Page 17 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. People receive personal support from staff in the way they prefer and want. Their physical 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 safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are supported with their personal care to varying degrees depending on the needs of the person. Staff described how they enable residents to be as independent as possible and demonstrated that they know who needs what level of support. As a respite service, Lee Court is not involved in arranging annual health screening or taking people to specialist health appointments. On one occasion since the last inspection, has a guests health changed whilst they were staying DS0000064235.V372199.R01.S.doc Version 5.2 Page 18 at Lee Court. The guest developed a temperature and was generally unwell. Records show us that the out of hours Doctors service was contacted the same day and that a doctor visited within half an hour, leaving antibiotics which were started with immediate effect. We can see from records that the person’s health was monitored and recorded and that two days later he was feeling fully recovered. Medication systems have improved. The service is now liaising with GP’s to confirm prescribed medication for each resident prior to admission. This helps to ensure information is up to date and accurate so the home can administer the medication as it is prescribed. Copies of prescriptions or written directions from the surgery are now available for reference. There have however been two medication errors in respect of the same guest on two separate occasions. On the first occasion he received a drug too early. On the second occasion for a few days he was not given enough of his medication for epilepsy. He was given one tablet instead of two. The directions had been incorrectly transcribed onto the Medication Administration Record in spite of the fact that directions from the surgery were clearly available. The concern is that a witness system is in place to avoid such incidents of human error, which for reasons unknown has failed on these occasions. The manager must take steps to assess the reasons for the errors so improvements can be made. On each occasion when an error has been made, medical advice has been sought and adhered to with there being no ill effect on the guest. We were not informed of these incidents. Medication was also looked at for the two people whose care we assessed. For them, medication records provide an accountable audit of administration indicating they have received their medications as prescribed during their stay. A risk assessment is in place to enable a guest to continue to self-administer her insulin, as she is accustomed to doing so. This was managed successfully with no concerns arising from her stay. All staff who administer medication have been trained. DS0000064235.V372199.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. 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 takes action to follow up any allegations. However recruitment practice is not fully protecting people when new staff are appointed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Minutes of a Parent Carer Meeting in April 2008 showed us that our findings at the last inspection were shared with parents / carers present. They were told that the ‘‘Inspector understood parents and carers are not aware of how they should complain’. The recorded response of relatives is that they ‘could not contemplate complaints to Lee Court would be a major issue because guests are happy to stay at Lee Court.’ Evaluation forms given to the service at the end of guests’ stays confirm this. Of eleven received since the last inspection all were very positive and expressed their enjoyment and thanks for their care. All three guests, who supported by their families, completed and returned surveys to us, said they know how to complain if they are not happy about something. This represents an improvement since the last inspection. Since the last inspection, one guest has submitted a complaint. This was taken seriously, investigated and the manager met with the guest and his advocate on more than one occasion. The complaint was not upheld but was resolved to DS0000064235.V372199.R01.S.doc Version 5.2 Page 20 the satisfaction of the complainant within nine days. Records detailing the complaint and the response are thorough. There have not been any disciplinary actions against staff, or admissions to accident and Emergency, no physical interventions and only minor recorded accidents to staff and guests. Accident figures are submitted to head office so trends can be analysed. We noted three of the seven-recorded accidents are falls by service users and advise that falls risk assessments are carried out to try to identify measures that may limit a repeat fall. All staff have in 2005 done Adult Protection training, except a new staff member. About half of the team have received refresher training in April 2008 and the service is aware who still needs to complete this. We talked to the new staff member about adult protection issues and he was aware of steps he must take if he became aware of possible abuse, as was a trained second staff member we talked to. Both staff members feel that guests are safe and happy. Neither staff member had any concerns about the welfare of any of the guests who receive a service. A staff member told us ‘generally we are a lovely happy unit, every staff member really cares, we have a lovely rapport between ourselves and the guests’. Staff and the manager responded, as we would expect them to when a guest recently made an allegation of abuse describing to them something that had happened to her in another service. This is now being investigated by Social Services. The manager is aware of Lee Court’s duty to ensure future protection related to this matter and said that the issues would be discussed with the Social Worker and would be subject to risk assessment. The manager will first attend a planned strategy Meeting with partner agencies to assess the level of risk and agree ways of reducing any agreed risk. Guests’ monies are managed accountably with sufficient records and safe holding facilities. DS0000064235.V372199.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. People stay in a safe and wellmaintained home that is homely, clean, comfortable, pleasant and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We toured the premises and found them to be homely, clean, odour free, comfortable and well maintained. The shower room has been re tiled and now has a modern quality finish. The manager explained that the plan is to address the bathroom next and we agreed, that whilst adequate the bathroom does present as a little dated. We suggested too that the newly built storage cupboard we saw at the last inspection is painted. Currently it is bare MDF and a coat of paint will provide an improved finish. There were no evident hazards and steps have been taken to further reduce risks to service users by fitting fire closures to bedroom doors and restrictors to windows. These measures mean guests can safely prop their bedroom doors and windows open limiting risk to them in the event of fire and intruders. Guests do not currently DS0000064235.V372199.R01.S.doc Version 5.2 Page 22 have keys to their bedrooms. This has been identified by the service as a shortfall in the Quality assurance tool and plans are in place to discuss this with guests and their families. To avoid the risk of scalds thermostatic valves were adjusted shortly after the last inspection. Perusal of water temperature records at this inspection shows water to be safely regulated with the exception of outlets in the kitchen and laundry. However we found the laundry to be locked to limit risk. Moreover, risk assessments state risk from kitchen water must be controlled through adequate supervision of guests by staff. We spoke to a guest who said she likes her bedroom and is comfortable in it. Two staff confirmed that they have all the resources they need to support guests and that the layout and facilities meet the needs of all guests who currently stay from time to time. The premises are domestic in style and homely. Guests are provided with information in public areas of the home without this detracting from its homely feel. For example we saw literature on the walls about advocacy services, how to complain about Lee Court in an accessible format and also how to make a complaint about us, CSCI. We found toilet and bathing areas furnished with soap and paper towels. We inspected on a Friday, which was guest changeover day. We saw staff changing the entire bedding ready for their new guests. All the bedrooms were very fresh and pleasantly scented. On the second day of inspection, the manager was pleased as she had that day received confirmation from Telford and Wrekin that they have been awarded a grant to support good infection control practice. Staff had told us that some guests are incontinent of urine and that only manual sluice facilities are available. The grant will enable them to buy a commercial washer and drier with built in sluice facility as well as new breathable waterproof wipe clean mattresses, pillows and duvets. This is important given the high turnover of people using the beds given that the service provides short stays. DS0000064235.V372199.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. People’s needs are met because staff get the right training, supervision and support they need from their managers. People have confidence in the staff at the home however inspection has shown that checks to make sure that new staff are suitable are poor. Staff turnover however is low and new staff have been well supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence from a range of sources tells us that guests and their relatives are satisfied with the care that staff provide indicating they are competent. In a completed survey a guest with help from a relative said ‘Lee Court staff are very good with everyone’. There is a good system in place to ensure staff attend appropriate training courses with records kept of each staff member’s training needs. Staff have attended between 10 and 23 courses in total, with training being available promptly and to national standards for new staff. A new staff member told us that the training and support received, as part of the induction process had been helpful. DS0000064235.V372199.R01.S.doc Version 5.2 Page 24 Person centred planning training has not been provided as suggested at the last inspection. The manager explained that they are working with Telford and Wrekin on the development of this and are dependent on their time scales. Staff speak highly of the training opportunities available to them and they along with records tell us that they also receive regular supervision to support and monitor their practice. Staff meetings are held regularly to ensure staff receive the information they need to carry out their jobs. Minutes of these show us that staff receive direction and leadership about what is expected but that the process works two way, with staff able to provide feedback at meetings to the manager. Two members of staff are on duty from 7.30 until 8.00am (this includes a night staff member who finishes at 8am) with two thereafter. There is a waking and sleeping staff member at night to support 5 guests. Staff tell us that this is sufficient. Staff have had to adjust to a changed shift pattern to better facilitate activities for guests. This has been a big change for staff. In a survey one staff member expressed concern about undertaking 14 hour shifts without a break. We looked at rotas and could see that this is very infrequent. Discussion with another staff member told us it is possible to take breaks and the shift system is not a problem. Discussion with the manager confirmed how infrequent the 14-hour shifts are and that this had been agreed with staff in advance who opted for this system rather than an alternative offered. We looked at how two new staff have been recruited. There was evidence of some good practice. For example we could see that the applicants had completed application forms, had been interviewed, issued with job descriptions, contracts of employment and their identity as well as their medical heath had been checked. However key checks designed to safeguard vulnerable people had not been sought and received before the new employees started in employment where they have access to and information about vulnerable people. For one new staff member we could see that two references were sent for eight days after s/he had started in post with only one having been received back. The second was not pursued. A POVA first check was received some five weeks after employment. This tells new employers whether the person is suitable to work with vulnerable people. Unaware the person had already started, upon receipt of the POVA first, head office told the service in an email that s/he ‘may now start work under supervision until full CRB is received’. A Criminal Record Bureau check was sent for after the new employee had started and was received back some 3 months later. The situation was similar for a second new starter. In this case two references had been received in a suitably timely way. Head office was unaware however DS0000064235.V372199.R01.S.doc Version 5.2 Page 25 that on the day they were sending for Criminal and POVA first checks, the new recruit had already started in post. Regulation 26 monitoring visits by the provider as well as quality assurance tools failed to recognise these shortfalls. The manager in her AQAA to us before inspection stated, ‘When recruiting, the Leonard Cheshire Disability ‘recruitment and retention of staff’ policy is used ensuring compliance with regulations’. At inspection the manager acknowledged that she was not aware of the shortfalls, should have managed the situation more closely and given her inexperience of recruiting processes should have referred to the policies and procedures. Further assessment of the situation however by talking to staff, the manager and perusal of many rotas assures us that as a result of a robust induction, the two newly recruited staff were supernumerary at all times prior to receipt of the checks and were supervised on all occasions by experienced staff. The new staff furthermore did not engage in the provision of personal care to guests. So the evident risks were minimised. We have advised the Manager that in exceptional circumstances, where new staff are appointed on a POVA first check whilst waiting for a CRB, all other checks and documentation must be in place prior to starting. Also an experienced staff member must be clearly identifed on the rota as the mentor responsible for them. In the 24 hours between the end of inspection and the writing of this report, the registered manager has submitted a comprehensive action plan to us. This includes an analysis of what went wrong and what she will do to protect guests in future when recruiting new staff. The action plan also includes a commitment to the monitoring of recruitment by senior managers, to ensure that recruitment practice immediately improves. The service intends to recruit volunteers. We will be assessing the roles of volunteers used in the future and how safely they have been recruited. DS0000064235.V372199.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good. People have confidence in the care home because it is run and managed well generally on a day-to-day basis. The environment is safe for people and staff because health and safety practices are carried out. Lax recruitment processes have had the potential to put people at risk. The manager recognises this and we are confident in the manager’s ability to put this right. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000064235.V372199.R01.S.doc Version 5.2 Page 27 Generally the service is managed well and the manager has worked hard to address the areas we identified for improvement at the last inspection. She has managed the change process well and reflects on how she has developed as a manager. Staff speak highly of her. A staff member described her as ‘‘a very fair manager’ who is ‘on the ball’, who ‘likes things right’ and ‘everything is much more organised’. A second staff member said the manager ‘is doing a very good job’. In a survey a staff member expressed concern for the manager saying she is expected to do too much with the various projects she is involved with. Exploration of this at inspection told us that since January 2008, the manager has been supporting a new service in Wrexham, which has taken her away from Lee Court ‘about two days per week’. We had not been aware of this. The arrangement will be coming to an end within the next month. Staff however said that throughout this time she had always been contactable and available to them. We have advised that she should include herself on the staff rota so that her time on and away from the premises is transparent and accounted for. The manager feels well supported and appreciates regular supervisions that meet her needs. She has undertaken a number of training courses since the last inspection to update her knowledge and skills. She had commenced her Registered Managers Award to qualify her for her post, but the training provider has gone into administration and alternatives are being sought. The minutes of Parent Carer forums tell us that relatives are happy with the service and how it is being managed. We met two relatives of two guests on the first day of inspection. Both had no concerns (other than in one case the medication error) and said Lee Court does a good job. It is recorded in a regulation 26 report, that relatives have noted evident improvements in the service since Ms Redford became manager. All service maintenance records that we requested were available and were up to date. These along with sight of accident records and up to date environmental risk assessments assure us that the premises are safely managed and have been improved (See NMS 24 – 30). A new development has been to put emergency plans in place for a range of possible diverse emergencies. Quality assurance systems to help the service assess and improve its own performance are mixed. It seems that satisfaction surveys sent out to guests from head office were overlooked for Lee Court in 2007 and 2008 and therefore this opportunity for feedback and improvements based upon feedback has been lost. Having identified the problem the manager says she has taken steps to ensure Lee Court’s guests receive the next surveys in January 2009. In the meantime there are the evaluation forms that some guests complete at the end of their stay/s. These are very positive. In DS0000064235.V372199.R01.S.doc Version 5.2 Page 28 addition there is the ‘Self Assessment Report’ tool completed in 2008, which has identified some areas of strength and need with target dates for action. Regulation 26 monitoring visits take place regularly and the Manager, with the exception of recruitment, by and large completed the annual return (AQAA) in a way that demonstrates a good assessment of the service’s performance. It is therefore disappointing that with a variety of systems at its disposal, omissions we identified in recruitment, which are critical to the safety of residents were not identified. Similarly, that the none-submission of regulation 37 notifications have not been identified. However, the manager has responded positively to feedback and we have received a robust action plan to ensure improvement. The Manager has demonstrated her ability to make improvements and we are confident that on this occasion she will. The service has demonstrated that it has significantly more strengths than areas for improvement. Therefore we are satisfied that Lee Court provides a ‘good’ quality service. DS0000064235.V372199.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 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 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 3 DS0000064235.V372199.R01.S.doc Version 5.2 Page 30 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. 1 Standard YA34 Regulation 19 Requirement The registered person must not employ a person to work at the care home unless the person is fit to work at the care home and he has obtained in respect of that person all documentation required by regulation to assure that s/he is suitable to work with vulnerable people. This is to ensure the protection of vulnerable people. New requirement arising from this inspection September / October 2008. The Registered person must give notice to CSCI without delay of the occurrence of any incident as defined in Regulation 37 1(a) to 1(g) and any notification given orally must be confirmed in writing. New requirement arising from this inspection September / October 2008 Timescale for action 02/10/08 2 YA41 37 02/10/08 DS0000064235.V372199.R01.S.doc Version 5.2 Page 31 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 YA20 Good Practice Recommendations The Registered Manager should review the medication witness system to ensure that it works effectively to reduce the risk of human error so that people always receive their medication as prescribed. New recommendation arising from this inspection September / October 2008. The ‘new’ storage cupboard in the hallway should be painted / stained to ensure it looks completed and fits in with its surrounds. New recommendation arising from this inspection September / October 2008. The registered manager should ensure that she is included on the staff rota to account for the time she spends on and away from the premises. It should be clear on the rota whether the managers ‘shift’ is supernumerary management time or whether she is part of the carestaffing ratio. New recommendation arising from this inspection September / October 2008. 2 YA24 3 YA41 DS0000064235.V372199.R01.S.doc Version 5.2 Page 32 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. 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