Care Home: Lulworth

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What the care home does well Staff interact with people who use the service in a meaningful and appropriate way. People who use the service have a comprehensive assessment prior to admission. Involvement with the local community is actively encouraged. People who use the service are free to conduct relationships of their choice in private or are supported to go out to do so. A choice of meals is offered in pleasant surroundings. The physical environment is of a very high standard and meets individuals` requirements. Outcomes in this area were excellent What has improved since the last inspection? This is the first inspection to a newly registered service. What the care home could do better: The home is performing well in all areas. CARE HOME ADULTS 18-65 Lulworth 4 Nursery Lane Worthing West Sussex BN11 3HS Lead Inspector Sheila Gawley Unannounced Inspection 4th March 2008 12:30 Lulworth DS0000070778.V359579.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 Lulworth DS0000070778.V359579.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. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lulworth Address 4 Nursery Lane Worthing West Sussex BN11 3HS 01903 212384 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) Miss Rebecca Karen Ward Miss Rebecca Karen Ward Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Lulworth DS0000070778.V359579.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 category: People with a learning disability - Code LD and People with a physical disability - Code PD. The maximum number of service users who can be accommodated is 14. 2. Date of last inspection N/A Brief Description of the Service: Lulworth is a care home offering personal care to younger adults with a learning disability or a physical disability. It consists of a main house offering accommodation to ten people and an annex, which will accommodate four people who use the service. There are not any people who use the service accommodated in the annex as yet. The buildings are purpose built, the main one being three storey and the annex is single storey. A passenger lift is provided. The home is decorated and furnished throughout to a high quality and is domestic in nature. Heating is under floor. Both parts of the home have kitchen, bathroom and laundry facilities. The fees charged range between £1337-£1467. Fees are calculated according to need. Lulworth DS0000070778.V359579.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 site visit as part of the inspection process took place on 04/03/08. Prior to the visit all files held by The Commission for Social Care Inspection (We) were examined. We were in receipt of the Annual Quality Assurance Assessment (AQAA), which contained all of the information we asked for. The registered manager facilitated the inspection and any documents required on the day were made available. Care plans, Medicine administration charts, some policies, procedures and staff files were inspected. We were in receipt of three surveys from people who use the service and one from a relative, which had been held in the home for the inspection. All comments in the surveys were positive. During the visit, where possible, people who use the service were spoken to and their opinions sought. All indicated satisfaction with the care and support offered. The atmosphere in the home was very relaxed and sociable. People who use this service experience good outcomes because they receive care from a well-trained and motivated staff in safe and comfortable surroundings. What the service does well: Staff interact with people who use the service in a meaningful and appropriate way. People who use the service have a comprehensive assessment prior to admission. Involvement with the local community is actively encouraged. People who use the service are free to conduct relationships of their choice in private or are supported to go out to do so. A choice of meals is offered in pleasant surroundings. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 6 The physical environment is of a very high standard and meets individuals’ requirements. Outcomes in this area were excellent What has improved since the last inspection? What they could do better: 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. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 7 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 Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 8 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): 2,5 The individual aspirations and needs of people who use the service are assessed and all have a contract and terms and conditions People using this service experience good outcomes in this area because needs are fully assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence of comprehensive assessment prior to admission in the care plans including the care management plan from Social and Caring Services. This included information on accommodation, support, family contact, specific conditions related needs and specialist input. One person was met who was visiting the home to have lunch before deciding to move in. Contracts for people who use the service were seen and these coved all aspects of the agreement such as room to be occupied, fees and personal support and services provided. All people who use the service receive information about the home in the Service User Guide. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 9 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): 6,7,8.9 Residents know their assessed and changing needs and personal goals are reflected in their individual plan, they can make decisions about their lives and can take risks as part of an independent lifestyle. They are consulted on life in the home. People using this service experience good outcomes in this area because they make decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were examined and the residents were spoken to. Residents spoken to stated that they make decisions about their lifestyle and are supported in daily lifestyle choices. These decisions were seen recorded in their care plans as were wants, aspirations, future goals and plans to achieve these. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 10 Risk assessment is in place and people who use the service are allowed to take risks, There are not any people who use the service who self medicate at present. If anyone asks to do this they would be risk assessed. Needs are addressed in a person centred way, those able to take care of personal needs are allowed to do so. Risks associated with needs or behaviours are clearly documented, as are management strategies. Equality and diversity issues are identified and addressed. There are regular meetings for people who use the service usually chaired by themselves and this process feeds change in the home such as changes in the risk taking policy. Autonomy is always promoted and service users are provided with information so they can make an informed decision - an example of this is the provision information about all political parties at election time. Advocacy is encouraged Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 11 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 People who use the service are able to take part in age, peer and culturally appropriate activities and are part of the community. They engage in appropriate leisure activities and have appropriate personal, family and sexual relationships. The rights of people who use the service are respected and responsibilities recognised in their daily lives. People using this service experience good outcomes in this area because they can participate and contribute to the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Areas of development and interest are identified in care plans and people who use the service are encouraged to achieve this. They are actively encouraged to go out into the community, they go on shopping trips and all doctor, Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 12 hairdresser, optician and dental appointments are accessed in the community. The communal areas of the home are bright and comfortable and people who use the service were observed using Nintendo games or listening to music in a calm and relaxed environment. There was evidence of hobbies in bedrooms such as tapestry. Needs and preferences in sexuality is also recorded and privacy is respected. Staff knock prior to entering bedrooms, if entering when the person in not in the room such as to demonstrate a communication device for inspection the permission of the person was sought. The modern kitchen is domestic in style and is fully wheelchair accessible. There is a varied menu in place and people who use the service are consulted on this. Mealtimes are relaxed and flexible and people who use the service can choose when and where to take their meal. Those requiring assistance received it in an appropriate manner. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 13 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): 18-20 Residents receive personal support in the way they prefer and require and residents’ physical and emotional health needs are met. Residents can retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. People using this service experience good outcomes in this area because the resident directs personal support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal support required is noted in the care plans and residents confirmed they receive support as they wish. Any complex or condition specific healthcare needs are clearly deatailed in care plans and involvesas is the input input from outside professionals such as community or specialist nurses. Staff spoken to stated that the home is run in the interests of the residents and is very friendly. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 14 Medicines are appropriately received, administered and recorded. Two medicines were unsigned for which the registered manager investigated and rectified immediately. There were also some issues with codes not being used when medicines are not given, this too was addressed. All medicines are currently administered by staff and should a person who uses the service request to administer their own medicines they would be risk assessed to establish if they could do so safely. The wishes of people who use the service in relation to the administration of medicines were recorded, for example the wish to receive it in a bedroom rather than in communal areas. The home is supported in the management of medicines by a local pharmacy. . Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 15 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 Residents feel their views are listened to and acted on. Residents are protected from abuse, neglect and self-harm. People using this service experience good outcomes in this area because they are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The views of people who use the service are sought on a day-to-day basis and in meetings. There is a complaints procedure in place and all people who use the service receive a copy. The people who use the service and the relative surveyed commented that they would be able to complain and that complaints and concerns would be addressed. The West Sussex safeguarding adults policies and procedures are in place in the home and staff training is up to date. Staff receive safeguarding adults training in induction. There is also a whistle blowing policy. Staff are aware on how to report concerns or allegations. Staff files had evidence of training and supervision. Physical intervention is not used at the home and the financial affairs of people who use the service are monitored with stringent recording procedures which prevent finanacial abuse. These records were seen on inspection. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 16 Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 17 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, 25, 27, 29, 30 Residents live in a homely, comfortable and safe environment. The home is mostly clean and hygienic. People using this service experience excellent outcomes in this area because they live in a homely, clean, safe and comfortable and well maintained environment This judgement has been made using available evidence including a visit to this service EVIDENCE: This is a new and purpose built home and as such is fresh, clean, homely and comfortable. It is decorated and furnished throughout to a contemporary high standard. It is fully wheelchair accessible. All rooms are ensuite toilet and shower facilities and the necessary adaptations are in place such as ceiling hoists. It is within easy reach of the town and seafront. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 18 There is a passenger lift allowing access to the first floor. The heating is under floor. All bedrooms are personalised as the people who use the service wish and there is evidence of hobbies and interests. Bedding and furnishings are of a high quality. There are ample sockets for televisions and computers. Locks are provided on doors and people who use the service can have a key if they wish. There is a lounge on each floor and a dining room. People who use the service say they have choice in where they sit or take their meals. There is a call bell system in place, modified with a larger push pad for those who can not push a button, there are further electronic assisted communication devices which allow people who use the service with varying abilities more choice and independence such as in choosing channels. There are not any shared bedrooms. Both the main house and the annex have full kitchen and laundry facilities accessible to wheelchairs. The laundry is sited so that soiled material is not carried through any areas where food is stored, prepared or eaten. The laundry floors and walls are impermeable to allow easy cleaning. The machines have the necessary programmes and temperatures to control the risk of infection and there are hand-washing facilities. There are policies and procedures and training in place for the control of infection and the Control of substances Hazardous to Health (COSHH). There are suitable sleeping and shower facilities for staff. The home meets the requirements of the local fire service and environmental health department. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 19 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): 32,34,35,36 People who use the service are supported by competent and qualified staff and are protected by the homes recruitment policy, practices. Staff supervision and training is up to date. People using this service experience good outcomes because they are supported by an effective staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team were motivated and supported the people who use the service in an empathic way. The staff communicated with service users as equals. Staff are well informed about individuals needs and are committed to achieving the best outcomes for people who use the service. There is a mandatory trainiing programme in place and all staff receive induction. National Vocational Qualification level 3 is undertaken and also condition specific training such as that on epilepsy and commmunication. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 20 There is a robust recruitment procedure in place. Staff files inspected contained a Criminal Records Bureau Clearance and POVA check, two eferences, application form with employment history. People who use the service meet candidates at interview and their views are sought as to the suitability of a candidate. All staff receive a job description and full terms and conditions. A probationary period applies and monthly supervision is in place. All staff receive a copy of the General Social Care handbook and are expected to adhere to the principles contained within it. Staff sign to confirm they have understood and undertake to adhere to policies and procedures. Regular staff meetings are held to discuss client need, home management and general practice. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 21 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. People who use the service benefit from a well run home and are confident their views underpin all self-monitoring, review and development by the home. Health safety and welfare are protected and people who use the service benefit from competent and accountable management. People using this service experience good outcomes because the home is run in their best interest. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has many years experience in the care industry. She is completing NVQ 4 and RMA qualifications. She ensures that policies and procedres are implemented and updated with changes in practice and legislation. She demonstarated strong leadership skills during the inspection Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 22 and she supports staff to develop and make the most of their skills and abilities. There is a six monthly quality assurance system which is now due to be completed. Views on the quality of the service are sought from service users, their families and those who have professional contact with the home. This self-monitoring allows the management to identify where procdures can be adapted to meet the changing needs of people who use the service. Health and safety matters are addressed as they arise and regular checks made to ensure the health and safety of all service users and staff. Staff are reminded of the policy which demands they identify health and safety concerns without delay. Staff are trained in COSHH, Health and Safety, Fire, Food Hygiene, Moving and Handling, and First Aid. This is monitored by the manager. The home is maintained and areas which relate to electrical safety, boiler maintenanace, equipment servicing are documented. Risk assesssments relating to equipment and safe home management are in place and updated. Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 23 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 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 4 25 3 26 X 27 4 28 X 29 3 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 3 X 3 X 3 X X 3 3 Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A 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. Refer to Standard Good Practice Recommendations Lulworth DS0000070778.V359579.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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