Care Home: Lyme House

What the care home does well What has improved since the last inspection? The grounds have received further upgrading. In particular the service has complied with standards around disability access so that the grounds and facilities are now accessible by wheelchair users for example. What the care home could do better: There was some discussion around the use of restraint in the home and good practice guidance is followed with staff receiving appropriate training. The reporting process must include the completion of a report to the Commission [Regulation 37 form] in all instances. This was discussed on the last inspection but not all staff are fully aware of the criteria for reporting. There is an outstanding requirement regarding the frequency of testing for the emergency lighting in the service.The information available in the form of the Statement of Purpose and Service User Guide was discussed with the manager. CCTV has been installed in the home some time ago and the ethical considerations have been debated with the Commission over the last year. The home have supplied a rational for the use of this equipment and there is a need now to fully include this rationale in all of the information guide and particularly the service user guide so that any prospective user of the service at Lyme House can be aware and make an informed choice regarding admission. The policy document on safeguarding adults was seen and was not clear with respect to reporting as it contained an out of date referral number. The document was poorly reference with no date or front cover. This was discussed and the manager will liaise with social services safeguarding team to possibly update the procedure. It is also recommended that the home access local training by Social Services, which will compliment existing training by TRU. [Also recommended on the last inspection]. The training record in the front of the policy file is also not complete. Clinically there appears to be a lack of external auditing in terms of quality around brain injury rehabilitation specifically and evidencing ongoing clinical governance and this should be considered with reference to comments in the report and discussions with the manager. The management communication with the regulatory body is not always consistent. For example there was a lack of initial consultation with the Commission over the management changes and also a failure to supply the commission with the Annual Quality Assurance Assessment [AQAA] in the time scale provided so that the inspection schedule had to be rearranged. CARE HOME ADULTS 18-65 Lyme House Grange Road Haydock St Helens Merseyside WA11 0XF Lead Inspector Mike Perry Unannounced Inspection 6th March 2008 10:00 Lyme House DS0000022413.V360241.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 Lyme House DS0000022413.V360241.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. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyme House Address Grange Road Haydock St Helens Merseyside WA11 0XF 01744 609954 01744 609953 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) www.trurehab.com TRU Limited Mrs Elizabeth Ann Kettle Current acting manager Brenda Tunney. Type of registration No. of places registered (if applicable) Care Home 21 Category(ies) of Physical disability (21) registration, with number of places Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 21 PD One named service user sectioned under 117 Mental Health Act 1984 The service should employ a suitably qualified and experienced manager who is registered with the CSCI 26th October 2006 Date of last inspection Brief Description of the Service: Lyme House is registered to provide personal care and support to 21 service users with physical disabilities. Ages can range between 18 and 65 years. The home specialise in rehabilitation for service users who have acquired brain injuries and aim to assist them back to independent living. The home is owned by TRU (Transitional Rehabilitation Unit). The Registered manager is Ann Kettle and the Responsible individual is Mr Bill Kenyon. Service users are encouraged to undertake paid work at the home linked to achieving agreed aims and objectives on individual care plans. The home is part of a comprehensive rehabilitation service involving another Care Home and community services as well as a variety of work based units. The home is located in the rural area of Haydock and is set in its own grounds with gardens. The home receives referrals nationwide due to the specialist area of care given. The current fees for the service range from £2,750 to £4,100 weekly. Lyme House DS0000022413.V360241.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 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and was conducted over a period of 6 hours on one day. Day and recreation areas were seen and one of the bedrooms of residents. Records kept in the home were also viewed. Staff records are held separately at Margaret House, which is the administration sector for the organisation and these were viewed on a previous inspection visit to another home in the group and the evidence used for his report. The inspector spent time with residents and spoke with three in more depth. There were no visiting relatives on the day. The manager and care staff were interviewed along with clinical psychologist working at the service. Prior to the inspection visit the manager completed an Annual Quality Assurance Assessment [AQAA], which gives an overview of the service in the last year and supplies the inspector with information on the service. The inspector also sent out some ‘comment cards’ for residents to complete and return. These are aimed at getting more views of people who use the service and comments are used in the report. A social care professional who has made referrals to the home was spoken with by phone following the site visit. The inspection is a ‘key inspection’ for the home and covered the key standards that the home is expected to achieve. What the service does well: The assessment process prior to admission includes comprehensive assessment by the nuoropsychologist followed by a home visit by the unit Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 6 management team. Assessments seen on care files were very detailed. Additional assessments once admitted include a physiotherapy assessment for all residents as well as the psychological and behavioural assessments made over the initial 16 week period. This ensures that clients care and rehabilitation needs can be met. Care plans are comprehensive and well organised. Many professionals (e.g. speech therapist, occupational therapist, physiotherapist] had had input into formulating a rehabilitation program which was specific to the residents needs. Regular review meetings are held and involve the client and all concerned with the programme. A professional consulted who had referred residents stated that the communication through these meetings was very good and comprehensive reports were available to monitor progress. A client described the monthly reviews of care and felt included in this; ‘Coaches listen to me and I can talk to them’. One client felt that they had achieved much in a short spell of time. This was echoed by the social care professional who had referred the client to Lyme House: ‘They have literally given X a life back. They have turned x’s life around. The improvement has been dramatic. Prior to admission there had to be a 24 hour care package and [the client] was totally dependant. Now X is independent in personal care and is aiming for occupational work in the longer term. There is some confidence this will be achieved’. Other client’s comments were equally as positive and evidenced improved outcomes for people who use the service: ‘Yes, I personally presume that T.R.U has done a remarkable recovery from my R.T.A.’ ‘I heard from a good friend about TRU & thought it sounds good/great. This is now half way through my 7th month here and I do love it, the home, clients & staff’. There are regular, monthly, family days were visiting is encouraged. Staff reinforced the idea that family support and awareness is vital to progress made by residents and so contact is facilitated. This is extended to the training programme – parts of which are accessible to relatives as means of encouraging understanding and support. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 7 The inspector spoke to clients who explained that the daily routine is individually planned through the daily diaries in conjunction with coaching staff. For the purposes of experiencing a ‘normal day’ the diaries are written with respect to routine daily activities of living such as getting up, washing, having breakfast etc with the purpose of reinforcing accepted social norms and behaviours. Some resident’s programmes include the use of local facilities such as the leisure centre and local shops and places to eat. All clients are reviewed medically on a regular basis by the unit’s own psychiatric and nuoropsychologist input. There is evidence of other professional input such as speech therapy. What has improved since the last inspection? What they could do better: There was some discussion around the use of restraint in the home and good practice guidance is followed with staff receiving appropriate training. The reporting process must include the completion of a report to the Commission [Regulation 37 form] in all instances. This was discussed on the last inspection but not all staff are fully aware of the criteria for reporting. There is an outstanding requirement regarding the frequency of testing for the emergency lighting in the service. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 8 The information available in the form of the Statement of Purpose and Service User Guide was discussed with the manager. CCTV has been installed in the home some time ago and the ethical considerations have been debated with the Commission over the last year. The home have supplied a rational for the use of this equipment and there is a need now to fully include this rationale in all of the information guide and particularly the service user guide so that any prospective user of the service at Lyme House can be aware and make an informed choice regarding admission. The policy document on safeguarding adults was seen and was not clear with respect to reporting as it contained an out of date referral number. The document was poorly reference with no date or front cover. This was discussed and the manager will liaise with social services safeguarding team to possibly update the procedure. It is also recommended that the home access local training by Social Services, which will compliment existing training by TRU. [Also recommended on the last inspection]. The training record in the front of the policy file is also not complete. Clinically there appears to be a lack of external auditing in terms of quality around brain injury rehabilitation specifically and evidencing ongoing clinical governance and this should be considered with reference to comments in the report and discussions with the manager. The management communication with the regulatory body is not always consistent. For example there was a lack of initial consultation with the Commission over the management changes and also a failure to supply the commission with the Annual Quality Assurance Assessment [AQAA] in the time scale provided so that the inspection schedule had to be rearranged. 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. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 9 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 Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 10 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): Standards 1 and 2 The quality outcome in this area is good. This is based on the available evidence on the inspection. The information available describing the purpose and activity of the home is generally comprehensive and the admission process assists clients in their choice of whether to accept admission. EVIDENCE: The client interviews and survey feedback revealed that the information supplied by Lyme House is generally quite comprehensive. Care files included a copy of service users rights, which outline rights and responsibilities whilst on the unit and residents signed these and they are also posted up in bedrooms. Terms and conditions of residency are also given to residents. The information available in the form of the Statement of Purpose [SOP] and Service User Guide [SUG] was discussed with the manager. There has been a change of manager at Lyme House since the last inspection due to internal changes. The current manager is now applying for registration to the Commission and will add her details to the information documents. There has also been a lot of discussion regarding the homes use of CCTV. This has been installed in the home some time ago and the ethical considerations have been debated with the Commission over the last year. The home have supplied a rational for the use of this equipment and there is a need now to Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 11 fully include this rationale in all of the information guide and particularly the service user guide so that any prospective user of the service at Lyme House can be aware and make an informed choice regarding admission. Residents were generally satisfied that they had been given enough information about the unit and felt that the admission process had been useful as a way of getting to know the service as it usually includes a site visit to the service. One professional consulted was very impressed with the whole of the admission process including written information available. It was described as ‘thorough’ and this had been the case with all referrals made to the service. The assessment process prior to admission includes comprehensive assessment by the nuoropsychologist followed by a home visit by the unit management team. Assessments seen on care files were very detailed. Additional assessments once admitted include a physiotherapy assessment for all residents as well as the psychological and behavioural assessments made over the initial 16 week period. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 12 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): All key standards Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff agree a structured care programme with residents that also includes setting personal goals and targets so that residents are able to exercise some choice and control over the overall care strategy. EVIDENCE: Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 13 Three care plans were seen. All were comprehensive and well organised. Many professionals (e.g. speech therapist, occupational therapist, physiotherapist] had had input into formulating a rehabilitation program which was specific to the residents needs. A weekly meeting is arranged for residents and their key staff. Plans and progress are discussed as part of this session. The larger multi disciplinary team then reviews the plans and progress on a monthly basis. The professional consulted who had referred residents stated that the communication through these meetings was very good and comprehensive reports were available to monitor progress. One resident discussed his care package, which included specific attendance at arts and craft sessions in the activities unit. Another resident felt he has progressed but would like further progress and more time over at Mgt House where there is more rehabilitation facilities. He described the monthly reviews of care and felt included in this; ‘coaches listen to me and I can talk to them’. One resident felt that they had achieved much in a short spell of time. This was echoed by the social care professional who had referred the client to Lyme House: ‘They have literally given X a life back. They have turned x’s life around. The improvement has been dramatic. Prior to admission there had to be a 24 hour care package and [the client] was totally dependant. Now X is independent in personal care and is aiming for occupational work in the longer term. There is some confidence this will be achieved’. Other client’s comments were equally as positive and evidenced improved outcomes for people who use the service: ‘Yes, I personally presume that T.R.U has done a remarkable recovery from my R.T.A.’ ‘I heard from a good friend about TRU & thought it sounds good/great. This is now half way through my 7th month here and I do love it, the home, clients & staff’. Some of the goals are ‘self determined’ and because of this they are open to choice and the resident exercises some control over the care programme. For example choosing different activities and work placements. The home together with the other sites under the TRU banner operate an internal token economy system aim at rewarding met targets agreed on the care plan. All residents interviewed had a clear concept of this and were able to understand how it worked. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 14 The concept of risk is clearly understood by the care team and comprehensive risk assessments were seen in the care files. The clinical team assesses untoward incidences of aggression and there is always a plan formulated in terms of future management. There was some discussion around the use of restraint in the home and good practice guidance is followed with staff receiving appropriate training. The reporting process must include the completion of a report to the Commission [Reg 37 form] in all instances. This was discussed on the last inspection but not all staff are fully aware of the criteria for reporting. For example one resident discussed who had had some brief restraint had not been reported through. Lyme House DS0000022413.V360241.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): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a planned approach to the organisation of social activities and programmes in the home, which encourages personal development for residents. EVIDENCE: Due to the highly structured nature of the daily routine at Lyme house there is not always the freedom choice to alter this on a daily basis without consultation with staff. This is reflected in some comments from residents who say they ‘can’t do what we want in the day’ but there is a general understanding that this is for therapeutic reasons and seems to be accepted. The range of activity, including vocational work is very good and includes the possible use of all facilities across three sites. Another example of restrictions is the visiting policy. The service does not have an open visiting policy. Residents do not always benefit from unplanned visits due to the wide variety of structured activities which they participate in. Residents reported regular contact with their families however including visits Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 16 home. There are regular, monthly, family days were visiting is encouraged. Staff reinforced the idea that family support and awareness is vital to progress made by residents and so contact is facilitated. This is extended to the training programme – parts of which are accessible to relatives as means of encouraging understanding and support. There was some discussion around the needs of clients in terms of intimate relationships. Although this is not encouraged on site there is a recent example for one client who is supported externally with visits from a partner being facilitated. The unit is registered for both male and female clients and one female was resident on this inspection. Staff reported that any female admissions to the home would have to be care fully assessed and managed on a one to one basis and this was so in this case. The inspector spoke to clients who explained that the daily routine is individually planned through the daily diaries in conjunction with coaching staff. For the purposes of experiencing a ‘normal day’ the diaries are written with respect to routine daily activities of living such as getting up, washing, having breakfast etc with the purpose of reinforcing accepted social norms and behaviours. Some resident’s programmes include the use of local facilities such as the leisure centre and local shops and places to eat. The planned menu on the unit offers one main hot meal and then a choice of a snack type meal or a sandwich if this is preferred. Clients are working in the kitchen on a daily basis requiring different levels of support. Some budget and cook their own meals. 0n this visit most of the clients where off site until after dinner time as they were out on an arranged walk. Lyme House DS0000022413.V360241.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): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care is offered on an individual basis, which encourages independence and helps ensure appropriate standards so that residents are supported. EVIDENCE: Most clients are able to attend to their own personal hygiene needs and the staff role tends to be helping to set agreed goals and prompts in this area. The pre inspection information [AQAA] sent by the manager states: ‘Clients are given support via verbal reminders, checklists and repetition.’ Staff interviewed were clear regarding the principals involved if they were to carry out any personal care and were able to explain these. For example one resident has improved in terms of maintaining their own personal care by means of constant reinforcement and extending responsibility for this area of care so that independence is encouraged with necessary support. The client in question was able to see how progress had been made. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 18 Another resident is on a behavioural programme, which aims to reduce the incidence of some anti social behaviour, and the records [and observation] evidenced that progress was being made here also so that the client’s dignity could be enhanced. The provision of onsite physiotherapy is part of all clients care package following admission and then further if needed. One client has very diverse medical conditions and the management is highly complex including the medication regime. There was evidence of continued monitoring by health professionals including an onsite [TRU] nurse who does routine health monitoring and a staff responsible for liaising with medics regarding medication reviews. There are no clients currently self-medicating. Lyme House is the first stage of a rehabilitation process that includes another unit and community support team so that self-medication is considered at a latter stage in this process. Staff were able to relate instances of self-medication at times on the unit, however, linked to individual need. The medication recording sheets were clear and residents reported that medicines are given on time. Due to the in-house medical support there are frequent medication reviews. There is an on site clinical psychologist who overseas the programmes on a daily basis and is available for staff support and mentoring. All clients are reviewed medically on a regular basis by the unit’s own psychiatric and nuoropsychologist input. There is evidence of other professional input such as speech therapy. Lyme House DS0000022413.V360241.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): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home acts on concerns raised by clients and provides a safe process for investigating more serious complaints and allegations so that clients feel protected. EVIDENCE: The AQAA for the service states: ‘On admission all clients are given a bill of rights, complaints procedure, terms and conditions of residency. Client meetings are held weekly and any concerns can be aired. All staff are trained in POVA, data protection, Equality and diversity’. It is clear that residents are free to raise issues of concern as evidenced by the complaints file, which shows twelve issues of concern since the last inspection. These are dealt with by the management team and the aim is to get the response time to one week. Residents interviewed felt reassured by the coaching system, which gives clear lines of communication and residents felt comfortable that they were able to raise any concerns. Comments included: ‘The mature coaches have excellent time for you to sit down and also calm you down if needed also put a soft ear to anything you say to them’ Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 20 ‘The staff will listen if I have a complaint’. ‘ I can write a complaint form to the manager’. There have been no complaints or concerns raised through the regulatory body [Commission for Social Care Inspection] since the last inspection. Staff interviewed had had some internal training around the Protection of Vulnerable Adults and safeguarding although the training matrix at the front of the policy file only evidenced less than half of the staff trained. There was discussion around the use of local interagency procedures for alerting and referring allegations of abuse and the manager and staff were aware of the need for this and have had experience of working with the safeguarding team. The policy file was seen and was not clear however with respect to reporting as it contained an out of date referral number. The document was poorly reference with no date or front cover. This was discussed and the manager will liaise with social services safeguarding team to possibly update the procedure. It is also recommended that the home access local training by Social Services, which will compliment existing training by TRU. [Also recommended on the last inspection]. The psychologist on the unit was able to discuss a planed training programme based around the new Mental Capacity Act and issues of consent and mental capacity evidencing planned good practice in this area. Lyme House DS0000022413.V360241.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): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment at Lyme House is generally being developed along appropriate guidelines and principals which helps ensure therapeutic, comfortable and safe living conditions for residents. EVIDENCE: The unit continues to develop with reference to good practice with the completion and now regular use of an activities centre onsite. There is also a small woodland area, which includes a pond for fishing. There are grassed areas for football and other activities including gardening. The activities unit was seen and residents interviewed where appreciative if this facility. Since the last inspection their has been attention paid to making the service more accessible for disabled people with mobility needs so that paths have been paved and road / parking areas have been resurfaced so that wheelchair users can now get around more easily. The laundry is now accessible also. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 22 Internally the unit is maintained satisfactorily. Areas were clean. The housekeeper works alongside residents to ensure that basic standards are maintained. One resident said ‘This Unit is 100 clean and fresh, it has its own personal cleaners and we clients just polish and vac each evening’. Disabled access internally is satisfactory, the unit being all on one level. The issue of the CCTV cameras was again discussed with the manager and also with staff and residents. The last inspection report contained a requirement to remove these with the following rational: ‘Given the intensive nature of the therapy at TRU there is always going to be a trade off in terms of the amount of privacy afforded residents at times. The instillation of CCTV cameras does appear an unnecessary invasion however. The rationale of protection of residents in terms of security is not convincing given residents views and also the high staffing ratios on the unit’. Since this time there have been a number of meetings with the managers at TRU to discuss this issue. The managers together with the clinical lead have produced a written rational for the use of CCTV and the manager gave a practical example of its use in a clinical situation on the unit involving two of the residents. The document produced evidences compliance with data protection and includes a ‘privacy impact assessment’. It also includes the following, which addresses some of the concerns around the use of the cameras with this clinical group: [On paranoid thoughts] ‘Whilst this is a concern and some clients will be aware and focus on the cameras initially, research shows that this effect is rather short lived. Within a short time the cameras blend in and are not the point of focus they may be after their initial instillation’. On this inspection there were no comments received from interviews or surveys conducted regarding the presence of CCTV. Lyme House DS0000022413.V360241.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): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment and training of staff ensure that client’s needs are met. EVIDENCE: The staffing on the day of the inspection consisted of 20 care staff of different grades, the manager and senior coaching staff, psychology staff and primary and support coaching staff. This number is reduced in the afternoon and evening. This is for 14 residents at the time. The staff ratio is very high and is important to carry out the coaching role that plays a vital part of the care system at TRU. Staff interviewed were very knowledgeable about the residents in their care and displayed a high level of competence in discussing the care programmes. They are supported by daily on site psychology staff. Residents expressed a high level of satisfaction when talking about the ability of the staff. It was observed that staff were continually interacting with residents and supporting and providing feedback through out the day. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 24 The training programme in the home is very well structured, particularly around the clinical background of acquired brain injury and the behavioural techniques used by staff to work with residents. All staff undergo the same training programme, which is ongoing, and covers staff needs at different levels of clinical competence from induction to primary coaching and advanced training. The induction-training programme includes a prolonged ‘shadowing’ component which staff reported as being particularly useful. Comments received from staff about their role include: ‘My experience has prepared me for the tasks I am involved in. in my role at T.R.U’. ‘Ongoing training is given. Also training specific to clients needs’ There are plans to introduce a number of components to the staff training including awareness of the Mental Capacity Act. Staff interviewed were unaware of the Code Of Conduct issued by the General Social Care Council [GSCC]. This also needs to be addressed. All care staff will be registered with this body and the Code is an integral part of establishing good practice principals for all social care staff. The manager should obtain and provide a copy for all coaching staff and include awareness on induction training. Staff were questioned about the recruitment process and all were satisfied that the company had been very careful to collect references and also check for any criminal records. The staff records are maintained at Mgt House, which is the administration sector of the organisation. This has been visited within the last 6 months with respect to another service at TRU and the staff records seen were comprehensive and met standards. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The current management systems ensure that Lyme House continues to develop with the best interests of people using the service but there can be more developments in terms of external quality audits so that there is evidence of ongoing clinical governance. EVIDENCE: The Registered Manager of Lyme House has moved to another part of the organisation and a new manager, Brenda Tunney, who has previous registered managers experience working on the community side of the organisation, has now been in the acting manager role at Lyme House of a number of months. Brenda explained the change has come about from a developmental initiative with respect opt each of the managers in the organisation. There remains a need for Brenda to register as the manager of Lyme House and this process has been started. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 26 As with all staff that work for TRU she has come through the organisation experiencing all staff roles and training in order to become a manager. The service is able to demonstrate ongoing review of the quality of the care through monthly review meetings. These form part of not only clinical update but also act as a quality assurance tool in terms of ensuring that the service is able to demonstrate development for each resident set against measurable targets and goals. The review process is attended by the resident and all concerned with the care and support. Both verbal and written feedback is given to all parties including family and funders of the care. Case conferences are also held 3 monthly and referring health professionals, social workers and family can all attend. The professional interviewed, as part of the inspection, commented that the reporting system was very professional and helpful. In terms of staff and systems audits the home has Investors in People status. Staff have regular supervision sessions. Clinically there appears to be a lack of external auditing in terms of quality around brain injury rehabilitation specifically and evidencing ongoing clinical governance. There was some discussion with the manager regarding the possible use of the CARF [Commission for the Accreditation of Rehabilitation Facilities] award. Yearly objectives are identified in the development of the unit and an annual report is produced outlining achievements and targets for the forthcoming year. [This seen on past visits but not asked for on this visit]. The fire logbook was seen. Requirements were made on the last inspection for routine checks on testing of emergency lighting [monthly]. These routines are listed on the ‘fire schedules’ listed at the front of the fire logbook. The records were still incomplete. The management response to inspection reports is normally positive and the organisation as a whole have been anxious to have meetings and correspondence with the Commission over a number of issues [eg CCTV] since the last inspection. This interface is not always consistent however. For example there was a lack of initial consultation with the Commission over the management changes and also a failure to supply the commission with the Annual Quality Assurance Assessment [AQAA] in the time scale provided so that the inspection schedule had to be rearranged. The production of this document is an annual requirement. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 27 Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 28 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 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 2 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 2 X 3 X X 2 X Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 29 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 YA9 Regulation 37 Requirement Any incident involving the use of restraint must be reported to CSCI using the regulation 37notification process. Last requirement date 01/11/06 not met. 2 3 YA37 YA42 9 23 An application for registration of the current manager must be made. Fire records must be updated to include testing of emergency lighting [monthly] as indicated on the ‘fire schedules’ in the fire logbook. [Last requirement date 1.5.06 not met]. 01/06/08 01/05/08 Timescale for action 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Lyme House Refer to Good Practice Recommendations DS0000022413.V360241.R01.S.doc Version 5.2 Page 30 1 2. 3. Standard YA1 YA23 YA39 The homes Statement of Purpose and Service user guide needs to be updated as discussed with particular reference to the use of CCTV in the home. Social Services adult protection team should be contacted regarding updating policies and providing any training. The managers should give due consideration to the importance of future returns of the AQAA document within the stipulated time scales. There should be consideration of an external quality audit such as the CARF accreditation which would benefit the organisation in terms of external clinical audit and governance with respect to brain injury rehabilitation. Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lyme House DS0000022413.V360241.R01.S.doc Version 5.2 Page 32 - 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. 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