Care Home: The David Lewis College Residential Service

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What the care home does well The process of helping people decide if the college is suitable for them is thorough so they will know their needs can be met there. New students are given detailed information about the college and the home, and they are able to visit before moving in so they know what to expect when they take up their places at the home. Students are encouraged to make choices about what they do each day and they are helped to develop skills such as social, communication and independent living skills so they can live as independently as possible. Students are helped to organise their own meetings to talk about things that are important to them at the home so they can have a say in how it is run. Almost all students told us they where happy with the range of activities on offer so they can keep up their social life and activities in the community. There are thorough recruitment procedures used at the David Lewis Centre to make sure that staff are suitable to work with the students living in the home. There is a good staff training programme to make sure that students are supported by a competent and qualified staff team. What has improved since the last inspection? Person centred care planning continues to be developed to make sure that staff know what to do to meet people`s needs and goals in the way they would prefer. Support workers were aware of equality and diversity issues and were able to discuss this in relation to developments in person centred planning. Arrangements for the recording, safekeeping and administration of medication have improved to make sure that students` medicines are continue to be kept safely and securely in a way that is consistent with the regulations. There is a comprehensive staff training and development programme and sixty eight % of the support staff team have now achieved an NVQ in care at level 2 or above or are working towards the qualification so there is a competent, qualified staff group. Complaints processes have improved and a revised adult protection policy and procedure has been introduced across the David Lewis Centre. This ensures there is a co-ordinated approach to the protection and safeguarding of vulnerable adults. Opportunities for recreation and social activities on and off the David Lewis Centre campus have been improved so students can chose from a range of suitable options or are helped to arrange their own leisure time and do what they want to do. Improvements and refurbishments have been made to the houses in the College Core Unit so students live in comfortable surroundings that suit their needs. Fire risk assessments have been reviewed and revised so students, visitors and staff will be safe in the event of a fire. What the care home could do better: Where appropriate, assessments and person centred plans should be developed to address the needs of students from ethnic minority backgrounds in enough detail to show how the persons` needs are to be met. This will help to ensure that staff have the skills and knowledge they need to support young people from a different ethnic or cultural background to them.Where an assessment of a student`s capacity to make their own decisions is necessary, the reason for this should be recorded in the person centred plan along with details of what decisions are to be made and who will be consulted about them. This will make sure that students` rights to make decisions are observed, protected and promoted. Individualised procedures for managing behaviour that is likely to cause harm to the student or others must be established and agreed with the student and their representatives. This will make sure that staff have guidance they need to respond to difficult or harmful behaviour in a safe and appropriate way so the rights of the student are respected and their well being is assured. Risk assessments must be developed in consultation with students and their representatives so they receive care and support in a way they prefer and understand why measures to protect them from harm are put in place. The range of healthy eating options should be improved to meet students` tastes and personal preferences so they are encouraged to eat healthily. Communication in the home between managers and staff needs to improve so staff receive the information, support and guidance they require to meet the needs of students in a safe and appropriate way. CARE HOME ADULTS 18-65 David Lewis Centre College Core Unit Mill Lane Warford Alderley Edge Cheshire SK9 7UD Lead Inspector David Jones Unannounced Inspection 27, 28 November & 3, 4 & 5 December 2007 12:30 David Lewis Centre College Core Unit DS0000006653.V350806.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 David Lewis Centre College Core Unit DS0000006653.V350806.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. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service David Lewis Centre College Core Unit Address Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640000 01565 640100 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) David Lewis Centre Deborah Gittins Care Home 29 Category(ies) of Learning disability (29), Physical disability (29) registration, with number of places David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The service is registered for a maximum of 29 service users in the categories of LD (learning disabilities and PD (physical disabilities) aged between 16 & 25 years only. The 29 service users can be accommodated as follows: * A maximum of 19 in Elizabeth Maybin House. * A maximum of 6 in 9/10 Mill Lane * A maximum of 4 in 7/8 Mill Lane 5th February 2007 2 Date of last inspection Brief Description of the Service: The David Lewis Centre is a specialist service for children and adults who have epilepsy and associated conditions. It is in rural Cheshire in 170 acres of open grounds. The David Lewis Centre College Core Unit consists of 3 houses: 7/8 Mill Lane (4 places), 9/10 Mill Lane (6 places), and Elizabeth Maybin (19 places). Some of the students who attend the college have complex medical needs and also learning difficulties, and some require high levels of support and personal care. The David Lewis College provides a 24-hour curriculum, which includes learning opportunities in the college, in the residential units, in the community and, where appropriate, on work experience placements. Individual programmes of residential support are available and there is a range of specialist clinical services on site. Information about The David Lewis Centre College Core Unit including fees and charges and copies of the most recent inspection report can be acquired by contacting the centres administrative staff or the registered manager on 01565 640000. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced key inspection visit of the David Lewis Centre College Core Unit took place on 27 and 28 November and 3, 4 and 5 December 2007. The visit was carried out by David Jones, Inspector, and an “expert by experience” took part in the inspection*. The visit was just one part of the inspection. Before the visit, the manager of the service was asked to complete a questionnaire to provide detailed information about the home and how it is meeting the needs of the students who live there. CSCI questionnaires were also made available for the students, their families and health and social care professionals, such as nurses and social workers, and their views have been taken into account. Other information received since the last key inspection was also reviewed. During the visit, various records were looked at and a tour of the home was carried out. The “expert by experience” visited the houses that make up this service and spoke with the students about the quality of accommodation, available activities and services provided and their views have been taken into account. * An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. What the service does well: The process of helping people decide if the college is suitable for them is thorough so they will know their needs can be met there. New students are given detailed information about the college and the home, and they are able to visit before moving in so they know what to expect when they take up their places at the home. Students are encouraged to make choices about what they do each day and they are helped to develop skills such as social, communication and independent living skills so they can live as independently as possible. Students are helped to organise their own meetings to talk about things that are important to them at the home so they can have a say in how it is run. Almost all students told us they where happy with the range of activities on offer so they can keep up their social life and activities in the community. There are thorough recruitment procedures used at the David Lewis Centre to make sure that staff are suitable to work with the students living in the home. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 6 There is a good staff training programme to make sure that students are supported by a competent and qualified staff team. What has improved since the last inspection? What they could do better: Where appropriate, assessments and person centred plans should be developed to address the needs of students from ethnic minority backgrounds in enough detail to show how the persons’ needs are to be met. This will help to ensure that staff have the skills and knowledge they need to support young people from a different ethnic or cultural background to them. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 7 Where an assessment of a student’s capacity to make their own decisions is necessary, the reason for this should be recorded in the person centred plan along with details of what decisions are to be made and who will be consulted about them. This will make sure that students’ rights to make decisions are observed, protected and promoted. Individualised procedures for managing behaviour that is likely to cause harm to the student or others must be established and agreed with the student and their representatives. This will make sure that staff have guidance they need to respond to difficult or harmful behaviour in a safe and appropriate way so the rights of the student are respected and their well being is assured. Risk assessments must be developed in consultation with students and their representatives so they receive care and support in a way they prefer and understand why measures to protect them from harm are put in place. The range of healthy eating options should be improved to meet students’ tastes and personal preferences so they are encouraged to eat healthily. Communication in the home between managers and staff needs to improve so staff receive the information, support and guidance they require to meet the needs of students in a safe and appropriate way. 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. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective students’ personal needs and aspirations are assessed so they and their representatives know how their needs will be met at the college. They visit the college and are given information about the accommodation, facilities and services provided so they can make an informed choice about moving in. EVIDENCE: There is a range of information available to help prospective students decide whether to take up a place at the college including a service users guide, college prospectus and student handbooks. Students who completed CSCI’s questionnaires told us that they received enough information to help them with their decision making before they moved in. The service users guide and college handbooks are illustrated with photographs, diagrams and symbols to make them easier to understand and there is a website which also provides relevant information about the college including accommodation, care, facilities and services provided. This means that all potential students have access to relevant information about the college and the facilities and services provided. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 10 Two care files were checked during the visit and both showed that the student had had a multidisciplinary assessment before they moved in. There is an established assessment and moving in process for the college that is designed to involve the prospective student and place them at the centre of decisionmaking. When potential students are referred to the David Lewis Centre College Core Unit, a pre-assessment questionnaire is completed along with a home visit. Needs assessment documentation is obtained from placing authorities and this forms the basis for a three-day multidisciplinary assessment, which is carried out at the college by qualified and experienced staff. Assessments were detailed and covered the individual needs and personal preferences of each student. However, the assessment for one student, who was from an ethnic background, did not deal with their cultural needs in sufficient detail. Staff involved in the assessment had done some research about the student’s background but had not found all the information they needed to make sure they could meet the student’s needs appropriately. The house manager and unit manager agreed that further work needed to be done to assess this student’s diverse needs. They agreed to do some further work on the student’s assessment with the student, their relatives and health and social care professionals. This will be dealt with at the student’s forthcoming review staff will have all the guidance they need to meet the diverse needs of the student in a person centred way. Prospective students visit the college during the three-day assessment so they are able to make an informed choice as to whether it is suitable for them. In addition new student and parent induction days are arranged to allow students and their families to visit the college to meet staff and care professionals before they move in. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Students’ rights to take control over their lives and to make their own decisions are recognized by staff but students are not always involved in actively planning their own care so may not have the chance to say how they would prefer their needs to be met. EVIDENCE: Observation, discussion with staff and the daily records confirmed that care staff help students to lead purposeful, fulfilling lives and independence is promoted. Student meetings are held regularly; students get together once a week, or whenever they wish, to discuss things they feel are important to them. Staff will help them at the meetings if they wish but it is the students who are in charge of the meeting. They take the notes and come to agreement on decisions that they want to be made. By having these meetings students feel that staff listen to them and support them to do the things they want to do. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 12 Person centred care planning processes are used at the college so students and family members/others are involved in planning their own care and support. However these processes needed further development so students receive the care and support they need in the way they prefer. The development of person centred plans is based on an assessment tool known as the “Listen to me” document. This is a very important part of the assessment process, designed to help students to express their needs, personal preferences and life goals. In some instances this document had been used to good effect as students’ needs were clearly recorded. However, it was noted that the form used had been photocopied from one previously partly completed on a staff training exercise and it still contained the information about the member of staff’s aspirations. These had been crossed out on some assessments but on two care files, these goals had been ticked as if they were relevant to the aspirations of the student. One student told us that these goals were nothing to do with him but he had said yes when staff asked him about them because it sounded like a good idea at the time. This indicates that staff may not fully understand the process of person centred planning and may benefit from further guidance to make sure that the ‘Listen to me’ assessments include only the students’ goals and preferences. Students who were spoken with told us they were happy with their person centred plans and that their needs were known and met in the main. However one student was concerned that some staff had placed unreasonable restrictions on him. He told us he sometimes wanted to go out for a walk but there were restrictions on him doing this and he did not understand why. He had seen a risk assessment but did not agree with it or why the restrictions were necessary. Further work needs to be done to make sure that the established procedures are followed and the rights of the student to be involved in the development of their own care plans are recognised. Further information provided confirmed that there had been three occasions when staff had responded inappropriately to this student’s behaviour including two instances of physical intervention and one where staff had tried to lock the house doors to stop him leaving the building. The unit manager told us that whilst the staff were acting in the interests of the students’ safety, it was apparent that they had not considered his rights to self-determination in full. The manager was aware that no student should be subject to physical restraint unless it is the only practical means of ensuring the welfare of the student and there are exceptional circumstances to justify it. The circumstances relating to this student’s needs were complex so a behaviour management plan had been drafted to make sure that staff had the guidance they needed to respond to their behaviour appropriately, but this was not available on the individual’s common care file. The person centred plan indicated that the behavioural guidelines must be read and understood by everyone working with the student but, as these were not available on their David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 13 file, staff did not have the guidance they needed. This oversight was brought to the attention of a senior staff member at the beginning of the inspection visit but the required guidelines were still not available on the student’s common care file six days later and the house manager had not been made aware that that this important guidance was missing. This lack of guidance and poor communication between managers and staff could mean that the student’s needs for support may not be met in an appropriate or safe way. Where students’ behaviour may put them or others at risk of harm individualised procedures for the management of the behaviour must be established and agreed with the student and their representatives. This will ensure that staff have the guidance they need to respond to the behaviour in a safe and appropriate way so students’ rights are respected and their well being is assured. The manager told us there was some concern that one of the students may not have capacity to make decisions immediately before or after having an epileptic seizure. This was not recorded in their person centred plan but was under investigation. The student’s person centred plan needs to reflect their capacity and their ability to make decisions. Where an assessment of an individual’s capacity is deemed appropriate, the reason for this must be recorded in their plan along with information on how a decision has been reached including who has been consulted on the matter and when. This is a requirement of the Mental Capacity Act, which came into force in April 2007. This will make sure that students rights to make decisions are observed, protected and promoted. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff work with students so they are able to make choices about their lifestyle, and are supported to develop their life skills. EVIDENCE: Lifestyle for all students revolves around the 24-hour curriculum, which includes attending college, and continued learning at home. Students are encouraged to practice and apply their existing and new skills each day. Support staff help them to recognise their responsibilities by involving them in all ordinary domestic routines in the home including keeping rooms tidy, doing their laundry, preparing meals and washing up. Students have drawn up a rota for washing-up, putting away and keeping the dining and living room tidy, which works well. Each student also has a programme for social and leisure activities including using community based facilities and various social/ recreational activities on the DLC campus. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 15 Tutorial review meetings take place periodically or at least once each term. They involve the student and all interested parties from the college and the home so students receive the help and support they need to achieve their goals. Students have the use of a range of educational facilities both on and off site such as literacy, numeracy, communication, horticulture, creative arts, personal and social development, information technology, personal health and social education, and citizenship. In addition, various clubs have been set up on site to increase the range of leisure and recreational activities on offer throughout the week. These clubs run from 16.30-20.30 every evening and include opportunities to do golf, football, swimming, computers, music and reading. Most students spoken with told us they are satisfied with the range of activities on offer but the activities are not to everyone taste. However, students are also encouraged to arrange their own social activities and are supported to go out and use facilities in the community. The timetable for one student showed that arrangements were being made for him to go to the pub once a week. He said this had not happened yet but he was looking forward to it. Most weekends students will decide if they would like to do their shopping in Macclesfield, Wilmslow or Knutsford and will also decide on a group activity such as going to the cinema or other place of interest. Support staff were able to show how they help students to look at their options for leisure activities and make choices. Students were aware of their rights to make choices and were able to choose from a range of options. Common care files show that students are helped to maintain personal relationships and keep in contact with their families at home. Students who live on Elizabeth Maybin receive a weekly menu, which includes a range of options that they must choose two days in advance. Healthy eating is promoted. If people are not happy with the meals on offer, they can choose their own and support staff will help them to cook it. In the smaller houses, food is prepared daily and students can choose what they want to cook and eat from the fridge. Fresh fruit is always available and staff try to encourage healthy eating but records of meals show that a high proportion of processed foods are used and chips are chosen with almost every meal. Students say they like chips and processed foods so this shows that their right to choose what they eat is respected. However, parents of one student raised concerns about that the amount of processed food consumed and how this might be having an adverse affect of the health of their son or daughter. Managers and staff should explore how the range of healthy eating options can be improved to meet students’ tastes and personal preferences so they are encouraged to eat healthily. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care that students receive is based on their individual needs so their needs are met in the way they prefer and the principles of respect, dignity and privacy are put into practice. EVIDENCE: The personal care needs of each student are confirmed in their person centred plans so staff know how much support each person needs to carry out ordinary personal routines in a way that will maintain their independence and promote privacy and dignity. One relative told us the home “provides care and emotional warmth supporting their son or daughter with lots of positive guidance and praise”. Each student’s specialist health needs, including epilepsy and dietary requirements, are clearly recorded in their common care files and health action plans. These give a comprehensive overview of each individual’s health needs and are valuable for health monitoring, as they will alert support workers to significant health changes. Consistency and continuity of care for each person is ensured through using designated key workers and working in partnership David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 17 with the person and their representatives, including relatives and health and social care professionals. Each student’s health is monitored and potential problems are identified and referred to appropriate health and social care professionals. Students are registered with the local GP surgery and some health care needs are met by the on site multidisciplinary team that includes social work staff, nursing staff and clinical specialists in epilepsy, psychology, speech and language therapy, physiotherapy, art therapy and occupational therapy. Medication management policies and practices have been reviewed and revised. Appropriate arrangements were in place for safekeeping, recording and administration of medicines in the home. All staff involved in the administration of medication receive regular training and their competency is assessed from time to time to make sure that medicines continue to be given safely. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students are protected from abuse and have access to an effective complaints procedure so they are able to express their concerns and have them acted upon. EVIDENCE: The Student Handbooks include a copy of the complaints procedure. These are illustrated to make them easier to understand and can also be made available in a range formats to suit individual communication needs. All students who completed the CSCI survey told us that they know what to do if they are unhappy about something and know how to make a complaint. Complaints records show that DLC College Core Unit had received eight complaints since the last inspection. All had been investigated, acted upon and responded to within 28 days with the exception of one. The manager told us the late response was because she had been off work and was unable to respond with the 28 day timescale. The college has thorough procedures for safeguarding vulnerable people from abuse. Staff have access to these written procedures and have received training so they know what to do in the event of any evidence or suspicion of abuse. Records show that four adult safeguarding referrals had been made to the social services department since the last inspection. In each case the issues raised where investigated and appropriate action taken to ensure the protection and well being of students. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The houses are well maintained so that students live in safe, comfortable surroundings that suit their needs and enable them to be as independent as possible. EVIDENCE: All the houses in College Core Unit were visited during the inspection visit; all were found to be well maintained, clean and fresh throughout. All students have single bedrooms with access to bathroom and communal facilities suitable to their individual needs and personal requirements. In Elizabeth Maybin, all bedrooms have en-suite showers and there are two additional shared bathrooms. Students are able to personalise their own rooms. A range of comfortable communal space is provided and there is ample outdoor space on site for a range of activities. Each house has a garden. The lounge at Elizabeth Maybin has been redecorated and the kitchen has been completely refurbished and extended so students can cook for themselves if David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 20 they wish. Other improvements have been made to the exterior of the house at 7/8 and 9/10 Mill Lane with the provision of a landscaped and lit pathway. The expert by experience and her supporter visited Elizabeth Maybin to speak with the students who lived there. All students said they were happy with the home. It was found to be warm, well equipped and had a nice atmosphere. The house manager has been given a project to look at how the home could be improved to meet the changing needs of students. He intends to consult students and all stakeholders before coming to any conclusions on how best the home might be improved but consideration is being given to divide the premises into two smaller 8 bed units. The office areas in 7/8 and 9/10 Mill Lane have been rearranged and tidied to make them look less office like and more homely and the office in 9/10 that is currently used by the college nurse has been re-designated as an office for staff. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students are supported by competent and qualified staff and are protected by thorough staff recruitment procedures. . There is a competent, qualified staff team so students receive the support they need and staff recruitment procedures are thorough so that students are protected from possible harm or poor practice. EVIDENCE: The staff are committed to meeting the personal care and support needs of students and helping them to develop their skills in a way that they prefer. Staff receive regular supervision and have good relationships with students and their relatives. Students told us that they like the staff. One student said that the staff make him laugh and happy and another said he gets on with all the staff. The recruitment procedures are thorough to make sure that staff are suitable to work with the students. Two staff recruitment files chosen at random were David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 22 checked and showed that the David Lewis Centre operates thorough recruitment procedures. These meet the regulations and incorporate equal opportunities and anti discriminatory practice. Staff are employed in accordance with the code of conduct set by the General Social Care Council and are given a copy of the code. All required recruitment checks are obtained before staff start work with the students. Relatives of students who completed the CSCI survey told us that staff usually have the right skills and experience to look after students properly but concerns were raised as to whether all staff have the skills and knowledge required to support young people from a different ethnic background. Staff have access to the David Lewis Centres policies on equality and diversity and they know that it is important to develop an understanding of all students’ differing needs and personal requirements. Some staff have received training on equality and diversity through the skills for care induction and NVQ training programmes and the unit manager advised that further training will be provided for staff in the future. Support workers and managers benefit from a comprehensive staff training and development programme. The induction course for new staff incorporates ‘Skills for Care’ criteria and training standards. We were told that 70 of the support staff team have an NVQ in care at level 2 or above or are working toward the qualification. Training is delivered at the DLC’s training centre and covers mandatory and other specialist training. All staff members have individual training and development files so house managers are able to monitor and keep track of their training. Staff training records held by house managers confirm staff have received training on fire safety procedures, first aid, resuscitation, challenging behaviour, person centred planning, moving and handling, food hygiene, child and adult safeguarding procedures, administration of medication and a number of other specialist topics including rescue medication. There was a relatively high number of vacancies within the college core unit staff team. Managers seek to provide continuity of care by using agency staff alongside existing and experienced staff and ensuring that all agency staff are familiar with the home’s policies, procedures and ways of working. A number of agency staff have been block booked so, over time, they have been able to develop a good working knowledge of the policies, procedures and ways of working of the home as well as an understanding of students’ needs. This will help them provide a better-informed standard of care and support. However one agency worker told us that they did not fee valued or a part of the team even though they had worked at the home continuously for a long period of time. Managers should ensure that block booked agency staff receive appropriate levels of support including one to one supervision and invitation to staff meetings where appropriate. This will help managers and staff to achieve continuity of care for students, which is important to most of them. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in the best interests of students, although managers must ensure good communication so staff receive the information, support and guidance they require to meet the needs of students in a safe and appropriate way. EVIDENCE: The unit manager is suitably qualified with considerable experience in the field of social care for people with epilepsy and or learning disabilities. She has a range of qualifications including the Registered Managers award in management and care at NVQ level 4 and a BTech National Diploma in Social Care. She has maintained and increased her knowledge through attending additional training courses provided by the David Lewis Centre. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 24 Each house in College Core Unit has a designated staff team of support workers headed by a house manager. House managers report directly to the unit manager who maintains responsibility for and an overview of the delivery of care in each unit. The manager takes steps to ensure that staff follow the policies and procedures of the home so care and support is provided in a way that is consistent with best practice and students’ rights. However, at the inspection visit, communication problems between managers and staff were found. For example, a serious omission in support/care planning relating to the management of one student’s behaviour was brought to the attention of a senior member of staff on the 28th November. It transpired that an important behaviour management plan had been removed from the student’s common care file for review and revision some weeks before. Past experience had shown that staff needed the guidance in the behaviour management plan to enable them to respond to the behaviour presented by the student in a safe and appropriate way. It was not clear why senior staff had not retained a copy of the behaviour management plan so support staff would have the information they needed and this problem could easily be resolved. However, six days later, it was clear that the house manager had not been made aware of the problem and the behaviour support plan was still missing from the student’s file. Managers must ensure good communication in the home so staff receive the information, support and guidance they require to meet the needs of students in a safe and appropriate way. The views of students and their representatives including parents and other stakeholders are obtained by a ‘satisfaction’ questionnaire and suggestions for development are welcomed. Managers and staff are able to show how they have responded to complaints and concerns by improving quality of the service provided and, where appropriate making services more responsive to the individual’s precise needs and requirements. Person centred planning, when carried out effectively, puts the student and their representatives at the centre of decision-making. Regular student meetings take place in the houses to give students the opportunity to take part in the day to day running of the houses and enable them to choose and plan social activities. Students and their representatives are invited to attend an annual review, which focuses on the quality of service delivered. Where possible students are asked to contribute to the written reports that form the basis of the review to help them express their views and wishes. All students have three way tutorials, involving the student, tutor and key worker. These tutorials review how the college is supporting students to make progress and assistance is provided to help them set goals and personal objectives. Fire risk assessments were reviewed and revised for all houses on College Core Unit in November 2007 and we were told that all routine maintenance of David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 25 electrical circuits, lifts, hoists, fire detection equipment, heating system and gas appliances are up to date to ensure the health and safety of all employees, visitors and students. David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 26 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 4 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 15 (2) (a) (b) (c) (d). Timescale for action Individualised procedures for the 20/01/08 management of behaviour that is likely to cause harm to the student or others must be established and agreed with the student and their representatives. This will make sure that staff have guidance they need to respond to the behaviour in a safe and appropriate way so the rights of the student are respected and their well being is assured. Risk assessments must be 20/01/08 developed in consultation with students and their representatives so they know and understand why measures to protect them from harm including any agreed limitations on their freedom of movement or power to make decisions are put in place. Requirement 2. YA9 14 (1) (a) (b) and (c). David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 28 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 YA2 Good Practice Recommendations Assessments and person centred plans should include full information about students’ ethnic and cultural backgrounds to show how individual student’s needs will be met. This will ensure that staff have the knowledge to be able to meet the needs of students from different ethnic backgrounds. Where an assessment of an individual’s capacity to make decisions is considered to be necessary, the reason for this should be recorded in their person centred plan along with information about how the decision has been reached including who has been consulted on the matter, why and when. This will make sure that students rights to make decisions are observed, protected and promoted. The range of healthy eating options available on menus should be looked at to see how they could be improved to meet students’ tastes and personal preferences so they are encouraged to eat healthily. Agency staff who are used regularly through block bookings should receive appropriate levels of support including one to one supervision and invitation to staff meetings where appropriate. This will help managers and staff to achieve and improve continuity of care for students. Communication between managers and staff should be effective to make sure that staff have the information, guidance and support they need to provide appropriate and safe care for students. 2 YA7 3 YA17 4 YA36 5 YA37 David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 David Lewis Centre College Core Unit DS0000006653.V350806.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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