Care Home: Warrington Community Living - Lucklaw

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What the care home does well Lucklaw is well managed by a qualified and experienced manager who is committed to improving the home so it is managed in the best interest of the people who live there. Managers and staff are good at involving people and their relatives and other representatives in developing person centred care plans. This means that people get the care and support they need in the way they want and prefer. The people who live at the home enjoy good relationships with the staff. They were not able to tell us directly because of communication difficulties but we could see that they were at ease with the staff and were able to make their needs known through body language and gestures. Person centred care plans provided guidance about each person`s preferences so staff could help people make choices about their daily lives. Relatives told us that the care, facilities and services provided by the home were good. One comment was "the home is fantastic, the staff are very approachable, professional and caring - we can only describe the home as excellent". The home has a complaints procedure and thorough adult safeguarding procedures so the people who live there are able to express their concerns, are listened to and safeguarded from abuse and neglect. Staff are trained and have gone through thorough recruitment processes so they are suitable to work with the people who live at the home. Most of the staff had or were working toward a national vocational qualification (NVQ) in care at level 2 or above. NVQs are nationally recognised qualifications for staff in the care profession. This showed us that the people who live at the home are in safe hands because the staff providing their care are qualified and competent. What has improved since the last inspection? We could see that the manager and staff had done a lot of work since our last inspection to improve arrangements for care of the people who lived at the home. Managers and staff have worked in partnership with the people who live at the home and their representatives, including health and social care professionals, to make sure that their needs were met. Essential lifestyle planning meetings had been held and person centred plans had been developed for all the people who live at the home. In this way each person`s diverse needs were recognised and recorded so care staff have the guidance they need to provide care in the way the individual wants and prefers. The range of activities on offer had been improved and staff were actively helping people to look at new opportunities to take part in appropriate activities in the local community. Records showed that the people who lived at the home were getting out more and were offered more activities in the home. The manager had introduced a new system for reviewing the quality of care provided at the home. Surveys had been sent out to relatives. Other survey questionnaires were being prepared for staff and health and social care professionals so their views can be taken into account. The manager intends to produce an annual development plan for the home and will produce a report on quality issues so the people who live at the home and their representatives will know that their views have been taken seriously and acted upon. This shows us that the home is being run in the best interests of the people who live there. What the care home could do better: The statement of purpose and service user`s guide should be made available in a range of easy read formats so people with a learning disability are helped to understand it. The people who live at the home should be provided with a document that confirms terms and conditions so they and their representatives know their rights and responsibilities in relation to the services they receive. Risk assessments must be carried out so all potential hazards are identified and, where necessary, risk management plans must be put in place so people who live at the home are safe and protected from accidents and injury. Plans to improve and provide appropriate bathroom facilities need to be put into practice so all people who live at the home have the facilities they need. All new staff should receive induction training within their first six weeks of working at the home so they have appropriate skills and knowledge to meet the needs of people who live there. CARE HOME ADULTS 18-65 Warrington Community Living - Lucklaw Lucklaw Burtonwood Road Great Sankey Warrington Cheshire WA3 3AN Lead Inspector David Jones Unannounced Inspection 18, 19 and 25 March 2009 3:30 Warrington Community Living - Lucklaw DS0000027018.V374454.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 Warrington Community Living - Lucklaw DS0000027018.V374454.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. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warrington Community Living - Lucklaw Address 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) Lucklaw Burtonwood Road Great Sankey Warrington Cheshire WA3 3AN 01925 230474 Warrington Community Living Manager post vacant Care Home 4 Category(ies) of Physical disability (4) registration, with number of places Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered for a maximum of 4 service users accommodated in the category physical disability (PD) 19 September 2008 Date of last inspection Brief Description of the Service: Lucklaw is a care home registered to provide personal care and accommodation for four adults with physical disabilities. It is a domestic four-bedroom bungalow in a residential area of Warrington and blends in with neighbouring properties. The premises have been adapted to accommodate the needs of people with a disability. There is level access throughout the bungalow with low gradient ramps to the front door and gardens. People who live at the home have their own specially adapted transport enabling them to go out for day trips and to the local community. Information about Lucklaw including copies of the most recent inspection report is made available to each resident and their representatives and can be acquired by contacting Warrington Community Living on 01925 246870. Fees range according to the needs of the individual. Contact Warrington Community Living on 01925 246870 for further information. There are no additional charges other than agreed transport costs shared between the four people who live at the home. Warrington Community Living - Lucklaw DS0000027018.V374454.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 This key inspection was unannounced. The visit to the home took place over three days and took 12 hours in total. It started at 3:30 pm on the first day. In this report we say “we” when referring to our activities and findings, as it is written on behalf of the Commission. This visit was just one part of the inspection. Before the visit took place we asked the manager to complete a document called Annual Quality Assurance Assessment or AQAA for short. We ask all services to complete this document once a year. It gives us information about how the home is meeting the needs of the people who use the service and includes future plans for further development. We made our questionnaires available for the people who use the service and the staff; their views about the home have been taken into account in this report. We also looked at the information that we already had about the service and this, with the information from the AQAA, helped us to form our inspection plan. We looked at the care records of two of the people who live at the home to see the care they receive. Some people were spoken with and their views taken into account. We looked at the recruitment records for a new staff member and some of the home’s policies and procedures were also checked to see if these were up to date and provided staff with appropriate guidance. What the service does well: Lucklaw is well managed by a qualified and experienced manager who is committed to improving the home so it is managed in the best interest of the people who live there. Managers and staff are good at involving people and their relatives and other representatives in developing person centred care plans. This means that people get the care and support they need in the way they want and prefer. The people who live at the home enjoy good relationships with the staff. They were not able to tell us directly because of communication difficulties but we could see that they were at ease with the staff and were able to make their Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 6 needs known through body language and gestures. Person centred care plans provided guidance about each person’s preferences so staff could help people make choices about their daily lives. Relatives told us that the care, facilities and services provided by the home were good. One comment was “the home is fantastic, the staff are very approachable, professional and caring - we can only describe the home as excellent”. The home has a complaints procedure and thorough adult safeguarding procedures so the people who live there are able to express their concerns, are listened to and safeguarded from abuse and neglect. Staff are trained and have gone through thorough recruitment processes so they are suitable to work with the people who live at the home. Most of the staff had or were working toward a national vocational qualification (NVQ) in care at level 2 or above. NVQs are nationally recognised qualifications for staff in the care profession. This showed us that the people who live at the home are in safe hands because the staff providing their care are qualified and competent. What has improved since the last inspection? We could see that the manager and staff had done a lot of work since our last inspection to improve arrangements for care of the people who lived at the home. Managers and staff have worked in partnership with the people who live at the home and their representatives, including health and social care professionals, to make sure that their needs were met. Essential lifestyle planning meetings had been held and person centred plans had been developed for all the people who live at the home. In this way each person’s diverse needs were recognised and recorded so care staff have the guidance they need to provide care in the way the individual wants and prefers. The range of activities on offer had been improved and staff were actively helping people to look at new opportunities to take part in appropriate activities in the local community. Records showed that the people who lived at the home were getting out more and were offered more activities in the home. The manager had introduced a new system for reviewing the quality of care provided at the home. Surveys had been sent out to relatives. Other survey questionnaires were being prepared for staff and health and social care professionals so their views can be taken into account. The manager intends to produce an annual development plan for the home and will produce a report on quality issues so the people who live at the home and their representatives will know that their views have been taken seriously and acted upon. This shows us that the home is being run in the best interests of the people who live there. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Warrington Community Living - Lucklaw DS0000027018.V374454.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 Warrington Community Living - Lucklaw DS0000027018.V374454.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, 3, 4 and 5 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service have their needs assessed so they receive the care and support they need. EVIDENCE: The people who live at the home have lived together for a long time and no new people had moved in for a long time. However, information provided in the AQAA showed us that there are good procedures for introducing new people to the home. These help the person and their representatives to make an informed choice about moving into the home. The manager and support staff would work closely with the person and their representatives including family members, health and social care professionals to make sure that the person’s needs are assessed before they move in. Care plans would be drawn up with the individual so appropriate arrangements can be made to meet their needs in the way they would prefer. People interested in living at the home are encouraged to make a number of visits so they can see the home and meet and get to know the other people who live there. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 10 We could see that the managers and staff understand the importance of providing people who use the service, and their representatives, with the information they need to help them decide if the home is suitable for them. There are information leaflets about the home to that tell people what it does and who it is for. These are called the statement of purpose and service users’ guide. The manager is looking at ways of making these documents available in a range of formats including using photographs and illustrations to make the information easier to understand. The service users’ guide needs to include a standard form of contract. This will ensure that the people who live at the home and their representatives have written information about terms and conditions so they know their rights and responsibilities. A summary of the complaints procedure should also be included in the service users’ guide so people know how to make a complaint. Warrington Community Living - Lucklaw DS0000027018.V374454.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, 8, and 9 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live at Lucklaw are actively involved in developing their own care plans with help from their relatives and other representatives so their care is based on their individual needs and the principles of respect, privacy, dignity and promoting independence are put into practice. EVIDENCE: We could see that the manager and staff believe it is essential to involve people in planning the care that affects their lifestyle and quality of life. All of the people who live at the home had benefited from recent review meetings and assessments carried out by their social workers. A senior social worker told us each person’s review had established that the home was meeting their needs. In addition essential lifestyle planning meetings had been held. Records showed that each person and their representatives, including their health and social care professionals, had been invited to attend these planning meetings so the person received the support they needed to make important decisions about their care. Person centred care plans and been produced and Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 12 agreed with each person’s relatives so they received care in the way they wanted and preferred. We could see that staff were responsive to each person’s body language so they could help them to make choices about their daily lives. Communication problems meant that staff could not directly ask people about what they wanted to do but person centred care plans provided guidance about their personal preferences so staff know what the person wants. Limitations on choice and liberty to make their own decisions are only made in the person’s best interest and are agreed with their representatives so their rights are promoted. We could see that the manager had made some progress on the need to develop risk assessments and risk management plans whenever there are identified hazards to a person’s safety. A risk assessment on the use of bedrails had been produced but needed dating so it could be reviewed and evaluated. We also could see that further work was needed to make sure that all possible hazards were identified and managed. For example, risks associated with bathing and risk of falls had not been recorded in a risk assessment. A risk screening should be done so all possible hazards to a person’s health and safety are identified and managed. This will make sure that people who live at the home and staff are safe. Where appropriate the manager had established individualised procedures for the management of challenging behaviours. We could see that the manager and staff were working closely with the person’s heath care professionals to ensure that their needs were met and their well being was assured. However the risk assessment on the management of challenging behaviour needed reviewing because it contradicted the guidance produced by heath care professionals on how staff need to respond to make sure that the negative behaviours were not reinforced. The risk assessment instructed staff to engage with the person, offering them various activities, but the behaviour management plan stated it is important that staff do not engage as this may heighten agitation and reinforce negative behaviour. It is important that this is reviewed so staff have clear guidance on how they should respond. This will help ensure that continuity of care is always provided. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service are supported to make choices about their life style and can take part in a range of activities in the home and local community. EVIDENCE: We could see that the people who lived at the home enjoyed good relationships with staff. In the evening of our visit we observed three staff supporting three people who lived at the home. The staff provided care with competence, skill and dedication. They were all happy and enthusiastic about their work. They maintained a buoyant and positive atmosphere, offering each person a range of options including hand massage, sing-along, musical instruments and made physical contact giving hugs and holding hands. The outcome was that all three people were happy, content and engaged for most of the evening. We could see that the manager and staff had done a lot of work since our last inspection to improve the range of activities on offer. Person centred care Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 14 plans had been developed and staff were actively helping people to look at new opportunities to take part in appropriate activities in the local community. Records showed that the people who lived at the home were getting out more and were offered more activities in the home. Further development was needed because records showed there were times when no activities had been offered or the activity recorded appeared inappropriate. For example the records showed that one person who was blind and unable to read, write or speak had taken part in a crossword with staff. We observed support staff preparing meals and helping people who needed assistance with their meals. Staff were sensitive to the needs of each person and provided them with the support they needed, at a suitable pace. We saw that people were offered well-balanced, appetising meals that they enjoyed. One of the staff was a trained and accomplished cook and she knew exactly how the people who lived at the home liked their meals. For example, mashed potato was prepared with cream, garlic and butter just the way one of the people liked it. We could see they were very happy about this as they whooped happily in anticipation of the meal they could smell cooking. Records showed that a varied and nutritious diet was being provided for people living at the home. Links with family members were supported and relatives told us they were always made to feel welcome, were kept informed of significant events in the home and were more than satisfied with the standard of care facilities and services provided. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 15 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 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs so they receive personal care in the way they prefer. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Personal health care needs, including specialist needs and dietary requirements, were recorded in each person’s care records so staff know what to do when a person is unwell, including who to contact when further advice and guidance is required. All support staff we spoke with had a good knowledge of each person’s health care needs. Anticipatory care calendars were being used to highlight changes in the person’s health or well being. Care records showed that each person’s health care needs were monitored and, where necessary, support staff had made contact with the person’s health and social care professionals so their health care needs were met. However, we could see that some staff needed training or guidance in keeping accurate care records. For example fluid balance chart records were not clear or accurate. Some staff were using imperial measures and others were using metric. Some staff recorded that the person had a ¼ or ½ cup but then Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 16 confused matters by adding that they did not take it well. This meant that it was impossible for staff analysing the record to determine precisely what the individual had drunk throughout the day. A check of medication records showed that the people who live at the home received appropriate levels of support with their medication so their health care needs were met. Medication records were up to date and stocks of medication were found to be correct. Staff training records showed that all staff with the exception of one had received training in administration of medication including rectal diazepam. This means that they had up to date knowledge on how to give medicines safely so that mistakes did not happen and people received their medicines as prescribed by their doctors. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 17 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 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home has a complaints procedure and thorough adult safeguarding procedures so the people who live at the home are able to express their concerns, are listened to and safeguarded from abuse and neglect. EVIDENCE: No complaints about the home had been received since our last inspection there. The home’s complaints procedure provides appropriate guidance on making a complaint but is only available in a standard format. This should be made available in a format that is suitable and more accessible for the people who live at the home and their representatives. Various methods of communication should be explored including using illustrations and possibly audiovisual media. There are thorough procedures for responding to suspicion or evidence of abuse or neglect in place including whistle blowing so that staff know they can highlight poor practice if needed. Training records show that most support staff had received training and guidance on adult safeguarding procedures so they know what to do in the event of any suspicion or evidence of abuse. Two adult safeguarding referrals had been made to the local authority since our last inspection of Lucklaw. Managers and staff had worked in partnership with the police and the local authority to make sure that vulnerable people were safe. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 18 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, 27, 29 and 30 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well maintained so the people who live there have comfortable, bright and cheerful accommodation of a design and layout that generally meets their needs. EVIDENCE: Lucklaw is a bungalow located in a residential area of Warrington. The home looks like other houses in the area so it does not stand out as being a care home. It provides spacious, comfortable, bright and cheerful accommodation. Interior decoration, furniture, fixtures and fittings are good and each person’s bedroom reflects their individual needs and personality. Relatives of the people who live at the home told us that it provides excellent accommodation. Changes have been made to the home over time to meet the needs of people who live there, and alterations have been made to make it easier for people to use the back garden. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 19 The main bathroom has a toilet in it. Unfortunately, the only other toilets in the home are those in two people’s en-suite bathrooms. This means that staff and the people who do not have en-suite facilities have to use the toilets in other people’s bedrooms when the main bathroom is engaged. This is inappropriate because it compromises the privacy and rights of the people who live at the home. An assessment previously carried out by a suitably trained member of staff had indicated that the bath is too low and this may present dangers to staff who are helping people to bathe. Requirements made to improve bathroom and toilet facilities had not yet been met in full. However, the manager wrote to the commission to confirm that arrangements are being made to improve the bathroom facilities. Although there is no sluice in the home, appropriate arrangements are made for the handling and disposal of waste and infection control. The home is clean and well presented throughout. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Staff are trained, and employed in sufficient numbers to meet the changing needs of people who use the service. Recruitment procedures are thorough to make sure that new staff are suitable to work with the people who live at the home. EVIDENCE: Records and our discussions with staff showed us that staff were employed in sufficient number with a minimum of two staff on duty in the mornings and evenings and up to five staff on duty between 1pm and 3pm when shifts overlapped. This shift overlap provided opportunities for staff to offer people a range of activities in the community including shopping, visiting, cafes, pubs or going for a walk. However, the rota showed that there had been times when only one member of staff was on duty in the home for up to one hour. Whilst this is a relatively short period of time we were concerned about the safety of the people who live at the home because they need close supervision to keep them safe from falls and other potential accidents. The manager told us that additional staff hours for the home had been agreed and wrote to the commission shortly after the inspection giving assurances that minimum Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 21 staffing levels of a least two staff on duty during the day will always be adhered to. This will help to make sure that the people who live at the home are always safe and well looked after. We checked the staff recruitment files for one new staff member who had been recruited since the last inspection and we discussed recruitment procedures with the manager and some staff. Records show that the home’s recruitment procedures are thorough so people who live at the home are safe and protected from harm and abuse. We talked with the assistant manager and some staff about staff training opportunities and we looked at staff training records. These show that more than 90 of the staff have or are working towards National Vocational Qualifications (NVQs) at level 2 or 3 in care. These are nationally recognised qualifications for people who work in the field of care and help to show that they are knowledgeable and competent to carry out their work. Staff files contained certificates for a range of relevant training and development subjects including medication and health care procedures, administration of rectal diazepam, health and safety at work, food hygiene, safeguarding adults from abuse, moving and handling, fire safety training, sensory awareness and other specialised topics including PEG feeding systems. All staff have an annual appraisal which helps them and their managers to identify further training needs to make sure they continue to have the skills and knowledge to provide care for the people who live at the home. The training records showed that one new recruit had not received induction training even though they had been working as care workers in the home since August 2008. The manager told us that this staff member had been booked on an appropriate training course with the local authority but this was not due to take place for some time. The manager should not rely on training provided by the local authority alone and must take action to make sure that all staff are appropriately trained. All new staff should receive structured induction training that meets “Skills for Care” common induction standards within six weeks of them starting work in the home. This needs to be done so new care workers always know how to work safely and effectively. All care staff were cheerful, friendly and helpful. They told us they were well supported and appreciated the leadership and guidance provided by the manager and other senior staff. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 22 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 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well managed so that it is run in the best interests of the people who live there. EVIDENCE: The management structure is suitable for the home’s stated purpose and includes the manager, assistant manager and eleven support staff posts. Both the manager and the assistant manager are registered nurses in learning disabilities. The manager is experienced in the field of learning disabilities but does not hold a management qualification so is working towards the registered manager’s award. It is important that the manager completes this qualification so they can demonstrate that they have the necessary skills to manage the home effectively and ensure all the needs of the people who live there are met. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 23 The manager was appointed manager of the home on 31 March 2008 but had not yet applied for registration with us (the commission) because of some unforeseen complications. They told us that they expect to resolve these problems and will put in an application for registration in the near future. Information provided in the AQAA and discussion with the manager showed us that the manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. Significant improvements have been made since our last key inspection at the home including implementation of essential lifestyle planning and development of person centred plans for all the people who live there. In this way each person’s diverse needs are recognised and recorded so care staff have the guidance they need to provide care in the way the individual wants and prefers. Warrington Community Living revised quality assurance procedures for its care homes in 2007 but this work had not been put into practice at Lucklaw. However the new manager showed us that the views of relatives and health and social care professionals who have interests in the home were being sought by survey questionnaires. A report on quality issues will be published so people will know their views are taken seriously and acted upon. Information provided to us indicates that fire precautions are in place and routine maintenance checks of gas and electrical systems, hoist, electrical appliances, lift, fire alarms, extinguishers and emergency lighting systems are undertaken and are up to date. Some risk assessments were missing and there was not enough evidence that action had been taken to identify and minimise risks to the health and safety of the people who live and work at the home. However, we could see that the manager was working toward meeting the requirements of the regulations and national minimum standards so the people who live at the home are safe and well cared for. Staff told us they had not received any specific training on equality and diversity; however some had covered it on NVQ training and had an understanding of the issues. They were aware that the home aimed to meet each person’s diverse needs through person centred planning. Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 3 4 3 5 2 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 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 13(4)(c) Requirement Risk assessments must always be carried out when there are identified hazards to a person’s safety, including risks of falls, so the people who live at the home are safe. There must be enough suitably qualified, competent and experienced persons working at the care home to make sure the needs of the people living there are met and their wellbeing is assured. (Previous timescale 30/09/08 not met in full.) Timescale for action 15/05/09 2 YA33 18(1)(a) 15/05/09 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 YA1 Good Practice Recommendations The service user’s guide and statement of purpose for the home should be available in formats that are easier for the people who live there to understand. DS0000027018.V374454.R01.S.doc Version 5.2 Page 26 Warrington Community Living - Lucklaw 2 YA5 The service user’s guide should include a standard form of contract or provide a statement of terms and conditions so people know their rights and responsibilities relating to the service provided. Action should be taken to continue to explore a range of suitable activities so people who live at the home have opportunities for recreation, leisure and social interaction in the home and local community. Staff should have clear instruction and guidance on completing health care records so they know how to do them accurately. This will help to make sure that the people who live in the home receive the health care they need. Plans to improve and provide appropriate bathroom facilities need to be put into practice so all people who live at the home have the facilities they need. New staff should receive induction training that reflects Skills for Care induction criteria within six weeks of them starting work at the home so they know how to work safely and effectively. 3 YA12 4 YA19 5 YA27 6 YA35 Warrington Community Living - Lucklaw DS0000027018.V374454.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North West Region Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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