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Inspection report

Date of Inspection: 10 July 2014
Date of Publication: 12 August 2014
Inspection Report published 12 August 2014 PDF | 90.78 KB


Inspection carried out on 10 July 2014

During a routine inspection

One adult social care inspector inspected Lambert House. At the time of the inspection there were nine people using the service.

We were unable to talk with the people who used the service but spoke with a person’s relatives and a number of staff from all staff groups. We reviewed the care records for three people. We also reviewed a selection of other records including training schedules, staff files, audit results and the provider’s policies and procedures.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

The management team had been trained and understood their obligation to apply the principles of the MCA and DoLS. People who used the service had a number of ‘best interest’ decisions recorded. These included decisions about restricting the person to leave the home, their personal hygiene and the administration of their medicines. The management team had appropriately assessed people’s capacity, and sought the agreement of the person’s health professionals and relatives/ representatives, before putting these decisions into practice.

No person living in Lambert House had a DoLS authorisation. The manager told us that they were in liaison with the DoLS team at the local authority to determine whether they should apply for DoLS authorisations due to the number of ‘best interests’ decisions made for each person.

We saw evidence that staff had received training and education in relation to mental capacity and safeguarding. The staff we spoke with showed a good understanding of both of these safeguards.

Medicines were stored correctly in locked cupboards and we noted that people’s Medication Administration Records (MARs) contained all of the required information for the safe administration of medicines and had no gaps. We saw evidence that all of the staff who administered medicines had received the appropriate medicines management training.

We reviewed the mandatory training schedule for the service and noted that staff were up to date with their training with dates highlighted for when refresher training was due.

We found that the provider had effective recruitment and selection procedures in place and undertook the necessary checks to ensure that employees were of good character, and had the skills and qualifications needed to provide safe and effective care to people.

We saw evidence that the provider’s audit schedule was effective. This included regular auditing of the quality of the service, as well as accidents and incidents and environmental risks.

Is the service safe?

The care records we reviewed were outstanding. There was ample evidence to demonstrate that the care and support people received reflected their needs. Care plans were evidence-based and reflected nationally recognised standards of caring for people with autism. People’s care plans and risk assessments were reviewed and updated on a regular basis in order to reflect any changes in people’s needs.

Each person who used the service had a key worker. People’s goals were documented in their care records and we saw evidence that people were adequately supported and equipped to help achieve their goals. The staff supported people to develop ‘life skills’ to help them increase their independence.

We saw evidence that the provider had systems in place to ensure competent staff. Staff received regular supervisions and an annual appraisal. All of the staff we spoke with told us that their supervisions were meaningful and facilitated their competence and confidence to undertake their roles and responsibilities. Staff were encouraged and supported to access further training and education and we noted that this included training in relation to caring for people with autism, person-centred care and ethical care and control.

Is the service caring?

One of the relatives we spoke with said, “We couldn’t want anything more. The service is fabulous. Our (relative) gets everything they need. The staff are great and really understand the needs of people with autism. We get constant feedback about how our (relative) is progressing and the service has helped us understand about autism. We wouldn’t change a single thing about Lambert House.”

The staff had received training in person-centred care and this was evident during our review of people’s care plans and by observing the interaction between staff and the people who used the service. It was evident that staff thoroughly understood the needs of the people that they were caring for and treated people with compassion and respect. Different communication techniques were used to help facilitate effective communication and this was done in an appropriate and dignified manner.

Is the service responsive?

The environment was planned to help meet the needs of the people who used the service. This included different areas where people could choose to spend their time. We noted that there were secure gardens, a recreation room, a music/sensory room and numerous communal lounge areas.

It was evident that the care and support people received met their individual needs. People’s care plans included all aspects of the person’s activities of daily living and there were support plans in place for staff to follow to help ensure they responded to people’s needs in an effective way. We observed staff interacting with people in a positive way and this included encouraging people to develop certain skills to help them become more independent.

During our inspection a clinic was being undertaken for people’s relatives to meet with the person’s psychologist and the registered manager. The relatives we spoke with told us that the clinics gave them the opportunity to ask any questions they had in relation to their family member’s care and support, as well as responding to any concerns or anxieties that they had.

The provider had a complaints policy and procedure and we saw evidence that they took account of complaints and comments to improve the service.

Is the service well-led?

All of the staff we spoke with were positive about the management team at Lambert House. Staff told us that they felt well supported and were confident to raise any issues or concerns. They told us that the registered manager actively listened to what they had to say and responded in an appropriate manner. The non-care staff we spoke with told us that they felt part of the team and said that they felt the service was well-led.

There was a positive culture within the service and we noted that staff supported each other in a meaningful and productive manner. The relationship between the management team and the care and non-care staff was encouraging. We noted that the management team regularly worked alongside staff while they carried out their duties in order to support them.

The service had quality assurance systems in place to assess and monitor the quality of the service people received. We noted that the governance arrangements within the service promoted a learning environment.