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Inspection on 10/12/07 for 39 Silverbirch Road

Also see our care home review for 39 Silverbirch Road for more information

This is the latest available inspection report for this service, carried out on 10th December 2007.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Each person living there has a care plan so that staff know how to support them to meet their needs and achieve their goals. The person is involved in their care plan and always goes to their review meetings. The people living there go out often to the places they want to go to at the times they prefer to go. People are supported to make choices and decisions about their lives. The people living there said that the food was very nice. People are encouraged to eat a healthy diet that includes fruit and vegetables. People are supported to keep in touch with their family and friends.The people living there are supported to keep healthy and have regular health check ups. Staff notice when people are unwell and make sure that they go to the doctor. Each person has their own bedroom, which is personalised. They each have an en suite toilet and shower. There is also a bathroom downstairs that they can use if they prefer to have a bath. Staff know each person well and how they communicate so they can let staff know what they want and be understood. The home is clean and well decorated so it is a nice place to live.

What has improved since the last inspection?

Guidelines for people are updated often so that staff have up to date information about how to meet each person`s needs. The lounge had been redecorated and new flooring had been laid. This had made it a nicer place for people to relax in. Other rooms downstairs had been redecorated. Where people are prescribed medication `as required` there was written protocols in place that said when, why and how much of the medication should be given. This helps make sure that people have medication when they need it.

What the care home could do better:

There must be a risk assessment in place for the kitchen hob and if necessary a guard provided to minimise the risks of people being scalded. A detailed assessment process should be in place so that it is clear whether or not the individual`s needs could be met at the home. The individual and their key worker should sign all their care plans so it is clear they have been involved in developing it and agree to it. Individuals moving and handling assessments should be regularly reviewed and updated as needs changed. This will ensure that staff know how to support them with their mobility so minimising the risk of injury. Staff should be aware of the Mental Capacity Act and how this might affect the people living there. The bathroom should be better designed so there is more room to get in and out of the bath from either side and for staff to support people when using it. There should be at least six staff meetings each year so that staff are aware of any changes to the needs of the people living there, policies, procedures and within the organisation. All staff should have regular supervision with theirmanager to make sure that they are supported in their role and can meet the needs of the people living there. The manager should apply to the Commission for registration so that the people living there can benefit from a well run home. There should be a fire drill every six months so that all staff and the people living there would know what to do if there was a fire.

CARE HOME ADULTS 18-65 Silverbirch Road (39) Erdington Birmingham West Midlands B24 0AR Lead Inspector Sarah Bennett Unannounced Inspection 10th December 2007 09:50 Silverbirch Road (39) DS0000039326.V353909.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 Silverbirch Road (39) DS0000039326.V353909.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. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silverbirch Road (39) Address Erdington Birmingham West Midlands B24 0AR 0121 250 2067 F/P 0121 250 2067 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) New Outlook Housing Vacant post Care Home 6 Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be aged under 65 years. The home can continue to accommodate one named service user over 65 years. 2nd December 2006 Date of last inspection Brief Description of the Service: 39 Silverbirch Road is registered to provide personal care and support to six adults with a learning disability/visual impairment, who have been assessed as requiring full assistance with daily living tasks. The home is staffed 24 hours a day including waking night and a sleeping in member of staff. People are admitted to the home following a full assessment that would determine the level of support they require. The full range of medical services, leisure and social activities are provided for the people living there. A number of adaptations have taken place within the home in order to meet the assessed needs of individuals. The people living there are encouraged and supported to maintain links with their families and the local community. The care needs of the people living there are monitored and reviewed and action is taken to address any concerns. The home is situated in Erdington, a residential area of Birmingham and has ready access to local amenities. The service users guide stated that the fees charged are £1050 per week. Extra payments are required for external day care, chiropody and alternative therapies such as aromatherapy. The information included in this report applied at the time of inspection and the reader may want to obtain more up to date information from the care service. A copy of the last inspection report is available for visitors who wish to read it. Silverbirch Road (39) DS0000039326.V353909.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 two star. This means the people who use this service experience good quality outcomes. The visit was carried out over one day; the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire was sent to the manager about the home – Annual Quality Assurance Assessment (AQAA). Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home and the staff on duty were spoken to. Time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: Each person living there has a care plan so that staff know how to support them to meet their needs and achieve their goals. The person is involved in their care plan and always goes to their review meetings. The people living there go out often to the places they want to go to at the times they prefer to go. People are supported to make choices and decisions about their lives. The people living there said that the food was very nice. People are encouraged to eat a healthy diet that includes fruit and vegetables. People are supported to keep in touch with their family and friends. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 6 The people living there are supported to keep healthy and have regular health check ups. Staff notice when people are unwell and make sure that they go to the doctor. Each person has their own bedroom, which is personalised. They each have an en suite toilet and shower. There is also a bathroom downstairs that they can use if they prefer to have a bath. Staff know each person well and how they communicate so they can let staff know what they want and be understood. The home is clean and well decorated so it is a nice place to live. What has improved since the last inspection? What they could do better: There must be a risk assessment in place for the kitchen hob and if necessary a guard provided to minimise the risks of people being scalded. A detailed assessment process should be in place so that it is clear whether or not the individual’s needs could be met at the home. The individual and their key worker should sign all their care plans so it is clear they have been involved in developing it and agree to it. Individuals moving and handling assessments should be regularly reviewed and updated as needs changed. This will ensure that staff know how to support them with their mobility so minimising the risk of injury. Staff should be aware of the Mental Capacity Act and how this might affect the people living there. The bathroom should be better designed so there is more room to get in and out of the bath from either side and for staff to support people when using it. There should be at least six staff meetings each year so that staff are aware of any changes to the needs of the people living there, policies, procedures and within the organisation. All staff should have regular supervision with their Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 7 manager to make sure that they are supported in their role and can meet the needs of the people living there. The manager should apply to the Commission for registration so that the people living there can benefit from a well run home. There should be a fire drill every six months so that all staff and the people living there would know what to do if there was a fire. 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. Silverbirch Road (39) DS0000039326.V353909.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 Silverbirch Road (39) DS0000039326.V353909.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally information is provided so that prospective service users have the information they need to make a choice of whether or not they want to live there. It is not clear whether staff at the home complete a detailed assessment of a person’s needs before they move in to ensure their needs can be met there. EVIDENCE: The service users guide had been recently updated and included pictures of the people living there, photographs of the home, the details of how much it costs to live there and the details of the new manager. It stated that it was also available in different formats depending on the needs of the individual including large print, audiocassette, Braille or picture format. The statement of purpose included the relevant and required information so that prospective service users would have the information they need to make a choice as to whether or not they want to live there. One part stated the previous manager and other parts referred to the current manager so these should be amended to reflect the current management arrangements. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 10 One person had moved into the home since the last inspection. Staff at the home had completed an assessment of the person’s needs before they moved in. This was not detailed and stated that some information was not known so further assessment was needed. It was not clear whether this information was assessed. However, the community learning disability nurse had completed a full assessment of the person’s needs. Staff said that the person visited before they moved in. Minutes of meetings held with the people living there showed they had been consulted before the person moved in. Silverbirch Road (39) DS0000039326.V353909.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, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the individual is detailed in their care plan and risk assessments so that staff know how to support them to meet their needs and take risks whilst ensuring their safety and well being. The people living there are supported to make choices and decisions about their lives. EVIDENCE: Two records of the people living there were looked at. These included an individual care plan. The person, their friends and relatives and their key worker had been involved in developing the care plan. Care plans were detailed and included pictures making them easier to understand. They showed staff how to support the individual and ensured that new or temporary staff knew the important information about the individual so they could support them appropriately. Care plans included how staff are to support the person to regain and develop their independence skills and how staff can support them to make choices about their day-to-day lives. Because of the needs of the people living there information about how individuals communicate is Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 12 necessary for staff to be able to support the person appropriately. This information was detailed as to what ways the person communicates including gestures and facial expressions. Some care plans had not been signed by the person or their key worker to show they had agreed to this. Care plans had been regularly reviewed with the individual and updated where necessary to ensure that they were still receiving the support to meet their needs and help them to achieve their goals. Records showed that weekly meetings are held with the people living there. Several of these records stated that people had nothing to say. This was discussed with the deputy manager who said that as most people had lived there for a long time they do not have a lot to discuss in a formal meeting. However, they do talk to their key worker or other staff and these discussions were recorded often on a daily basis. It may not be necessary to always have formal meetings unless staff or the people living there think it is necessary to discuss a particular issue but to continue to record whenever people are involved in choices and decisions. Records showed and it was observed that people are consulted and offered choices in their day-to-day lives. Records included individual risk assessments that detailed what action was needed to minimise the risks to individuals from their behaviour, when having a bath or shower, when taking their medication, if there was a fire, their health and dietary needs, their personal hygiene, using the laundry and kitchen, ironing, moving around the home, going out on their own and going out in the community. All staff including temporary staff had signed to say that they had read the risk assessments so they are aware of how to support people and minimise the risks to their well being. Silverbirch Road (39) DS0000039326.V353909.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, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the people living in the home experience a meaningful lifestyle. The people living there are offered a healthy diet to ensure their health and well being. EVIDENCE: Some people go to day centres during the week; only one person goes to a day centre for five days. Other people go to day centres for a couple of days a week and then do activities at home on the other days. Staff said that one person does not like going out in the evenings so they are supported to go out during the day. Other people like going out in the evenings so they are supported to do this. Records showed and people said that they go to bingo, go out for meals, go shopping, go to church, the pub and to the Deaf Blind Club. The people living there enjoy music and a music session led by an external musician is held every fortnight at the home. This is the only group Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 14 activity that the people living there do, other activities are planned around individuals hobbies and interests. One person said they had been out to a pub for Christmas meal with their day centre earlier in the day. Another person said they were going out Christmas shopping with staff the next day. Records showed and people said that inside the home people do a range of activities depending on their interests. These include writing, music sessions, playing the keyboard, drawing, gardening, knitting, baking and listening to music and the TV. The home has a minibus that the people living there contribute towards financially. Four members of staff and some bank staff drive this so that the people living there can access the community. Staff said that the lease on the minibus ends in January 2008. They plan to replace this with a smaller, more accessible vehicle that will further benefit the people living there. Staff said that they support people who want to go on holiday to go to the places they want to go to. One person had booked to go away next April. Another person goes away on holidays organised by Deaf Blind UK and also went away last year to Dublin with friends from the church they attend. Other people are planning holidays for next year. Records sampled showed and people said that they are supported to keep in contact with their family and friends. This may be through telephone calls, visits to their family and friends, going out with them or their family and friends visiting the home. The people living there have a key to their bedroom so they can lock this when they want to. One person said that when they go out they leave their key at the home so they do not lose it. People who were able to were observed going to the kitchen to make a drink when they wanted to. Records showed that people are supported to be as independent as possible and help to take part in household tasks. All the people living there can use the lift independently so they can move around the house when they want to. Tea was served about 5pm. Some people had meat pie and chips and others had fish pie and chips. One person who had been out for a meal earlier asked for a small portion of tea, which they were given. They told staff when they had eaten enough and this was respected. Staff supported people to go to the table and supported them appropriately to eat and drink. In the dining room there are two small tables so people do not all have to sit together but can have some space to eat their meals. One person was asleep when tea was served so staff said they would have their tea later. Another person did not want their tea but said they would have a snack later. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 15 Food records sampled showed that people are offered a varied and healthy diet that includes fruit and vegetables. Some people choose not to eat what is offered. Their choice is respected but records showed that staff do try to encourage people to eat a varied diet and regular meals to ensure their well being. Staff said that the majority of the food is bought on-line and delivered to the home but that fresh foods are bought from local shops. A variety of fresh fruit and vegetables were available in the home. Menus showed that a variety of food is offered. Staff said that the menus had recently been updated and the people living there had been involved in this. The menu included a choice for each meal but staff said that people could have an alternative if they do not like what is on the menu. Silverbirch Road (39) DS0000039326.V353909.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, 20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that staff support people appropriately and ensure their health needs are met. Arrangements for the management of the medication ensure that people have their prescribed medication at the right time. The illness and death of people who live there are handled with respect and as the person would wish. EVIDENCE: All the people living there were dressed appropriately to the weather, their age, gender and cultural background. Each person had their own individual style of hair and dress. Staff were observed throughout the day supporting individuals appropriately and where necessary to manage their behaviour so they did not put themselves or others at risk. Staff were observed communicating with people in their preferred communication method. All staff can communicate using Deaf Blind Manual and were able to communicate well with individuals who used this. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 17 Records sampled included a moving and handling assessment that assessed what support each person needed with their mobility. One person’s assessment was dated August 2006 and it stated that it needed to be reviewed a year later. It was not clear if it had been reviewed as the person now uses a wheelchair when they go out but this was not mentioned in the assessment. It should be reviewed and updated regularly to ensure that staff are supporting the person appropriately with their mobility without putting the person or themselves at risk of injury. Records sampled included a Health Action Plan. This is a personal plan about what a person needs to be healthy and what healthcare services they need to use. These were detailed and included pictures making them easier to understand. Records showed that people’s weight is regularly monitored. This is important as a significant loss or gain of weight can be an indicator of an underlying health need. Where needed individuals are supported to follow dietary plans and agree to these before they are implemented. Records showed that where appropriate individuals are referred to health professionals. These included learning disability nurses, psychiatrist, epilepsy nurse, practice nurse, physiotherapists and specialist doctors as appropriate. Each person is registered with a GP and records sampled showed that people are supported to visit their GP when needed. Records included detailed outcomes of health appointments attended. The people living there are supported to have regular check ups with the optician and dentist and to attend chiropody appointments where appropriate. Two staff give out medication that is prescribed to the people living there. One member of staff was observed reading from the Medication Administration Records (MARS) what the person should have, the other member of staff took the medication from the pack, checked it again and gave it to the person with a drink. Boots supply the medication using the monitored dosage system. This helps to reduce errors as medication comes from the pharmacist in pre packed blister packs in the dosage prescribed to the person. Staff write on the MARS how much of each medication is received so they can keep track and check throughout the month that people are getting their medication as prescribed. Some of the medication prescribed for people cannot be stored in the blister pack as this method of storage may affect its effectiveness. As staff gave this medication they counted how many tablets were left in the box to ensure it is being given as prescribed. Staff said that before they can give out medication they complete the accredited ‘Safe Handling of Medicines’ training. Some people are prescribed PRN (as required) medication. A written protocol was in place that stated when, why and how much of this should be given to Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 18 ensure it is given appropriately. Staff record on the MARS when PRN medication is given. Sadly, one person who had lived at the home for several years had died a couple of weeks before the inspection. Staff had said that this had been a difficult time. The other people living there had been supported to go to the funeral if they wanted to. The person’s key worker had been with them during the night at the hospital when they died so they had someone they knew well with them. Staff said that the key worker had arranged the person’s funeral. For one person their records included a statement that if they required resuscitation they would wish this to be done. This had been discussed with and signed by the person, their close friend, relative and the manager and had been reviewed every six months. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on. Arrangements are generally sufficient to ensure that the people living there are protected from abuse, neglect and self-harm. EVIDENCE: There have been no complaints about the service provided received by the home or the Commission in the last twelve months. The complaints procedure included the relevant and required information so that people would know how and who to complain to if they were unhappy with the service received. The people living there are supported to manage their own finances as much as possible and there is provision for their money to be stored safely in the home if they want this. People were observed asking for the money they needed. Staff supported them to get their money and they signed to say they had received it. One person is being supported with budgeting and had a plan in place for this. They had agreed to this plan and were aware of the aims of it so they could afford to buy things that they wanted. People have their own bank accounts that their benefits are paid directly into. Records sampled for one person showed that their inventory of belongings had not been completed. In the other records sampled the person had signed to say that they do not need an inventory of their belongings, as staff are to be responsible for their possessions. Where individuals have not signed to say that staff are responsible for these an inventory of their belongings should be Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 20 completed and updated when they dispose of items or buy new things. This helps to track their belongings so if anything should go missing it would be easier to trace. Records showed that where staff had observed an agency member of staff upsetting and shouting at one of the people living there staff had ensured that this was reported and a complaint was made to the agency. The Deputy manager said that this person would not work in any of the organisation homes in the future. Records showed that staff had received training in adult protection and the prevention of abuse. Records sampled included an individual behaviour management plan that was very detailed. This stated how staff are to manage the individual’s behaviour so that it is managed consistently and reduce the impact of the behaviour on their well being and that of the other people living there. Records showed that the person is being supported to develop their skills in managing their anger. Staff records sampled showed that staff had received training in managing behaviour. Staff had not received training in the Mental Capacity Act. This legislation requires an assessment of people’s capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. Staff should be aware of this and the implications this legislation has for the people living there. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that people live in a homely, comfortable, clean and safe environment that meets their needs. EVIDENCE: The home is well decorated and maintained. All rooms are decorated with contrasting colours around doorframes, skirting boards and the middle of the walls so that people can find their way around more easily. The Christmas decorations were up and staff said that these were put up over the weekend. The people living there were observed touching the Christmas tree and feeling the decorations on it. They said they liked the decorations and the feel of them. The AQAA stated that communal areas have recently been redecorated and that new flooring had been laid in the lounge. Staff said that new curtains had recently been bought for the lounge. The lounge leads into the conservatory Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 22 that is used as a dining room. Half of the kitchen units are at low level so people who use wheelchairs can use these. There is a high level cooker and a separate hob. There was not a guard around the hob, which could put people at risk of being scalded by touching it. Staff said that the people living there do not use the kitchen unsupervised when the hob is being used. There must be a risk assessment in place for this and if necessary a guard provided to minimise the risks. All bedrooms have an en suite with a shower. There is also a bathroom on the ground floor that people can use if they prefer to have a bath. All bedrooms were personalised and contained photos, pictures and personal possessions. Bedrooms were well furnished and this was appropriate to individual tastes. Staff said that all bedrooms are to be redecorated and that the people living there would be involved in choosing how this is done. There was one vacant bedroom and staff said this would be decorated in neutral colours so it would be suitable for anyone to move in to and then they could personalise it. At the back of the home there is a long garden. There are ramps down to the garden with handrails on the sides so that all the people living there can access the garden safely. Staff said that the garden is used a lot in the summer and people often have their meals outside in the warmer weather. Garden furniture is provided. Staff said that one person living there is interested in gardening so they plan to involve them more in this. A lift is provided so that people can move from one floor to another. All the people living there can use the lift independently. An adapted bathing facility is provided in the bathroom so that all people can get in and out of the bath. Staff said that they are thinking of getting the bath moved. The bathroom is big but the bath is positioned in the middle. The bathroom could be better designed so there is more room to get in and out of the bath from either side. A nurse call system is provided in all rooms so that people can summon help from staff if needed. A door leads from the hall to a covered walkway outside that leads to the laundry. This means that soiled laundry does not have to be carried through areas where food is stored, cooked, prepared or eaten. Hand wash and hand towels are provided at all sinks to minimise the risk of cross infection. The home was clean and free from offensive odours throughout making it a pleasant place to live. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for staffing, their support and development are variable and could affect how staff meet the needs of the people living there. The recruitment practices ensure that the people living there are protected. EVIDENCE: The AQAA stated that most staff have achieved National Vocational Qualification (NVQ) level 2 or 3 in Care and that new staff who have not got this qualification will be enrolled to do so. The deputy manager said that two staff, one full time and one part time had recently been recruited and would be starting in the next few weeks. There would then be no staff vacancies apart from the Deputy manager position as she was due to leave at the end of December. Staff said that they have a regular team of bank staff who cover any vacancies and who know the people living there. Bank staff have supervision and the relevant training. At night there is one waking night staff and one staff who Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 24 sleeps on the premises. Rotas for the previous week showed that despite some absence due to sickness minimum staffing levels had been met at all times. A cleaner had recently been employed for four hours a week. The deputy manager said this is a trial to see if they are needed and if it would help care staff to have more time to spend with the people living there. The people living there are involved in cleaning their bedrooms and would continue to do this with the support of care staff. Staff meeting minutes showed that there had been five meetings in the last twelve months. To meet this standard there should be at least six staff meetings in twelve months. This ensures that all staff are aware of any changes to the needs of the people living there, to policies, procedures and within the organisation. Three staff records were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been received to ensure that ‘suitable’ people are employed to work with the people living there. Staff training records sampled showed that staff had received training in medication, care planning, moving and handling, fire safety, challenging behaviour, adult protection and the prevention of abuse, communication, sight loss awareness, epilepsy awareness and infection control. Staff said that they get good training and it is relevant so they know how to meet the needs of the people living there. Staff have completed the Learning Disability Award Framework (LDAF) training so they know how to meet the needs of the people living there. All staff complete a comprehensive induction workbook in the first few months of their employment at the home. All staff have an annual appraisal where their performance is assessed and training and development needs identified for the next year. It was not clear from sampling staff records that all staff have regular, formal, recorded supervision sessions with their manager to ensure they are supported in their role. The manager stated in the AQAA that this is something that had been lacking and would be improved in the next year. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Registration with the Commission will improve the management arrangements so ensuring that the people living there benefit from a well run home. The people living there can be confident that their views underpin the selfmonitoring, review and development of the home. Generally arrangements are in place to ensure that the health, safety and welfare of the people living there is promoted and protected. EVIDENCE: The previous registered manager left in August 2007 and another manager was recruited who started working there in October. They have experience for at least two years in a supervisory role within a care home. The manager has achieved NVQ level 4 & the Registered Managers Award. The manager has not yet made an application to be registered with the Commission. This should be Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 26 made so that the management arrangements ensure that the people living there benefit from a well run home. Staff spoke positively about the new manager and said she was supportive. The AQAA stated that the people living there are asked for their views on the home and these are used in the annual audit of the home. There are monthly audits of the home to ensure it is running well. Individual’s care plans are reviewed annually and in between as needed. Individuals are involved in developing and reviewing their care plans. The Operations Manager visits the home monthly as required under Regulation 26 to complete an audit. A valid certificate of employer’s liability insurance was displayed in the home. An electrician had completed the five-yearly test of the electrical wiring in July 2007 and stated that it was in an unsatisfactory condition. They made four recommendations to improve this. The deputy manager said that these recommendations had been met. The annual test of the portable electrical appliances had been completed so that they are safe to use. The annual test of the gas equipment had been completed and the Corgi registered engineer who tested it stated that it was safe to use. Records showed that the bath and the lift had been regularly serviced to ensure they are well maintained and safe to use. Fire records showed that an engineer regularly services the fire equipment to ensure it is well maintained and in good working order. Staff had tested the fire alarm weekly to make sure it is working until 9/11/07 but not since. Staff said that it had been tested but for some reason was not recorded. The manager said after the inspection that this is now being tested weekly and recorded. Staff had tested the emergency lighting monthly to make sure it is working. There had not been a fire drill since April 2007. These should be held every six months so that all staff and the people living there would know what to do if there was a fire. The manager said after the inspection that staff would be allocated to do this. Risk assessments were in place for the premises, fire, food and staff. There was a risk assessment in place for the kitchen but this did not assess the risk of the hob and this must be in place. Staff test the fridge and freezer temperatures daily to make sure that food is stored at the appropriate temperatures to minimise the risk of food poisoning. Records showed that these were appropriate so food is stored safely and where they had been too high or low staff had taken action to rectify this. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 27 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 4 2 X 3 X X 2 X Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 YA42 Regulation Requirement Timescale for action 31/01/08 13(4)(a-c) There must be a risk assessment in place for the kitchen hob and if necessary a guard provided to minimise the risks of people being scalded. 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. 2. 3. 4. Refer to Standard YA1 YA2 YA6 YA18 Good Practice Recommendations All of the statement of purpose should be updated with the relevant management arrangements. A detailed assessment process should be in place so that it is clear whether or not the individual’s needs could be met at the home. The individual and their key worker should sign all their care plans so it is clear they have been involved in developing it and agree to it. Individuals moving and handling assessments should be regularly reviewed and updated as needs changed. This will ensure that staff know how to support them with their mobility so minimising the risk of injury. Staff should be aware of the Mental Capacity Act and the implications this legislation has for the people living there. DS0000039326.V353909.R01.S.doc Version 5.2 Page 29 5. YA23 Silverbirch Road (39) 6. 7. YA35 YA27 YA33 8. YA36 9. 10. YA37 YA42 The bathroom should be better designed so there is more room to get in and out of the bath from either side and for staff to support people when using it. There should be at least six staff meetings each year so that staff are aware of any changes to the needs of the people living there, policies, procedures and within the organisation. All staff should receive regular, formal, recorded supervision sessions to ensure that they are supported in their role and can meet the needs of the people living there. The manager should apply to the Commission for registration to ensure that the people living there can benefit from a well run home. There should be a fire drill every six months so that all staff and the people living there would know what to do if there was a fire. Silverbirch Road (39) DS0000039326.V353909.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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