Inspection on 05/11/07 for The Roundabout

This is the latest available inspection report for this service, carried out on 5th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Roundabout 12/12/05

The Roundabout 07/06/05

The Roundabout 16/02/05

The Roundabout 09/08/04

The Roundabout 20/01/04

The Roundabout 26/08/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Roundabout (The) 96 The Roundabout Northfield Birmingham B31 2TX Lead Inspector Monica Heaselgrave Key Unannounced Inspection 09:30 5 and 7th November 2007 th X10015.doc Version 1.40 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 Roundabout (The) DS0000033604.V348081.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 Older People. 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. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roundabout (The) Address 96 The Roundabout Northfield Birmingham B31 2TX 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) 0121 475 5509 0121 6755509 Not known Birmingham City Council (S) Dorothy Ann Adams Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That home is registered to accommodate 42 people over 65 years who are in need of care for reasons of old age or dementia. Registration category will be 42 OP, DE (E) That minimum staffing levels are maintained at 5 care assistants throughout waking day of 14.5 hours enabling there to be minimum of 2 staff per floor with an additional member of staff to provide support and cover between the two floors. That additional to above minimum staffing levels there must be two waking night care staff. That one named person who was under sixty-five years of age at the time of application can be accommodated and cared for in the home on a regular respite basis. That if in the future the service users needs change and they need a permanent placement that the home informs the Commission without delay. That the home can provide care and accommodation for service users with `working age` dementia. 30th October 2006 4. 5. 6. 7. Date of last inspection Brief Description of the Service: The Roundabout is a home operated by the Local Authority and is registered to care for 42 people, who are in need of care for reasons of old age or dementia. The home is situated in South Birmingham in the predominantly residential area of Northfield. The home is easily accessible by bus, and Longbridge railway station is nearby. The Roundabout was originally on three floors, but the lower ground floor is now a day centre run separately from the home. All bedrooms are single occupancy with a wash hand basin facility, and emergency call system. Bedrooms are located on the ground and first floor, with access via a passenger lift. One double room is shared by a married couple, who also have access to a second room, which has been furnished as their private lounge area. Toilets and bathrooms are suited to those people who require assistance. Facilities meet the needs of people living at the home. There is level access for wheelchair users to the front entrance and throughout the home. Corridors are Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 5 spacious and allow people to move around the home freely and safely. The home has hoisting equipment and adaptations available to support people who require assistance with mobility. An accessible well maintained garden area is available for people to enjoy. There is a large dining area, with bar, on the ground floor. People who live at the Home have the use of three lounge areas. The main kitchen, laundry room, office and medication storage room, are also located on the ground floor. The first floor has additional lounge areas, two smaller dining rooms and a small kitchen. There is a small patio area to the front and back of the home where people can sit out. The garden is mainly level and enclosed. Copies of the previous reports written about the Home are displayed on the notice board, which also displays information about forthcoming events and other articles that may be of interest. The current charge for living at the home is £66.65 per week and £136.00 per week. The fees payable by the people being admitted to the home are dependent on their assets, which are assessed by social workers. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over two days. The inspection included talking to people who live in the home, staff and the management team. The inspector spent time observing support and interactions from staff, had a tour of the premises including peoples bedrooms, looked at care records and health care records and medication management. Health and safety records and staffing records were also assessed. All information looked at was used to determine whether peoples varied needs are being effectively met. Four people were identified for close examination of their care and this included reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as “case tracking” where evidence is matched to outcomes for people who live at The Roundabout. The manager completed an AQAA (annual quality assurance assessment), which tells CSCI about how well home management believe the Home is performing and achieving outcomes for the people who live in the Home. It also provides some factual information about the Home. Information from the AQAA was used to help inform the inspection process. There had been one adult protection issue raised by the manager, this related to inappropriate behaviour by a person living in the home which was resolved satisfactorily. One complaint was made to the Commission, which was being investigated by the Provider at the time of this report. Questionnaires were sent out to relatives as part of the fieldwork for this inspection. Relatives were generally positive about the care provided at The Roundabout. Comments from these are included in this report. The Roundabout was last inspected in October 2006. At that time the manager was required to address a number of requirements to improve the safety and well being of vulnerable people. What the service does well: Health concerns are identified quickly meaning the needs of the people who live in the home are addressed in a timely manner. There are good arrangements in place to show how the nutritional needs of a person are met. Staff related well to the people that they care for, and showed skill in engaging those who had dementia. This ensures an inclusive approach for those people who find it difficult to initiate activities or conversations by themselves. People Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 7 described staff positively, for instance ‘Staff are very good, caring and never too busy’. Relatives commented, ‘The Home is top, excellent, really look after my mom’. People appeared well cared for with personal care needs met in a positive manner. Staff had a clear understanding of the need to protect people from potential abuse and know what to do when they have concerns. There are good systems in place to manage complaints; this gives people who live in the home confidence to use procedures. Recruitment procedures are robust ensuring that appropriate checks have been carried out before staff is employed to work in the Home, this gives greater assurances that vulnerable people will be safeguarded from risk. The Roundabout provides a clean, friendly, welcoming, well-maintained and comfortable environment for the people who live there. Ongoing training opportunities have ensured that staff has the skills to meet the particular needs of the people who live in the home, providing a skilled team of carers and good continuity of care. What has improved since the last inspection? The Roundabout was last inspected in October 2006. At that time the manager was required to address a number of requirements. New structured individual service statements have been set up that show how individuals need to be assisted over a 24 hour period. There are manual handling, nutritional and tissue viability assessments in place for all the people living in the Home this means risk factors are monitored more closely so that vulnerable people are not exposed to unnecessary risk. Gaps in planning have been addressed and care plans now include the arrangements for pressure care and continence management. Daily records have improved and show how people are responding to care and what activities they engage in, this helps staff to identify the routines and preferences of people who may, because of their dementia, be unable to voice their choices. Social and recreational opportunities for people who have dementia have improved, staff has structured the activities so that people can enjoy the things the used to do. Continued physical improvements have meant that people have a well maintained and comfortable home. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 8 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. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An established assessment and admission procedure means people can generally be confident that the Home will meet their needs and that they know what to expect from the Home. EVIDENCE: Arrangements are in place to support this aspect of the service, this includes improvements in carrying out home or hospital visits to prospective clients, and ensuring that all the necessary records and assessment of needs are in place, prior to a person moving in. Thorough assessment of need ensures that the manager has the information necessary in forming a judgement as to whether they can be certain to meet the assessed needs of a person. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 11 The files for five people admitted to the home were sampled. All the files included copies of pre-assessments and assessments undertaken by the manager of the home prior to the admission of the individuals. Areas looked at during the assessment were health, abilities, personal care, memory, and dementia. The assessment also included a summary of more personal routines and preferences, which were detailed under ‘About Me’ and ‘’Treasured Memories’. This had a short personal profile of the individual that related to their needs and or history. The inspector spoke with several people who live at The Roundabout. Their comments were positive, one said ‘The staff was friendly and gave us information about what the home offers before I decided to move in’. Surveys were sent to relatives to seek their views about the service offered at The Roundabout. One commented ‘My mom is in an excellent home, the support is Top’. The systems in place have all the key elements of good practice, which in turn, helps staff to support individuals right at the start of their stay. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been improvements in care planning which has meant that the people who live in the Home receive individualised care and identified risks are minimised. The management of medication is good and ensures people receive their medication in a timely and safe manner. People are treated with respect and are clearly happy in the company of staff. EVIDENCE: People who live at The Roundabout have a plan of care that identifies their needs and gives staff instructions how to meet their needs. These are called Individual Service Statements, (I.S.S.). The five files examined had a plan of care generated from the initial assessment. There were a number of concerns at the last visit to the Home, which related to inadequate care plans - they did not contain sufficient information, and key information of peoples’ care needs was not in their care plan. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 13 At this visit there had been several improvements made. The I.S.S. included a brief statement “About Me” that gave a good, short overview of the individual. For instance, ‘ my mood changes, I like to be left alone. I get feelings that my clothes have been taken, so I often hide them.’ Three files had no ‘About me’ profile. In one, more information could have been included in this section to alert staff to the character of the person and key points to consider, for instance sexual behaviour, alcohol abuse and physical neglect, or dementia and how these are likely to affect the persons behaviour and or capabilities. Another section ‘Treasured Memories’ included such comments as, ‘Went to the cup final in 1966. Birmingham City V Manchester City in 1965. Man City won 3-1’. This information ensures staff has some insight into an individuals history or interests, which is important when supporting people who have complex needs such as dementia. There was some detail in the ISS about how personal care was to be provided. Information about how incontinence was being managed included the pad size and frequency of changes. In one I.S.S. it stated the person was prone to physical and verbal aggression. The current intervention plan could not be located to show how/what steps are being taken to minimise risks. The inspector did see the previous plan that had some good detail about low arousal and distraction techniques, which could be used by staff to diffuse a situation. Individual risk assessments were in place these had been improved since the last visit and showed what steps were taken to minimise the risk and keep the person safe. For instance manual handling to show how a person is moved or supported, tissue viability to show where people are at risk of developing pressure sores and how these can be prevented. Nutritional screening risk assessments were seen which showed if a persons’ fluid and food intake was monitored and their weight taken regularly to identify any problems. A risk assessment was also in place to support a person who goes out independently along agreed routes. For another person there was a risk assessment to monitor alcohol intake, it was particularly good that this risk assessment identified what should change if the person had been drinking, for instance ‘do not use the bath if drinking heavily’. ‘Use medium sling with two staff to support the person’. Generally risk assessments in place provided some good instructions for staff. One person who returned from hospital on the day of the inspection visit had a temporary updated plan specifying how his needs are to be met. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 14 Records did show some people and or their representatives contributed to the review process. This was good and shows that there is a good level of inclusion in this process. People who live in the Home feel they are treated in a respectful manner, and their right to privacy is respected. Some comments received were, ‘Staff are kind, they talk to you help you when you need it, they are never too busy’. ‘Some people get mixed up and sometimes they are loud the staff talk to them’. ‘There’s always someone around to chat to or sit with quietly, and we have our entertainment nights where we really have some fun, yes there is some good times’. All the files sampled included health care records, these gave an overview of visiting professionals. It was clear from these that health care needs of the people living in the Home were met. There was evidence of visits from doctors, district nurses, medication reviews, and visits from the continence advisor, dentist and optician. Where necessary the advice of more specialised health care professionals was sought, for example, the Mental Health Team, and Consultant Psycho-geriatrician. The inspector found that this information is available but it is difficult to find it in the wealth of information provided. It was advised that a system is implemented where health care needs are catalogued in date order at the front of the file for quick reference and the same system is used for events such as accidents or incidents. The daily records were looked at, these had good detail in relation to the general well being of and the care given to the people living in the Home, making it much easier to determine if needs were being met. The terminology used in one record was inappropriate. There have been improvements in the arrangements for medication since the last visit. The medication administration records (MAR) were well kept. There were no gaps in signing for medication. Medication was secure. The medication round was observed, medication was administered correctly. The inspector was also given a copy of the medication procedures. Each staff member has been given a copy of these since the last visit, to ensure everyone follows procedures so that people receive their medication in a safe manner. The people raised no concerns about their privacy or dignity. Staff addressed people appropriately, and personal care was offered discreetly. All bedroom doors were lockable with keys available, although the majority of people do not utilise this due to their dementia. It was nice to see that staff sat and talked to people and reassured them. Staff had good insight into the care needs and preferred routines of people, and observations showed that staff knew who needs assistance and in what areas. For instance being aware of dynamics between people which are likely to cause Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 15 some friction, staff were careful to seat people away from others or engage them in activity, just a chat, or a cup of tea. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been continued improvement in meeting the social and recreational interests of people who have dementia. There is a more structured activities programme. Minor improvement in monitoring would ensure people have opportunities that suit their interests. The dietary needs of people are well met, they benefit from meals that are well presented, wholesome and varied. EVIDENCE: The individual Service Statement (I.S.S) was in place for the four people who were case tracked. These were seen to reflect their known interests, and the information was gathered from them and their family. This has been an improvement since the last visit to The Roundabout, staff are working towards building a profile of social interests for each person which is particularly important where people have dementia and may need a great deal of support to engage in meaningful activity. Some people spoken with said they enjoy the entertainment, often having celebrations, and parties are a regular feature. There is a bar facility that people enjoy in the evenings. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 17 Questionnaires returned from relatives had the following comments; ‘The care home does provide activities but more regular activity and stimulation would be nice to see.’ ‘I think it could only improve by providing more activities, otherwise it is good.’ Staff said that planning of activities has improved, there is an identified activity worker, and a poster displaying a range of planned activities to include; a choir visit, Irish dancing display and visiting entertainers for four different dates. The inspector also saw receipts for purchasing art therapy sessions and dance/movement sessions over a twenty-week period. Staff seeks the views of people as to the activities they prefer, this was reflected in the minutes of the resident meetings, individual reviews with people and their families, and surveys that the home had carried out for their quality review audits. It was positive to see that the daily records are beginning to include reference to the activities people engage in, this is important to ensure that people who have difficulty in stating their interests are given similar opportunities to their peers. There is still room for improvement; staff needs to be vigilant in monitoring the daily records on a monthly basis to ensure that people in the Home are being offered and taking up a variety of activity. Daily records for one month were looked at and the only reference in this was that the person enjoyed the visiting choir, the rest of the month’s entries related solely to the persons’ behaviour. More structured monitoring of records will enable staff to measure to what extent the goals of the I.S.S are being met. This will ensure that the care planned for the individual is ‘person centred’ designed to meet their individual needs. There was good written information to guide staff in supporting people with their personal needs. People are helped to exercise choices and make decisions, especially those people who have dementia or memory loss. People stated they are able to go to bed and get up when they chose and spend their time as they chose. Some have personalised their rooms to their choosing as seen during the tour of the home. Several people said they made their own decisions this included what they wore, what they ate, activities and attending church or other community amenities. The menus provided by the home were good and varied and comprised a fourweek rolling menu. People said, “The food is good ”. Staff was observed talking directly with people to establish their meal choices. The arrangements in place for some people who require monitoring of their food or fluid intake ensures that their nutritional needs are met. This information was clear in their care plan and showed what measures are being taken to address these needs. Nutritional screening for the people who live in the Home is well established. Those who are at risk from low body weight have monitoring forms on file this means that they are identified quickly and plans Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 18 made to monitor and improve their nutritional intake. There have been positive outcomes for people, some have had a significant weight increase, and meals have been improved in variety, with an increase in fresh fruit, and fibre and protein content. The menus were well planned and included good choices for teatime and suppertime. People said ‘The food is good, they look after us well’. The mealtime occasion was relaxed and sociable, staff assistance was discrete and supportive. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service knows when incidents need external input and who to refer the incident to. They have experience in the Safeguarding Adults Procedures, and how to keep people safe, this is particularly important where people are vulnerable due to their dementia and or behaviour. There has been a significant improvement in ‘risk management’, which means people who live at The Roundabout have safeguards in place to protect them from known dangers. EVIDENCE: The Commission received no complaints about this service over the last twelve months. The Provider was investigating a complaint made prior to the inspection. Some people who live at The Roundabout were clear that they would speak to the manager or other staff member if there were a problem. They were happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. One of the questions on the ‘Have Your Say’ questionnaires sent out to some of the relatives of people living in the home asks if they know how to make a complaint. All the questionnaires indicated that relatives were aware of how to do this. This is particularly important as a large percentage of the people who live at The Roundabout have dementia and would require a great deal of support or an advocate to act on their behalf. It was pleasing to see that Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 20 during the course of the day, when some people were clearly confused staff sat with them, conversed, and on every occasion they were welcomed, reassured and redirected. These observations clearly indicate that the majority of people who live at The Roundabout would be unable to raise a complaint independently. Staff is accustomed to individual behaviour, which helps to identify when someone is feeling ‘out of sorts’ and there may be a problem. It was positive to see records showing that staff have explained and read the procedures to people at the point of admission to the Home. Formats suited to the needs of older people such as large print, are available on request. The complaints records show that a record of the investigation, action taken and outcome is maintained, and that a letter informing the complainant of the outcome is sent. This ensures the complainant has the opportunity to say whether they are satisfied or not with the action taken. A compliments book is maintained which enables visitors to comment on the care delivered, the entries were positive. The monthly regulation 26 visits showed that compliments and complaints are audited, this is a good means of quality assurance and another means of the service being able to obtain the views of people in order to make any improvements. Last year an adult protection incident highlighted serious shortfalls in how staff recognise and respond to incidents where vulnerable people may be at risk, the manager was required to make several improvements to the practice. It was positive to note that staff training has been implemented in order to equip staff with the knowledge and skills necessary to keeping people safe. Staff training records showed that staff had received training in manual handling and dementia care, helping staff to recognise potentially abusive situations or risks and how to respond to them in order to safeguard people. The training matrix showed, that further training is planned in adult protection procedures and managing challenging behaviour. This is particularly important where staff needs to understand the difficulties people may experience due to their dementia, and how this may affect their behaviour towards others. The inspector spoke with several staff that was able to identify the strategies in place to reduce conflict between individuals; this ensures that vulnerable people are not exposed to risk or conflict. Staff have had training and guidance in recording techniques, there has been a big improvement in recording in detail, the facts of incidents, in this way staff can clearly see the incidents and how the individual responds to staff, this helps to plan an appropriate response and lesson the distress to the individual. The manager has ensured that regulation 37 reports are sent to the Commission to inform of incidents. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 21 Risk assessments were seen to show how the risk of falls was being minimised. Moving and handling risk assessments were seen to show how people are to be supported this ensures that vulnerable people are not placed at risk or harm when they are supported with the hoist. The management team have improved the systems in place so that care practices are monitored and the management of risks posed to people is reduced. One adult protection issue had been raised at the home since the last inspection. The issue had been appropriately addressed by the home. Any incident that may be deemed, as adult protection must be reported to social care and health. At the time of this inspection the manager had raised this with social care and health and the social worker had undertaken an assessment of the situation. This shows that the management team are well aware of how adult protection issues should be reported, which in turn safeguards people who live in the Home from risk. Some of the people living at the home have behaviours that can be difficult. Daily records suggested that one person had made sexual advances towards one or more other people in the home. The I.S.S. (care plan) stated the person is physically threatening and aggressive and lacks insight into their behaviour. Reactive strategies need to be in place to show how staff should respond to and manage this individual’s behaviours. This was discussed with the management team who gave a good insight into the steps taken to minimise this behaviour, but when the file was checked the person’s strategy was missing from the main file. It is important that a ‘master copy’ is retained. A second person described as ‘ vulnerable’ due to flirtatious behaviour had no detail in the ‘About me’ section of the I.S.S. The home was making some efforts to manage the situation but there were no plans that showed that the individual was being monitored. These records are needed to show how the person is being protected. The financial records for three people were seen. The records showed that peoples’ financial affairs are well maintained. The home had a Comforts Fund that is used to buy extra comforts for the people living in the Home, the money for this account came from donations or funds raised by staff. The records for this were checked and the funds were spent appropriately for the benefit of the people living in the Home. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,24,25, and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Roundabout provides a pleasant, safe place for people to live. There are appropriate specialist aids and equipment to meet the needs of the people who use the service. Continued improvements have been made which have improved the facilities and comfort for the people who live in the home, but some areas were in need of refurbishment. EVIDENCE: The Roundabout is located at the top of the road in a corner position overlooking nice well-kept grounds. It’s an old building built approximately thirty five years ago, and as such does not meet some of the current standards in relation to room sizes, or en-suite facilities. On going improvements to the facilities has led to a comfortable environment for the people who live in the Home. Improvements noted at this visit included; redecoration of the communal areas, dining room and redecoration of the bedrooms. Last year new beds and bed sets and carpets had been purchased and new commodes provided. The stairway and corridors had also been painted on the first floor. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 23 The Roundabout provides a service to people who have dementia. There is lots of ‘wear and tear’ associated with some of the behaviours people have. The majority of people in the Home are vulnerable, suffer memory loss and get easily confused, for these reasons it’s important to consider colours to help orientate them around the home. The ground floor corridors are particularly poor, the paint work, door frames and carpets are damaged and worn and now need to be replaced to ensure that the people who use the service are provided with a good environment, particularly as most of them spend considerable amounts of time within the Home due to their frailty and dementia and need to have a comfortable and positive environment. Last year the kitchen was refurbished with stainless steel fitments improving food safety, and a new hot trolley provided to ensure meals are provided at appropriate temperatures for people to enjoy. New light fittings, and an improved nurse call system make it a safer and more homely environment for people. Old worn chairs have been recovered so that people have appropriate and nice furnishings around them. . A partial tour of the building showed it to be a well-maintained comfortable and pleasant environment, which meets with the needs of the people who live in the Home. Bedrooms were pleasant and had a lot of personal touches and possessions, it was evident that staff, support people in this area to ensure they are comfortable and have nice surroundings. The inspector met with a group of people who live in the Home they were generally positive with the facilities and said the Home was comfortable and clean, however they also commented on the need to improve the downstairs corridors to make it a much nicer environment. On this and previous visits to the Home everywhere was clean, fresh, and comfortable, all areas viewed were hygienic. The Home felt warm in all the areas viewed, and regular temperature checks are maintained to ensure people are kept warm enough. Comments received from relatives in the questionnaires sent out to them were positive; ‘Cleanliness is excellent’. ‘They keep the place warm’. The toilets are not located near to peoples’ bedrooms; this is a previously unmet requirement. Toilets do provide good accessibility and space for those who require assistance or the use of aids. The bathing facilities are modern, nicely tiled and provide for the current needs of people to include assisted bathing facilities, specialist baths and hoist equipment. This means people can be assisted in a safe and comfortable manner. The office area is very much a ‘hub’ of activity people who live at The Roundabout regularly gravitate to the office. They clearly enjoy the open door policy and sit in the office area having a chat or cup of tea. This is also a work Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 24 area for staff and it is nice to see that this too has benefited from some redecoration. As this is often the first point of contact for visitors it’s a much more positive impression of the professional status of the home. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have confidence in the staff. Training is focussed on improving outcomes for people who live at The Roundabout. Staffing levels provide sufficient numbers of trained staff to meet the needs of the people who live in the Home. Recruitment procedures are robust and provide safeguards for vulnerable people. EVIDENCE: Discussions with the manager and the information received on the AQAA evidenced that there had been little staff turnover at the Home. This was very good for the continuity of care for the people living at the Roundabout. There were some vacant hours that were being covered via agency staff. Interviews to recruit to these posts were planned for the 8th November. Staffing levels at the time of the inspection appeared appropriate for the needs of the people living in the Home. Rotas looked at showed some changes of shifts these were explained as staff taking annual leaves. Staff spoken with, were satisfied with their working arrangements. People living in the home were very happy with the staff team. Seven questionnaires were received from relatives and their comments were positive: ‘Staff understand the difficulties experienced by the people in the Home and deal with this in a professional manner’. ‘A good all round service, especially considering moms’ dementia’. ‘They attend to my moms’ every need’. ‘I feel the care home is fine just the way it is, they look after my mom very well’. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 26 The files for three staff were sampled. All three files contained the appropriate recruitment information ensuring checks are made prior to people taking up employment which safeguards vulnerable people. The inspector also sampled checks made on agency staff and it was good to see that the same recruitment checks are carried out and asked for prior to people from the agency working shifts in the Home. There was also a record of the qualifications, training and induction undertaken by the agency staff and it was good to see that where procedures or guidance had been given to permanent staff, copies of this were also evident on agency staff files ensuring they had the same information to support them in their work. The information received from the manager prior to the inspection and the training matrix viewed showed that over eighty percent of staff was qualified to NVQ level 2 or above, twenty one staff had completed training on infection control, ninety two percent on dementia care and sixty seven percent on adult protection. The inspector saw requests for further training in adult protection, activity planning, care plans and value base. The manager is proposing to complete the updating of staff training records and obtain more training in managing challenging behaviour and dementia care. Aspects of this training are specific to the needs of the people living at the Roundabout and will ensure that staff is equipped to meet the needs of the people in their care. A previous requirement was made in relation to recording continence management, and pressure care prevention on the care plan. This has been addressed. There has been continued improvement in ensuring a competent and appropriately skilled staff team supports people. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home with an inclusive atmosphere that enables people who live there and their families to feel involved and valued. There has been improvements in managing ‘risk’ and monitoring the care practice so that any problems with the service are acted upon to improve the outcomes for the people who live in the Home. The health and safety of the people living in the Home is well managed. EVIDENCE: The manager is experienced in the conditions that affect older people. She holds the NVQ level 4 in management and care and the Registered Managers Award. She has several years of experience in caring for older persons, and managing a staff team. She holds a diploma in managing care services and has undertaken periodic training to update her skills in the management role of Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 28 running a home for older people who have dementia. The manager has ensured that previous requirements made have been addressed in a timely manner and she continues to work towards providing a good quality service with a stable and committed staff group. Over the last twelve months there has been some disruption to the management team, the registered manager has been supporting another establishment and spends only short periods at The Roundabout to oversee the running of the Home, which is effectively being managed by the assistant manager on a daily basis. Both were present for the inspection and felt that overall this arrangement had worked, and that support was on hand when needed. The manager and assistant manager both had good relationships with the people living in the Home, people had no hesitation in approaching them with any queries or issues. The inspector received questionnaires from relatives these showed they were satisfied with the care standards this service provides. Relatives felt that their concerns are listened to and that they are made welcome and kept involved. Some comments received were, ‘The monitoring of healthcare is very good.’ ‘The staff are always approachable and there seems to be a relaxed approach to the clients’. ‘I would like to see more stimulation, regular activities to maintain the level of alertness, this is much needed’. ‘I think it could be improved by providing more stimulation and activities for residents to encourage physical and mental health’. The information provided by the Home prior to the inspection also identified ‘activities’ as an area for improvement and the training matrix showed training had been booked for ‘activity planning’, it is good to see therefore that the Home is in tune with the needs of the people they care for and have taken steps to improve this area. This will improve outcomes for people who live at The Roundabout. There are lots of platforms to encourage the inclusion of people in how the home is run; regular house meetings are held, regular audits are carried out, both by the manager, team manager and cross homes audits which consists of a manager from another home calling unannounced and auditing the practice. . It is evident that the views of people who use the service are actively sought and used to improve outcomes for people who live at The Roundabout. A compliments book is available with many positive comments as to the efforts of the manager and team in meeting the needs of people who live in the Home. Visits are taking place by the Registered provider on a monthly basis, copies of these reports showed that where shortfalls are identified these are acted upon; this ensures that the Home can take steps to avoid compromising the care of people using the service. Some of the people living in the home managed their own money the records for this were sampled and were found to be appropriate. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 29 Health and safety in the home is well managed. Staff had received training in safe working practices and the manager ensured all the required safety checks on the equipment in the Home were carried out. Records seen matched the servicing information sent to the Commission prior to the inspection. Risk assessments were in place for all safe working practices. There had been a big improvement in providing detailed risk assessments for the people in the Home who because of their dementia or behaviour, needed to be protected. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X X Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations To ensure that the people living in the home are safe guarded, there must be strategies in place to manage those behaviours that carry a degree of ‘risk’ for the vulnerable person. It is important that a ‘master copy’ is retained on the persons’ file to keep staff up to date. All I.S.S. ’s should be completed to include the ‘About Me’ section. This will ensure the current needs of all the people living in the home, are known to staff. It’s recommended that healthcare appointments and incidents be catalogued at the front of the file. This will ensure information can be easily tracked and shortfalls easily identified. Further work is required in expanding the range of activities available to people who live in the Home. This will ensure that people have planned activity time and stimulating opportunities. DS0000033604.V348081.R01.S.doc Version 5.2 Page 32 2 3 OP7 OP8 4 OP12 Roundabout (The) 5. 6 7 OP12 OP19 OP21 Staff should record all activities that people take part in, and review these to ensure they meet with the goals in the care plan. To ensure the home is kept to an acceptable standard for the people living there, Redecoration and replacement of carpets in the ground floor corridors is needed. This requirement becomes a recommendation because it does not pose a risk to people who live in the Home. To ensure people can access the toilets without difficulty, the location of toilets should be kept under review. Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Roundabout (The) DS0000033604.V348081.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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