Inspection on 10/04/07 for 1-3 Adams Street

This inspection was carried out on 10th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-3 Adams Street 29/05/08

1-3 Adams Street 05/02/07

1-3 Adams Street 22/11/05

1-3 Adams Street 19/08/05

1-3 Adams Street 07/01/05

1-3 Adams Street 25/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1-3 Adams Street West Bromwich West Midlands B70 9TH Lead Inspector Mrs Cathy Moore Unannounced Inspection 10th April 2007 07:45 1-3 Adams Street DS0000004806.V330325.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 1-3 Adams Street DS0000004806.V330325.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. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1-3 Adams Street Address West Bromwich West Midlands B70 9TH 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 532 6623 0121 505 7808 Pioneer Care Limited vacant post Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Adam Street is made up of two converted residential dwellings. It is located in the heart of a residential area of West Bromwich. The home is close to shops and local amenities, and close to a public transport route. Adam Street provides care for three people with learning disabilities and is owned by Pioneer Care Ltd. The front door can be accessed via a ramp or steps. The home is set out on two floors providing single bedrooms, one with en-suite space. There are shower and bathing facilities and an office on the first floor, a toilet, two lounges (one smoking) and dining and kitchen facilities on the ground floor. There is car parking on the street, and a front and rear garden. There are no lifts provided within the home and therefore the home may not be suitable for somebody with mobility difficulties. Weekly fees at present for this service range from £ 566.98 - £819.87. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on one day by one inspector between 07.45 and 18.15 hours. Prior to the inspection information was sent to the management and service users’ for completion in order for views on the service to be gained. I indirectly observed all service users,’ their exchanges with staff and heard some conversations. I spoke with two service users’ and three staff . The acting manager was involved in the inspection throughout the day. I looked at two service users’ files focussing on care planning, daily records and risk assessment processes. I looked at four staff files to see what recruitment and training practices were like. I looked at medication systems to judge their safety and health and safety records. I looked at the premises which included; two bedrooms, the bathroom and shower room, laundry, lounges, dining room, kitchen and garden. What the service does well: The homes’ atmosphere is very positive. The staff and service users’ were very friendly and helpful. The acting manager and staff are very keen to continue with improvements within the home to make sure that outcomes for service users’, are satisfactory. The home is of a good size for the three service users’ who reside there. It is comfortable, domestic in style with a ‘ homely’ feel. The ‘hand wash’ signs in the bath and shower rooms were the best seen I have ever seen in terms of instruction and their easy to read/ pictorial style. The home has its own transport allowing service users’ access to the local and wider community on a regular basis. Medication systems were generally found to be managed well and be reasonably safe. Service users’ are very much encouraged to be involved in the running of the home for example; on my arrival one service user showed me around and told me about the practical arrangements for fire safety. They are also very much encouraged to learn new/ or practice life skills such as ‘ cleaning ,cooking and shopping. There are no set times for meals. Service users’ can if they wish choose what they eat when they want. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 6 All service users’ are offered the opportunity of an annual holiday. They are going to Spain in the near future. One service user is supported to attend church every Sunday with his family. It was clear from speaking to staff that they enjoyed their work. One said; “It is very interesting and rewarding”. Another said; “ We work well as a team”. One other staff member said, “ Unlike other places the manager is very helpful and approachable”. What has improved since the last inspection? What they could do better: Previously the management of this home was of a concern. However, since the new acting manager has been in post the last two inspections have identified many areas of improvement, which is very positive. Staff and service users’ should congratulate themselves on their achievements to date. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 7 The manager inherited much work and practices which could not be described as good, but has continued to address areas in order of priority to improve . However, there is a lot of work still to do examples being; care planning for the remaining two service users, risk assessment, decorating of the premises and further addressing infection control matters. To hasten this process and to ensure that requirements made in this report are met the manager needs more supernumerary hours. Staff training needs to be secured in areas such as’ communication, abuse awareness, challenging behaviour and formal first aid and food hygiene. I was very concerned to identify that two service users’ are paying weekly fees ‘Top up’ to the organisation yet their terms and conditions state that Sandwell Social Inclusion are paying their full fees. The Commission is exploring this issue further. Concerns were raised in that one service user had paid for his own bedding and pillow out of his own money. Checks of service user financial records showed some withdrawals of money, which had not been confirmed by two signatures. I asked questions and raised concern about the leasing arrangements for the property, the Commission is also exploring this issue further. 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. 1-3 Adams Street DS0000004806.V330325.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 1-3 Adams Street DS0000004806.V330325.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): 1,2,5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information ,is available to prospective people however, this needs to be updated. Evidence was not available to show that all service users’ are reviewed at least annually by their funding authorities’ . Terms and conditions documents show inaccurate information. EVIDENCE: I saw that the home has a statement of purpose and service user guide. I saw written evidence on service user files to confirm that they have been made aware/ or shown these documents. The manager told me that he is working to update these documents to ensure they are accuratefor example; up to date information including staff qualifications were not included. The manager also told me that he was working to produce a new admissions policy. At the time of the inspection an admissions policy was not available for me to look at. It is positive that since the last inspection the manager has obtained a copy of the Commission document titled ‘ Inspecting for better lives’. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 10 Although the manager looked for written evidence there was nothing available to confirm that two of the service users’ have been reviewed recently by their funding authorities. This means funding authorities have not got up top date information of the care and other issues concerning these service users’ and that service users’ are not being given the formal opportunity to discuss their care. I was confused and concerned when I looked at terms and conditions- ‘ service user agreements’. One document ( dated 4/1/07) stated the weekly fee of £819.87- fee to be paid Sandwell Social Inclusion. Yet the personal finance records for this service user showed weekly withdrawals of £ 117.05 ‘ Top up’ or ‘ Taken to office’ as follows; 22/2/07 £117.05 ‘top up taken to office’, 7/3/07 £117.05 ‘top up money’, 14/3/07 ‘top up money’, 21/3/07 £117.05 ‘ taken to office’. The manager confirmed that this money was ‘rent’. There were no financial assessment papers on file ( for example, an AC8 document for Sandwell service users’) to confirm who is paying the fees, or if indeed, the weekly amount paid by the service user ( top up, rent ) has been agreed with Sandwell. The same issue was raised concerning another service user. There was evidence that £62. 25 of his money is being paid to ‘ The office’ every week but his ‘Service user agreement’ says that fees are ‘being paid by Sandwell’. The Commission is exploring these issues further. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls continue concerning care plans however, one of the three, care plan re-productions has nearly been completed which is of a much better standard. There was ample evidence to confirm that service users’ are all encouraged to make decisions about their lives and are consulted with about the operation of the home. EVIDENCE: For a number of years the standard of care plans within the home have been poor in terms of content and lack of review processes. A new manager was appointed in December 2006 who is aware of the shortfalls and what needs to be done. The updating/ reproducing of one of the three, service user care plans has nearly been completed. I saw this care plan, it held information on a range of care need subjects and has been produced in a mixture of writing and 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 12 pictures to aid understanding. The manager confirmed that the; “ Service user has been involved in putting it together”. I informed the manager of areas that needed to be added to ensure the care plan will be effective examples being; religious observance to include staff being aware of last rites as the faith of this person is Catholic, personal environment and satisfaction with what is provided in the bedroom against the National Minimum Standards, personal choices and needs, behaviour management and triggers to inform staff to prevent of behaviours’ which, may challenge the service. Care plans for the other two service users’ have yet to be re-produced/ updated. The manager confirmed that one service user will be; “ producing his own care plan with the help of staff”. It was extremely positive to observe and hear staff throughout the inspection, encouraging service users’ to make decisions. I heard staff asking service users’ what they wanted to do, where they wanted to go, what they wanted to eat and when. On entering the home one service user was asked to show me around ( to include his bedroom) and inform me of the fire procedures, which he did very well. I saw records concerning a process called ‘ Talk time’ where regularly service users’ are spoken to on a one to one basis and asked about their lives, routines, personal goals and aspirations. Following these sessions an action plan with timescales is produced in order for, where possible, these needs and wants to be met. I saw that a schedule of meetings has been produced and records to show that two service user meetings have been held recently- which is very positive. Discussion with the manager and viewing records indicated that there is still work to do in terms of personal risk assessment. One service user’ has displayed some behaviour which at times challenges the service. Rightly, the manager has referred this service user to Heath Lane for reassessment there may have to be new risk assessments put in place following this reassessment. 1-3 Adams Street DS0000004806.V330325.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. Service users’ are generally supported by the service to make choices about their lifestyle and to enhance their every day life skills. EVIDENCE: The manager told me that two of the three service users’ attend structured facilities in the community on a regular basis. I saw written evidence on one service user file to confirm that he attends a ‘drop in centre’ on Mondays and Fridays and college on Thursdays. Daily notes confirmed this further as follows; 18/01/07 ‘ attended college’. The service users’ living at this home are fortunate in that transport is available at all times enabling them to access the wider community on a regular basis. Easter bank holiday all service users’ went out for a picnic and then to a car boot sale. When the manager was telling me about this one 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 14 service user was listening and smiling indicating that he had enjoyed the outing. Activity planning, provision and recording has improved tremendously since the new manager has been in post. I saw written evidence on all service users’ files to confirm that they are asked weekly what activities they want to do the following week. An individual weekly activity plan is then produced and written records confirm activities undertaken or if there has been a change for whatever reason, then this is also recorded. One staff member told me ; “ We are all looking forward to the summer as we are planning to take the service users’ out on a lot more trips and outings”. It was pleasing to see written evidence to confirm that one service user who likes to follow his Catholic religion has this need met, as he attends church every Sunday. There was plenty of written evidence to confirm outside activities are undertaken by service users either based on leisure needs, or life skill needs for example; one service users notes read “ Out in the car to help do food shopping”. “ Out doing errands”. During the inspection I was aware of one service user who kept going out doing personal tasks for himself, one time was to the shop. Another service user went to the shop with a staff member. The manager told me that he and another staff member are escorting the three service users’ on holiday to Spain at the end of April 2007. One service user was nearby during this conversation and kept smiling. I was told by the manager that all service users’ have been to Spain before. I was interested to hear that one service user did not want night flights so he was encouraged by the manager to personally address this with the organisations head office. The outcome being- arrangements have been confirmed that the flights to Spain and back are during the day and are now to his satisfaction. I was interested to hear that the manager, since being in post, has taken time to establish and improve links with service users’ families. One service user had not had contact with his mother for many years but encouraged by home staff, sent her a gift, she in return had sent him a card. I saw that records have been put into place to document all contact staff/ service users have with families. One service user regularly stays overnight at his parents’ house, which is very positive. I noted from records that one of the three service users’ does not have any next of kin. I discussed with manager the possibility of an independent advocate being arranged for him, if he would like one. Service users’ choose the menus for the following week. On the day of the inspection one service user had chosen the main evening meal of stew, potatoes and vegetables. During the day I saw service users’ helping themselves to drinks and snacks. One service user kindly made me a number of drinks. At lunch time I heard staff asking service users’ what they would like to eat. All were encouraged to make their own lunch. One service user told me “ I have had some ice- cream- 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 15 it’s nice. I opened the box and have written the date on it”, this indicating that service users’ have an awareness of food safety, which is very good. Food stocks were ample. I saw that there was for example; plenty of fresh fruit, salad and vegetables. The manager told me “ As far as possible we use and cook fresh food rather that ready made”. I saw that the dining room table was nicely laid with artificial flowers, a cloth, mats and condiments. I looked at food intake charts. These are being completed consistently and to a fairly good standard. The one thing I did note was the lack of recording of fresh fruit intake. The manager told me that service users;’ “ Very often have fresh fruit between meals but this is not recorded”. He further said; “I will make sure it is recorded from now on”. There was no evidence to suggest that the dietary needs of service users’ have been assessed, as they should. However, I did note from a letter dated 11/10/06 that the irregular eating habits of one service user had been brought to the attention of a doctor who had prescribed as a short term measure, ‘ a nutritious supplement drink’. I gave the manager a leaflet that has been produced by Sandwell called ‘ Five for life’. This leaflet gives contact details for a nutritionist who has confirmed to the Commission that she is happy to assess dietary intake in individual care homes’. 1-3 Adams Street DS0000004806.V330325.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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Observations confirmed that staff show respect to service users’ and allow them privacy. ‘Fine tuning’ to evidence the full range of health care services is needed. Medication systems generally are managed well but need attention to two areas. EVIDENCE: I made observations during the inspection and identified that staff showed respect to service users and allowed them privacy examples of evidence are as follows; On the new care plan I saw that the preferred name of the service user had been recorded to ensure that he is addressed by this name. The service user who showed me around the home said; “ That is.. bedroom- we can not go in there without his permission”- demonstrating that service users’ have been informed about respecting each others’ privacy. Further, the service user who showed me around had a key to his bedroom door, which he used ,when he showed me his bedroom. Toilet and bathroom doors are fitted with 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 17 working locks to further enhance privacy and dignity. Throughout the inspection staff spoke to service users’ politely and sensitively. One concern that I did note from records was an entry made on one service user file which read; ‘ 19/03/07 well behaved when out’ and on another day ’ well behaved’ which is not age appropriate. It was evident from my observations during the day that staff encourage, where possible, service users’ to manage their own personal care/ hygiene needs which is positive. The new care plan that I saw was good in that it gave staff clear instructions on how to care for that service users’ personal care needs from how he likes his teeth to be cleaned and what to use, to how he likes to the bathed and shaved. I found it positive to see that staff weigh and monitor each service users’ weight regularly and that nutritional screening tools are in operation. Since the last inspection the manager has obtained ‘health screening assessment’ tools for the service users’ for better assessment and monitoring of health care needs. I saw evidence to prove that one service user has been referred and seen by healthcare services for well person screening. However, for another it was confusing in that an appointment for this service for one service user in the early part of the year had been cancelled and a new date given for 10/07 which is a long time to wait. The manager told me that this person had already received screening unfortunately, I could not find any written record of this. I looked at medication systems, I saw that the home has not yet purchased an approved medication cupboard, the manager however, confirmed that this would be addressed. The homes’ pharmacy provider has been changed recently, the manager told me; “ The system is better than the last one”. I saw that the home does not hold a lot of medications. Most service users’ are only prescribed a few each. I saw that all service users’ had been prescribed paracetomol on an ‘ as required’ basis. The manager told me that this; “Was in case they had a headache or anything else. It was best that the doctor prescribes this just in case”. This prevents complications with having to use homely remedy methods. It was positive that an; ‘ As required’ care plan had been produced for each service user to instruct staff when this medication should be given. No controlled medication was being prescribed when I checked the medication systems however, it was positive to see that the home has a controlled drug register in case needed in the future. I looked at medication records and saw that there were no gaps in staff signatures which means, records are being completed accurately and consistently. I saw that an up to date staff signature list has been produced to enable the manager to identify individual staff/ who was responsible if a problem with medication occurred. I did not see any evidence to demonstrate that one waking night staff has received medication training. The manager confirmed that; “she has not had medication training. If needed, the sleep-in staff member would be woken”. This process somewhat defeats the object of having waking and sleeping- in staff and is not adequate in terms of responsibility and accountability. For 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 18 example; if a service user needed ‘ as required’ medication now or in the future it would be the waking night staff member who had observed/ had contact with the service use to come to the decision that the medication was needed, but it would be a staff member who had not been involved with that service user who would actually have to give the medication and take the responsibility. 1-3 Adams Street DS0000004806.V330325.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 adequate This judgement has been made using available evidence including a visit to this service. Complaints procedures available for service users’ and their representatives to access, service users’ are informed of these procedures regularly by staff. Some areas concerning protection need further development, exploration and clarity. EVIDENCE: The home has not received any complaints. The Commission has not received any complaints about the home. A complaints procedure is available to all service users’ and their families. These are available in written and part pictorial versions. I saw that a copy of the complaints procedure was attached to one, service users’ terms and conditions document. When I looked at records concerning meetings and talk time written documentation confirmed that service users’ are reminded regularly about the complaints procedure and are asked if they are happy. A number of staff have received abuse awareness training, but not all. I discussed abuse awareness training with the manager as generally if it is not delivered by Councils’ then the vulnerable adults procedures for that council are not discussed to ensure staff know what they must do if an incident or allegation of abuse were to occur. I was pleased to see however, that the Councils ‘vulnerable adult procedures’ were mentioned in the homes’ in-house protection processes. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 20 I asked staff what they would do if they were told that a staff member hit a service user and got the following answer; “ I would tell the manager”. “ I would tell the person in charge”. I looked at the personal finance safekeeping processes in place concerning service users’ money. I saw that all money is safely locked away and that written records are maintained regarding deposits , withdrawals and expenditure which ensures safety. I was concerned however, about the following; One not the required two signatures had only verified a small number of financial transactions. There were no written agreements available between the home and the service user/ or the home and Sandwell Council to confirm what is and what is not included in the weekly fee rates. I saw records for expenditure for transport mostly taxi fares , bedding etc where the service users’ had funded these out of their own personal money. Examples being; 24/11/06 ‘ taxi doctors’ £3. 7/3/07 pillow £5. 7/3/07 new bed linen and bath set £25.95. 1-3 Adams Street DS0000004806.V330325.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): 24,25,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Generally, the environment is safe and comfortable and ‘ homely ’ in style. Some work is needed concerning re-decoration , personal needs in private space and infection control processes. EVIDENCE: I found the home’s atmosphere to be positive, warm, welcoming and friendly. The home is of a generous size. It offers two living rooms, a dining room a first floor bathroom and ground floor shower. The home also has a good size garden to the rear. All window frames are made of UPVC. They look nice and obviously only require minimal maintenance. The home has some decorating needs examples being; the first floor bathroom, bedrooms and some paintwork. The manager was not able to show me a full – forward thinking maintenance programme or written evidence to 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 22 show that a formal audit of the home’s redecoration or replacement needs has been carried out. However, the manager was aware of some redecorating needs and had documented a few areas that he felt needs attention. One staff member told me; “ We want to do some redecorating when the service users;’ are away on holiday. One room I would like to do is the bathroom. We have begun asking the service users’ there preferences for redecorating this room. I saw that the garden is of a good size, is fenced all around, but is in need of a good tidy for example; the grass needs cutting. The manager told me; “ I am going to do the garden soon, cut the grass and dig out bigger borders”. I was interested to hear that one service user has requested a new greenhouse, as he likes undertaking gardening tasks. All bedrooms are of single occupancy. I briefly saw one service user’s bedroom. Another, I went into. The service user himself showed his bedroom to me. This room looked comfortable and was personalised with his personal belongings. He was proud of his bedroom and told me; “ I really like my bedroom”. I did not see any evidence during the inspection to confirm that service users’ are being asked regularly if they are satisfied with the fittings/ fixtures and furniture provided in their bedrooms as they should be. A number of infection control issues raised during the last inspection are in the process of being addressed which is positive. The ‘ hand wash’ signs in the shower and bathroom are the best I have ever seen in terms of basic, but sound instruction and their pictorial format. A couple of infection control issues were raised which need to be addressed to prevent infection transmission. Examples being; I saw a body ‘buff’ sponge in the ground floor shower room and a jug in the first floor bathroom. If items such as these are used then they must be used for the individual only and returned to their room after use. Similarly, although a nice touch three service users dressing gowns were kept on hooks in the bathroom where they could be easily contaminated by airborne bacteria or hand contamination if touched by someone after using the toilet. 1-3 Adams Street DS0000004806.V330325.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. Generally, staff appear to have appropriate skills and are in sufficient numbers to support the people who live in the home. The managers must be enabled to have a greater number of supernumerary hours to effectively manage the home and make the further improvements and changes needed and staff require further training in order to maintain and enhance their knowledge and skill attainment. EVIDENCE: The manager told me that he had good contacts with a number of training providers and is in the process of addressing staff access to NVQ, communication, record writing and other training. As for example; NVQ training is lacking at the present. I saw evidence on two staff files to confirm that they have completed two LADAF modules which is positive. The staff that I saw and spoke to during the inspection were helpful, , informative and friendly. They all confirmed that they enjoyed their work and found it “Rewarding” and “ Interesting”. Staff also told me that there had been a turnover. Some staff have left, and new ones have started. One staff 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 24 member said; “ The new ones that have stated are very good, they are very good with the service users”. Another said; “ We work together well, as a team”. Staff/ service user interactions observed during the inspection were positive. I saw staff giving service users’ their full attention, when they spoke to them there was good eye contact and they gave them choices. Staff recruitment processes need further development whilst I was pleased when I saw that organisation of staff files, that staff have been given copies of the General Care Council codes of conduct and practice and evidence that all staff have been checked properly by the Criminal Records Bureau was available I also identified some shortfalls. One staff member had declared a physical problem on the health declaration but no risk assessment/ action plan had been carried out to reduce risk. One staff member’s induction had not been completed and there was no photo on file for her. Not all staff files held official evidence of their home address. Employment history for staff only goes back to 2004. Forms, staff are asked to complete such as; for working time directive and confidentiality do not have provision for them to put in the date they have signed the form which could invalidate them. Reference forms do not ask referees to stamp form/ or other to confirm the name of their company for better and more accurate auditing and cross referencing of recruitment practices. Each staff file that I looked at had evidence to confirm that they have received formal supervision which is positive as this has been lacking in the past. The manager told me that he has produced a supervision schedule to work to in the future to ensure that all staff receive supervision regularly. I saw a copy of this schedule on the office wall. The manager also told me that he will in the near future commence a staff appraisal system. 1-3 Adams Street DS0000004806.V330325.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): 37,38,39,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager operates the home with an ‘openness’ with encouragement for service user involvement and consultation. More work is needed to ensure that an effective on-going self- assessment of service process is in place. EVIDENCE: A new manager was appointed and commenced work in December 2006. From conversation and observation during the inspection I saw that he is very motivated, interested in his work and keen to meet requirements and improve the home. I saw that his interactions with the service users and staff alike were positive in the tone of voice that he used and his politeness. He at all times encouraged service users’ to make decisions a good example of this was 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 26 at lunch time when I heard him encouraging each service user to choose their food and help prepare it. His first six months are ‘ probationary’ after this time he assured me that he will, make an application to the Commission concerning his required registration. It was clear from my observations throughout the day and from reading records, that the home is run around the needs of the service users’ rather than routine, which is extremely positive. Quality assurance processes are in place an examples being; ‘ Talk time’ methods, where service users’ are asked a range of questions regularly concerning their goals and aspirations and general satisfaction with the home. I was interested to hear about the ‘ Happy gathering’ meetings that have been established by the organisation where a service user from each of their homes’ is asked to attend as a representative, I saw records to confirm that a service user from this home attends these meetings regularly. I was impressed by the time spent each month and level of assessment undertaken by the senior manager during her monthly Regulation 26 visits for example; I saw records for each month confirming that she is in the home for at least seven hours each time assessing for example, records, the service provided to individual service users’ and the environment . I randomly looked at health and safety records for example; fire safety / gas servicing documents and was satisfied with these with one exception, which was the lack of evidence to show that an assessment for asbestos has been carried out. I was pleased when I saw records to confirm that the electrical appliance testing had been carried out in 01/07, that a fire drill had been carried out on 15/03/07 and that in-house checks of fire prevention/ fighting equipment had been carried out at the beginning of April 07. I did note that there was exposed hot pipe work in the ground floor shower room which would benefit from some protection to prevent the possibility of accident. I was concerned when I looked at staff training certificates for subjects such as; 1st aid and food hygiene as I saw that video rather than an accredited trainer had delivered the training. Although it is the providers’ decision and risk, regarding the training methods they use, with the exception of initial induction purposes, I question the effectiveness of this video training method, especially in these important subjects. I saw that only one entry has been had been entered in the accident book, this concerned a staff member- this indicating that accident prevention within the home is good. I assessed the kitchen and found this mostly to be in order concerning records and food hygiene with the exception of a couple of issues as follows; paint was peeling on the wall inside one wall cupboard where food was stored. I saw that a packet of biscuits and a packet of cakes when opened had not been stored in an airtight container as they should have been. When I brought these issues to the managers attention he immediately stored the biscuits and cake properly and told me; “ The inside of the cupboard will be sorted today”. 1-3 Adams Street DS0000004806.V330325.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 2 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 2 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 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 3 2 2 x 2 3 2 x x 2 x 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 28 Yes 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 YA1 Regulation 4,5,6 Requirement The Registered Provider must review the Statement of Purpose ensuring staff qualifications are included - not met. Requirement originally made July 2006. The statement of purpose, service user guide and contracts of residency must reflect amendments to the Care Home Regulations 2001. 2 YA2 16(1) 23(1) Review the admission policy for the home ensuring the accuracy of the admissions criteria - part met. Requirement first made October 2003. The admissions policy must include clear and detailed information informing people that they will not be able to live at the home if they have a physical disability unless the home applies for a variation of registration and that this is approved by CSCI. 31/05/07 Timescale for action 31/05/07 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 29 3 YA2 14 The registered persons must ask Social Services to carry out a review for (P) and (J). The following must be discussed and clarified for (P); The holding of the will , tenancy agreement and rights/ capacity in terms of the operation of the home in ‘his home’. Advocacy services/ financial contributions. Copies of the minutes from these reviews must be provided to the Commission. The registered persons must ensure that a copy of an up to date financial assessment (for example in Sandwell this is known as a AC8) is on file for each service user which clearly details; Weekly fees Service user contributions Who is responsible for what contribution. This information must then be fully reflected in each service users’ terms and conditions agreement. This document must clearly state what is included in the fees and what is not. Copies must be provided to the Commission. 30/04/07 4 YA5 4 30/04/07 5 YA6 15 Care plans must be introduced for all identified needs including personal, health, social, emotional and financial needs. These must be based on each person’s needs and capabilities and be regularly reviewed. Care plans must include specific 31/05/07 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 30 aims and goals. (They must also contain the following; ant religious observances , complaints and protection, behaviour management and triggers, personal space requirements including furniture, fixtures and fittings). The home must be able to evidence that service users are actively involved in the compilation and reviewing of care plans. Timescale of 31/03/07 not fully met. 6 YA9 13(4) That risk assessments are completed for all identified needs. That risk assessments are regularly reviewed. Timescale of 31/03/07 not fully met. 7 YA17 17(2) Sched 4 (13) The registered persons must be able to evidence at all times that fresh fruit is offered to service users. Where fresh fruit is eaten then this must be recorded. That the home purchases a medication cabinet that complies with the Misuse of Drugs Act 1989. The registered provider must ensure that all waking night staff receive accredited medication training. That the home reviews its protection and physical DS0000004806.V330325.R01.S.doc 31/05/07 01/05/07 8 YA20 13(2) 31/05/07 9 YA20 13(2) 01/06/07 10 YA23 13(6) 31/05/07 1-3 Adams Street Version 5.2 Page 31 intervention policies and ensure they comply with relevant legislation. That all staff undertake physical intervention and challenging behaviour training, with certificates maintained. 11 YA23 13(6) 17(2) The registered providers must ensure that two signatures (staff or one staff and the service user) confirm all financial transactions concerning service user money. The registered providers must ensure that Sandwell Council are asked to confirm in writing what ;’ house hold’ items and transport service users’ can pay out of the own money and what they can not be charged for. In the interim staff must cease allowing service users’ to purchase personal items for their bedrooms such as bed linen and pillows. The registered persons must ensure that all staff receive abuse awareness training. That advice be sought from the Environmental Health Department with regards to the current situation for smoking in the home and legislation that will take effect from July 2007. That advice be sought and action taken to ensure efforts are made that the home and grounds comply with the Disability Discrimination Act. The manager was able to evidence that communication has started with environmental health for this to be addressed. 23/04/07 12 YA23 17(2) Sched 4 (8) 28/04/07 13 14 YA23 YA24 13(6) 16(2)(j) 31/05/07 31/05/07 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 32 15 YA24 23(2)(b) (c ) The registered providers must ensure that a full documented audit is undertaken concerning the whole premises from this a written’ planed maintenance programme’ must be produced complete with timescales. 31/05/07 16 YA30 16(2)(j) That all staff undertake infection 31/05/07 control training. That systems be introduced for the appropriate storage of mops and buckets. That a written policy and procedure be introduced for the sanitizing of mop heads. Timescale of 31/03/07 not fully met. The manager was able to provide evidence to prove that communications have started with environmental health for this to be addressed. 17 YA32 18(1)(a) All staff must undertake autism, and communication training, with certificates maintained. All staff must either hold a national vocational qualification or be enrolled to undertake this qualification. 31/05/07 18 YA33 10(1) 18(1)(a) A minimum of 24 hours per week must be allocated to the manager, supernumerary to care for management responsibilities and duties. The staff rota must clearly detail any care hours undertaken by the manager and those undertaken in his capacity as manager. 02/05/07 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 33 Timescale of 28/02/07 not fully met. 19 YA34 19 The registered manager must ensure that all employment checks are undertaken appropriately and that records are in place and available for inspection prior to the employment of any new staff part met. Requirement first made January 2005. All employment records as identified in Schedule 2 and 4 of the Care Homes Regulations 2001 must be in place prior to the commencement of employment of any staff with records maintain and open for inspection at all times - part met. Requirement first made October 2003 Timescale of 28/02/07 not fully met. 20 YA35 18(1) That a training and development plan be introduced at the home. That individual training and development assessments are introduced for all staff. That all staff undertake equal opportunities and disability awareness training. 21 YA36 18(2)(a) The Registered Provider must ensure that annual staff appraisals are carried out for each staff member and the Manager - not met. Requirement originally made July 2006. 31/05/07 31/05/07 02/05/07 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 34 22 23 YA37 YA39 8 24 That an application to register the Acting Manager is made. Develop an effective quality monitoring system. Ensure that the quality assurance system seeks views of stakeholders and staff. Publish results of service user surveys and ensure they are made available to service users, their representatives and other interested parties including the Commission for Social Care Inspection. Action must be progressed within timescales to implement requirements from National Care Standards Commission inspection reports - not met. Requirements first made before October 2003. 31/05/07 31/05/07 24 YA41 17 That records required by 31/05/07 regulation are in place and up to date. That the home introduces written policies and procedures for smoking. That these comply with legislation that takes effect July 2007. 31/05/07 25 YA42 13(4) 26 27 YA42 YA42 13(3)(5)(6) That all staff undertake health and safety training. 18(1)(a) The registered providers must ensure that all staff receive formal training in the following; 1st aid Infection control Food hygiene. 31/05/07 10/06/07 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 35 28 YA42 13(4)( c) The registered providers must have an assessment undertaken to identify/ eliminate risk from any possible asbestos. Ask Environmental Health if fly screens are required for the kitchen window. 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations That the home obtains an up to date copy of the Care Home Regulations 2001. That person centred plans be introduced. That staff receive training in person centred planning. 3. 4 YA7 YA17 That the minutes of meetings include agreed actions and timescales. That advice is sought from a relevant professional with regards to ensuring service users receive nutritionally balanced diets. The inspector gave an information leaflet which had a contact number detailed to the manager during the inspection. 5 6 YA23 YA30 It is strongly recommended that the registered providers secure abuse awareness training for all staff from Sandwell Council. That written evidence be sought from the Environmental Health Department with regards to the transportation of soiled laundry through the kitchen. That the home’s recruitment policy be expanded to contain DS0000004806.V330325.R01.S.doc Version 5.2 Page 36 2. YA6 7 YA34 1-3 Adams Street comprehensive information and guidance. 8 9 YA37 YA42 That computer and internet access is available in the home. That a second first aid box be purchased and located on the first floor of the building. 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 1-3 Adams Street DS0000004806.V330325.R01.S.doc Version 5.2 Page 38 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!