Inspection on 01/06/06 for 1-5 New Street North

This inspection was carried out on 1st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-5 New Street North 21/01/08

1-5 New Street North 02/04/07

1-5 New Street North 08/01/07

1-5 New Street North 17/01/06

1-5 New Street North 05/07/05

1-5 New Street North 23/03/05

1-5 New Street North 02/12/04

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 - 5 New Street North West Bromwich West Midlands B71 4AQ Lead Inspector Jayne Fisher Key Unannounced Inspection 1st and 2nd June 2006 09:30 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 1 - 5 New Street North Address West Bromwich West Midlands B71 4AQ 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 553 1755 0121 553 4254 enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17 January 2006 Brief Description of the Service: 1-5 New Street is a nursing home for 8 younger adults who are learning disabled and require additional support due to presenting behaviour that may challenge. The proprietor of the home is Lonsdale Midlands Ltd which is due to change in the near future, and the service was first registered by Sandwell Health Authority in June 2001 The home comprises of 8 single rooms, a domestic style kitchen, 2 bathrooms, laundry, 2 lounges, an activity area, sensory room and a dining area. A lift services the first floor. Entrance to the home is via a coded door lock at the front, leading to the porch area. The home is situated on a slip road just off the main road adjacent to Dartmouth Park in West Bromwich. West Bromwich town centre is within walking distance and parking space is available at the front of the home. There is a lawned area to the front of the building and a small patio area located to the rear. The service has its own transport and regularly accesses local facilities. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels was provided on 5 May 2006 which range between £1,100 - £1,600 per week. There are some additional charges for toiletries and hairdressing. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days between 09:30 and 18:30 hours on the first day, and 09.00 and 14:00 hours on the second day. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the acting manager, service manager and four staff. A visiting relative was also interviewed. All residents were at home during the inspection. Formal interviews were not appropriate with all residents, therefore the inspector relied upon brief chats, observations of body language, eye contact, gestures, responses and other observations of interaction between staff and service users. Questionnaires were sent to service users prior to the visit. Six were completed. All residents required help with completing these forms, some more than others. Staff assisted and as a result this produced some anomalies between their responses and the real life experiences of residents. Therefore where possible judgements have only been formed following discussion with the individual residents with regard to their responses on the questionnaire. Three residents’ care was case tracked by reading and assessing care documents, observing interactions and by talking to staff and chatting to residents. One meal time was observed. A tour of the premises was undertaken to assess the standard of the environment. Staff personnel files were accessed and a sample of maintenance and service records were examined. Other documentation was reviewed including a pre-inspection questionnaire completed by the acting manager and action plan sent by the provider, plus copies of visits undertaken by senior managers and other relevant information. What the service does well: Daily routines are flexible and geared towards meeting individual residents’ needs for example with regard to getting up and going to bed times. Residents can choose when to be alone or when to sit in communal areas. Staff respect their privacy and dignity when assisting with personal care tasks and strive to ensure that potential health care complications are quickly identified and dealt with. Residents are assisted to access a range of health care professionals. Staff support residents to maintain important links with their family members. There is a clear complaints systems that residents, relatives and staff members are familiar with so that people’s views and concerns are listened to. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 6 The premises is bright and airy. Residents’ bedrooms are decorated and furnished to reflect their individual tastes and they can choose their own colour schemes and furnishings. There is a small team of staff who have worked at the home for a long period and who know residents’ individual likes and dislikes. Staff appeared dedicated and caring and were seen to patiently assist and guide residents. The service provider has always acted responsibly with regard to any serious concerns raised by the Commission for Social Care Inspection. What has improved since the last inspection? What they could do better: Although there are slight improvements in some areas there is once again unfortunately deterioration in others, and overall the service is failing to make the necessary progress required. There are serious concerns with regard to failure to safeguard residents from abuse, poor food hygiene practice which jeopardises residents’ health, and poor systems for medication which has the potential to place residents at risk of harm. There are staffing shortages and high levels of sick leave and although agency staff are used to supplement any shortfalls, they are not always trained to the sufficient standard. The high use of agency staff and staffing shortages have impacted upon the consistency of care for residents including the lack of stimulating activities and opportunities for residents’ personal development. The service provider has already started to take action with regard to concerns raised at this inspection visit at the time of writing this report. An 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 7 improvement strategy meeting will be arranged with the Commission for Social Care Inspection in due course. 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. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 The statement of purpose gives up to date information for prospective and existing residents. Assessment of need processes and documentation relating to prospective and new residents’ is of a poor standard. Service users are not assured that their specialist needs and aspirations will be met. EVIDENCE: Since the last inspection the statement of purpose has been updated to reflect changes in staffing as previously required. As noted at previous visits although there is a service user guide consideration must also be given to the format of these documents, which could be more imaginative, and include pictures and photographs to allow the prospective placing authority and service user to assess whether the home meets its Statement of Purpose. It was pleasing to hear from the manager and staff that they were proactively attempting to address this issue and further advice was given. A new resident was admitted to the home six months ago. On examination of the case file, whilst there was a care plan available from the placing officer there was no evidence of any assessment undertaken by the manager prior to this resident’s admission, (in order to determine compatibility with the service user group and staff team etc.). During interviews staff said that to their knowledge a formal assessment was not undertaken during the introductory visits. There was no evidence that the manager had written to the prospective service user to confirm that the home could meet their needs. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 10 During staff interviews and examination of documentation it was determined that the new resident has been placed at the home for a short term until more suitable accommodation can be found. However this is not the philosophy of the home which is to provide long stay support and not rehabilitation. It is acknowledged by the manager and staff that the resident is generally not compatible with the rest of the service user group and during interviews the resident repeatedly stated that they were looking forward to moving out and did not like living at the home because they did not ‘like’ the other residents. At a previous inspection requirements were made for reviews of residents’ needs to be undertaken as part of a multi-agency approach. It is pleasing to see that the manager has continued to pursue meetings with relevant agencies to ensure that these are achieved. Five out of the eight residents have now been reviewed. Feedback from residents, staff and examination of documentation confirms that the home is still failing to competently demonstrate that all residents’ specialist needs are met. For example, some residents require increased staffing levels in order to access the community; funding has yet to be agreed with the Local Authority. There was some confusion with regard to two residents who are said by staff (who have worked at the home for a considerable period) to have Autistic Spectrum Disorder. This is not reflected in any information or care plans contained with the case files. The acting manager states that this has only recently come to his attention at review meetings with the community learning disability teams. It is disappointing that vital information regarding service users’ needs and behaviours has been archived. Other concerns raised by staff included one resident who is funded by Coventry Local Authority and who has to travel a considerable distance to visit their family and day centre as a result. High staff turnover, sickness levels, use of agency staff have all impacted upon the consistency of support provided to residents to meet their specialist needs. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The quality of care planning and risk assessment is poor and does not provide staff with all of the information they need to satisfactorily meet the needs of service users. EVIDENCE: On examination the quality of care plans and content were mixed. One resident who was admitted six months ago had only three care plans in place which do not do not cover all of the support needs or aspects of care. Needs identified in the placing officer’s care plan were not reflected in these care plans. For example the care plan regarding challenging behaviour only identified one type of behaviour whilst the resident can display a number of behaviours including physical aggression. It is stated that diversion strategies are in place but there is no description of what these strategies entail. Care plans which were in place contained vague and ambiguous guidelines; which during interviews staff had difficulty in explaining and interpreting. This is disappointing given that some service users’ care plans were comprehensive. Whilst record keeping in general is poor, with gaps in all documents seen, it is acknowledged that according to staff and management that some improvement has taken place in that previously a number of records were 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 12 not in existence. There is no evidence of person centred planning such as essential life style planning, life story books etc. Care plans have not been translated into formats that service users can understand. All residents require varying levels of support to manage their finances but there were no care plans in place to identify how they are encouraged with money recognition skills or other methods of support. Care plans fail to demonstrate how residents are supported to make choices for example with regard to meals and mealtimes. As with care plans, risk assessments are varied in quality and content. One service user had only a small number of risk assessments in place. There were no risk assessments in place for challenging behaviour, social inclusion including travelling on transport or independent living skills tasks. There was no risk assessment in place with regard to bathing. It was stated that this resident could have access to the shower unsupervised. It was concerning that upon examination of recorded water temperature checks that the shower exceeds safe temperature restrictions and a risk assessment must be undertaken to identify control measures. One resident’s mobility has recently deteriorated and a wheelchair is used for long distances. There was no risk assessment in place with regard to mobility or use of a wheelchair. There were a number of risk assessments in place covering various topics however these must be expanded to include use of the passenger lift and risk assessments with regard to bathing should include actual safe water temperatures. Improvements are still needed in order to fully demonstrate that service users are involved in the day to day running of the home and participate in all aspects of life in the home. It is disappointing that residents’ meetings are not facilitated. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Lifestyle outcomes for service users are poor with particular concern being in relation to personal development, therapeutic interventions and stimulation, meals and mealtimes. More opportunities are needed in order for service users to participate in meaningful activities and social inclusion in order to support and enrich their lives. EVIDENCE: Whilst it is encouraging to see that attempts are being made by staff and the manager to introduce improvements to activities, these are still in very early stages with positive outcomes yet to be experienced by service users. For example 2 staff have recently been appointed to oversee and plan activities and an activity board is being devised. Five residents attend varying forms of external day care provision including colleges. Three residents do not attend any day centres or college placements and opportunities should continue to be explored and sourced. There are currently no individual activity programmes for residents, or formal monitoring or evaluation of activities which do take place. ‘Activity timetables’ are completed retrospectively but on examination these contained a number of 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 14 gaps as well as failing to adequately describe the type of activity undertaken in order for effective evaluation. For example, one resident’s timetable included activities described as: ‘relaxing at home’, ‘socializing’ and ‘in-house activity’. There were no activities relating to independent living tasks or intensive interaction. One resident was asked if they felt that they had lots of interesting activities to which they replied ‘sometimes’. During interviews a visiting relative commented that they felt there were a lack of stimulating activities undertaken by their family member. It was observed that during the inspection visit some residents were left unattended when according to staff and records examined, they require one to one staffing at all times. Staff strive to support residents to access the community. One resident chatted about how they like to go to the local pub, “especially on match days” which staff explained was to watch football on the television screens. Staff were overhead asking the resident where he would like to go on an outing. During interviews all staff expressed concerns over the lack of activities and social inclusion due to insufficient staffing. As already stated extra funding is currently being sought to support some residents increased dependency whilst out in the community. Management also stated that the necessity of using agency staff also had an impact upon providing community activities. Staff reported that no service users were enabled to be politically active at the last local council elections. Staff fully support residents to maintain important family links. During the inspection visit two relatives visited to take their family members out for the day or an overnight stay. Daily routines are flexible and residents’ rights are respected. For example some residents were seen to choose when to go to their bedrooms during the day time and could choose when to get up. Residents can have their own bedroom door keys if they wish. However, as previously identified, records must be kept to demonstrate how daily routines promote independence. It was pleasing to observe efforts made by staff to encourage choices with regard to meals. For example, staff were seen to ascertain choices with regard to drinks by showing a resident the types of flavours available. A picture/photographic menu is starting to be devised to enable decision making. A lunch time meal was observed; staff were seen to encourage one resident to participate in making his own lunch with thoughtful prompts and assistance. Great care was taken by staff to ensure that the meal provided was exactly to the resident’s preference. There was some confusion with regard to one resident’s dietary requirements due to a recently diagnosed health complication. There was conflicting advice contained within the staff communication book and the resident’s care plan. This was quickly rectified by a member of staff. Two residents who were interviewed confirmed that they were given choices and one resident stated “I 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 15 like the food and I like the puddings”. It is pleasing to see a new strategy has recently been introduced regarding the menu plan to demonstrate how individual residents have made choices using a colour coded system. It is hoped that this will expand choices as examination of current food intake records (albeit inconsistently completed), demonstrate that residents are mainly having the same meal options. Whilst it is said that staff are familiar with residents’ individual likes and dislikes, these are not recorded in their care plans. There are however serious concerns regarding some residents who according to their care plans are supposed to be following healthy eating diets in order to lose weight and reduce obesity. Food intake records examined revealed that these residents were being provided with a high fat diet. For example during a seven day period meals provided included: corned beef and rice, a MacDonalds meal, chip sandwich, beans, eggs and sausages, lasagne, scampi and chips. Examination of corresponding weight charts for this resident showed a weight increase of 15 kg. within the last eleven month period. One resident who was case tracked had no nutritional screening assessment in place. Other residents’ nutritional screening assessments need review as these were last undertaken over twelve months ago. It is also suggested that the resident’s actual body mass index is calculated and identified on these tools. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Overall systems for personal and healthcare support are poor due to the fact that the procedures for the administration and control of medication potentially place service users at risk. EVIDENCE: Staff endeavour to provide sensitive support to residents; it was pleasing to see that one resident’s care plan regarding epilepsy referred to maintaining dignity and privacy. During interviews one resident confirmed that they went to bed at a time of their own choosing and could get up when they wanted as observed during the inspection. There are some aids and adaptations although the bath hoist on the first floor is currently broken (but according to staff is not used in any case as residents prefer the ground floor bathroom). The manager states that he is currently exploring whether or not overhead tracking could be installed. (See further comment in standard 24). Care plans need to identify residents’ preferences regarding how personal support is provided and a review needs to be undertaken as to whether the half hourly checks undertaken for all residents during the night time are necessary with outcomes documented in care plans. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 17 On the whole there are good arrangements in place to meet residents’ health care needs. For example, on the day of the visit one resident was taken to hospital as staff had found some bruising. Improvements have taken place with ensuring that routine health checks displayed on a notice board in the manager’s office are also contained within a monitoring sheet in residents’ case files. Case tracking revealed these to be up to date. There are a couple of areas which require slight improvement. Although one resident had epileptic seizures in May 2006 which required medication, a corresponding epilepsy chart for the month was not in place. Care plans need to be established with regard to screening for potential complications for breast, cervical and testicular cancer and strategies for monitoring and supplementing well person clinics and tests. Some improvements have taken place to meet outstanding requirements with regard to medication. For example ensuring all residents have received medication reviews, introducing comprehensive guidelines for the administration of ‘as and when required’ (PRN) medication and updated staff signatures and specimen list. However, in general the arrangements for the control and administration of medication are poor. A recent incident had occurred whereby a member of staff had omitted to administer evening medication to residents and had left medication openly accessible to service users. It was reassuring that the provider has taken proactive action. However, the manager had failed to obtain advice and instruction from the General Practitioner (and/or pharmacist) upon discovering these drug errors. Further concerns were identified at this visit including gaps in medication administration record (MAR) sheets where there was no staff initial to confirm whether or not medication had been administered. For example, during a period from 11 May – 31 May 2006 there were twenty two gaps counted with regard to one resident’s administration of Caveston cream. Other issues included: ‘as directed’ doses on MAR sheets failure to obtain two staff signatures when handwriting instructions on MAR sheets no date of opening on creams one service user without an up to date medication profile keys to medication cupboards not held separate from other master keys no key holding policy or handover sheet Staff have not received accredited training in the safe handling of medication. A comprehensive review of current practice is required in order to establish mechanisms for improvement. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The systems for protecting service users are poor and places them at risk of harm or abuse. EVIDENCE: There is a clear complaints procedure for service users and relatives, thereby ensuring individuals views and concerns are listened to and acted upon. During interviews staff gave good responses as to how they would support residents in making complaints. Two residents were able to be interviewed who clearly knew who to complain to if they were unhappy about any aspect of their support. A visiting relative was also very clear about who they could approach if they were not satisfied with service provided including contact with the service manager. Systems for protecting service users from abuse remain unacceptably poor. Concerns were raised by the Commission for Social Care Inspection (CSCI) in March 2006 following incidents of alleged abuse at the home which were not reported immediately and failure to adhere to Local Authority Multi-agency vulnerable adult abuse procedures. The manager at that time was seen to be unaware of the correct procedures to follow in respect of reporting and taking appropriate action. The provider acted responsibly by suspending the alleged perpetrator with regard to the two incidents which had been reported. An investigation has yet to be concluded. A further incident of abuse occurred in March 2006 which was reported to CSCI. Disappointingly the manager is unable to provide an up to date progress report regarding this incident. During interviews the manager remains unclear as to lines of responsibility and this was clarified with the 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 19 service manager who was present on the first day of the inspection. Written guidelines are to be established to supplement current adult protection procedures. On examination of the accident report book a further incident of abuse was discovered to have occurred in May 2006 which had neither been recognised as abuse or reported as one. The daily reports regarding the resident did not correlate with the information contained within the accident report. A serious concerns letter has been written to the provider requiring an investigation and retrospective action to be taken with regard to all potential adult abuse incidents. Staff have now received training regarding vulnerable adult abuse awareness, however during interview some staff were still unclear as to what constitutes abuse and one member of staff felt that they would like more ‘in depth’ training. It was disappointing that documented supervision records with staff who had failed to follow Whistle Blowing procedures contained no evidence that this had been discussed on a formal basis. Policies and procedures regarding service users’ monies require improvement. One resident had recently paid for their own replacement meal whilst out in the community which should have been funded by the home. This money must be reimbursed. It was also noted that the amount spent on a meal from a food outlet: Kentucky Fried Chicken, was rather substantial for one meal (£11.19). There was no receipt for the actual meal and this must be investigated further. Any other items discussed during evaluation of these standards are contained within the Requirements section of this report. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 and 30 The premises are spacious and generally safe with on-going attempts to provide a more homely environment. Service users like their bedrooms and the premises are adequate in general but some improvements are needed to meet residents’ needs and lifestyles. EVIDENCE: Some residents agreed upon request to show the inspector around their bedrooms. These were seen to be decorated and furnished to meet residents’ individual tastes. One resident confirmed that he had chosen the colour for his new curtains but upon enquiry said that he would like a foot stool. Service users do not have lockable spaces in their rooms and some bedroom furniture was broken and requires replacement. Not all bedrooms contained sensory equipment or tactile symbols. There is a sensory room located on the first floor but according to staff this is seldom used as residents prefer the ground floor as a communal area. Two communal areas were homely and furnished to a good standard. The third lounge however was sparse and uninviting with laminate flooring and little in the way of homely touches or comfort. During the inspection visit 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 21 contractors were present decorating and fitting blinds to windows which hopefully will promote a less institutional type atmosphere. The ground floor bathroom has an assisted bath with a fixed hoist. However this is a small space and as the bath itself is adjacent to a wall there is no room for staff to manoeuvre around the bath in order to adequately assist service users. The bathroom is uninspiring with little homely touches, no space for residents’ to store their personal belongings whilst bathing, and broken wall panels. The garden area is very small and could be made more interesting with plants and flowers and sensory equipment. There was only one table and two benches with no umbrella or other form of shade. The manager agreed that this would not accommodate all residents. The premises was found to be clean and hygienic with only a couple of exceptions: there was an offensive odour in one resident’s bedroom and the skirting board around the toilet on the first floor requires cleaning. The carpet on the first floor was stained and requires professional cleaning. The laundry area has now been fitted with a wash hand basin as previously required and although there was a supply of paper towels there was no liquid soap or supply of protective clothing which is stored elsewhere. It was pleasing to see that mops are colour coded and dried inverted. Laundry procedures incorporating good infection control measures should be devised and displayed in this area and information relating to the control of substances hazardous to health (COSHH) should also be contained within the laundry for ease of access. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Standards with regard to the number of staff who are NVQ qualified and who have received the required, specialist, mandatory, induction and foundation training remain poor. The turnover of staff, use of agency staff and levels of sick leave remain high resulting in a lack of consistency of care for service users culminating in poor practices. EVIDENCE: According to information supplied by the manager there are currently fourteen support staff employed only four of whom are qualified to NVQ II or above. There are four registered nurses employed. Serious concerns were raised a the last visit with regard to the lack of training and evidence to support training which had taken place. As required an updated training programme and training certificates were forwarded to CSCI. There is evidence of ongoing training which is reassuringly although this is a somewhat slow process. All staff have now received training in non-violent crisis physical intervention (NVCPI) which was confirmed during interviews with staff and upon sampling training certificates. The majority of staff have received training in fire safety. Only four staff have completed training in infection control and five staff have completed training in health and safety. Further training is booked for first aid awareness and moving and handling plus other statutory training. Specialist 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 23 training with regard to epilepsy awareness, Makaton, autism and continence has not yet taken place. Due to high levels of staff sick leave and vacancies a high number of agency staff are used. For example during the last eight weeks a total of 155 hours were covered by agency staff. The manager states that only agency staff who have completed NVCPI training (amongst other training) are employed. However, on closer examination it was found that this is not the case and the member of agency staff on duty had not completed this training. During interviews staff raised concerns about the use of agency staff and their lack of training. The lack of consistency with regard to staff was felt to be a determining factor in residents’ increased challenging behaviour. As already stated residents’ increased dependency levels has resulted in the home requesting extra funding but this has yet to be secured. There are a number of deficiencies in the service as identified at this visit which could be attributed to the lack of sufficient numbers of staff. Improvements are needed in the current recruitment and selection procedure for new staff. For example on examination of a recently appointed member of staff there was no written risk assessment in place with regard to control measures to safeguard residents from abuse whilst awaiting the return of a satisfactory criminal record bureau disclosure (CRB) check. There was no appointed member of staff to supervise the worker as required by the Care Homes Regulations 2001, Regulation 19(11). The CRB declaration had not been signed and the two written references were addressed ‘to whom it may concern’. The health declaration had been not be signed and there was no recorded evidence that health care problems declared had been discussed or risk assessed. There were no details held on the premises with regard to agency staff and CRB and POVA (Protection of vulnerable adults) checks or training. This was said to be checked and held at the organisation’s head office. However, upon request this information was not readily available from the head office and had to be requested directly from the agency. Staff are still not receiving induction and foundation training by an accredited learning disability awards framework (LDAF) provider within the first six weeks and six months of employment. Although a small number of existing staff are said to currently be undertaking this training. Staff supervision records were accessed and demonstrated that good efforts are being made to improve frequency of formal and structured supervision. The majority of staff files sampled contained at least two recent supervision sessions, however one member of staff had not been supervised since April 2005. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Poor outcomes detailed throughout this report indicate weaknesses in management, which the new management team are hoping to reverse. Poor practices have developed which do not always safeguard the health, safety and well being of persons using the service. EVIDENCE: A new manager was appointed in December 2005 and is currently in the process of applying for registration with the CSCI. A new service manager has also been appointed who is currently giving significant management support. Feedback from staff was mainly positive with regard to the new management team and the improvements which have already taken place. For instance staff feel that their ideas are listened to and could give examples of this. There are regular staff meetings to give support and guidance to staff. The acting manager does not currently hold a management qualification and a personal development must be submitted to the CSCI to demonstrate how he will be supported in achieving this qualification. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 25 A comprehensive quality assurance system is still in its infancy although it was Service user reassuring that staff are attempting to address this. questionnaires have been designed and are currently in the process of being completed which is commendable. Further advice was given regarding an annual development plan. A sample of maintenance and service records were examined which were found to be up to date. The fire officer has visited on two occasions since the last inspection and is now satisfied with the improvements which have taken place to rectify concerns identified at the first visit to the service. Examination of fire safety records confirms that standards are being maintained. Unfortunately once again there has been a marked deterioration with regard to food hygiene standards which pose serious risks to residents’ health, safety and welfare. Staff are failing to consistently check and record fridge and freezer temperatures. Examination of fridge temperatures undertaken reveal that these are repeatedly exceeding the safe limits and that staff had failed to identify this as an issue, and take appropriate action. For example, temperatures were recorded as 10°c on nine occasions during the last month. On two occasions fridge temperatures had been recorded as –34°c and –20°c. Disappointingly, additional monitoring checks (food hazardous analysis checks) undertaken on a daily basis also failed to identify concerns with staff recording that temperatures were within safe limits. On the day of the inspection the fridge temperature was reading 11°c. Upon this being pointed out the management team arranged for a new fridge to be purchased and delivered before the inspection was completed. Other concerns identified include: inconsistent checking and recording of cooked food temperatures (only 2 meals checked during a seven day period, despite the fact that hot meals are provided on most days). freezer door compartments broken and fridge requiring defrosting. bottles of mayonnaise opened but not subsequently stored in the fridge. high risk items not labelled with the date of opening (jam and spreads) high risk items labelled with date of opening but not removed from fridge when the expiry date was exceeded. dried foods opened but not stored in pest proof containers no records to demonstrate that the food probe had been calibrated. Although there was data sheets relating to COSHH found there were no corresponding risk assessment in place. It was also noted that the laundry door leading to the garden was unlocked and therefore residents could access this area (and did so during the visit). On examination of the accident/incident reporting sheets there is no system for monitoring by the manager in order to identify patterns or trends. Some 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 26 accidents/incidents reports were not fully completed and there was no corresponding daily report. For any other items discussed during this inspection please refer to the Requirements section of this report. 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 1 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 1 33 1 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 X 1 X X 1 X 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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 6 Requirement The Statement of Purpose and Service User Guide must be kept under review and should accurately reflect the services provided. (Previous timescale of 30/06/06 is partly met). Service Users needs assessments must be kept under review and revised at any time/ as part of a multi agency approach with other professionals (Previous timescale of 31/10/05 partly met). To ensure that confirmation is sent in writing to new service users that having regard to the assessment the home can meet their needs. 3. YA3 14 The registered person must 01/09/06 demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home, and to further demonstrate it offers care based on current good practice and DS0000004798.V291147.R01.S.doc Version 5.1 Page 29 Timescale for action 01/10/06 2. YA2 14 01/09/06 1 - 5 New Street North reflects relevant and clinical guidance (Previous timescale of 30/11/05 is not met) 4. YA6 15 1) To reproduce care plans in a format suitable for service users. 2) To ensure daily reports reflect goals identified in care plans. 3) To introduce effective evaluation, monitoring and reviews of service users plans which must be sufficiently detailed to reflect the changing needs of service users, and the objectives set. 4) Ensure that the care plans are compiled with the service user and/or their representative, and are dated/signed. (Previous timescale of 30/11/05 is not met). To generate a care plan for latest service user admitted from an holistic assessment of need which covers all aspects of personal, and social support and health care needs as set out in the National Minimum Standards 2. 5. YA7 15 To ensure that service users are 01/09/06 supported to manage their own finances and that care plans contain goals and objectives with regard to the assistance and supervision that is needed. 1) To demonstrate ways in which 01/09/06 service users are involved in the day to day running of the home and are consulted on issues affecting the service provision. 2) To further demonstrate how routines within the home are flexible and service users are enabled to exercise control 3) Staff to demonstrate how individual choices have been DS0000004798.V291147.R01.S.doc Version 5.1 Page 30 01/09/06 6. YA8 12 1 - 5 New Street North made and record instances when decisions have been made by others, and why. (Previous timescale of 31/10/05 partly met) 7. YA9 13(4)(c) To expand current documented risk assessments and risk management strategies with all Service Users, especially relating to their personal safety to be held on their individual plans. The home must ensure that the activity plans are reviewed and staff can demonstrate that opportunities for day care and education have been explored. Records of consultation and outcomes should be available and opportunities for service users at the home to take part in valued and fulfilling activities should be in place. (Previous timescale of 30/06/06 is not yet met). To ensure that all service users are enabled to be politically active if they so wish. The home must demonstrate how daily routines and house rules promote independence, individual choice and freedom of movement, and are subject to restrictions only as agreed in the individual Plan and Contract. Individual working records should clearly set out residents preferred routines, likes/dislikes etc The home must evidence and demonstrate that service users rights are respected and routines are flexible to suit the needs of individual service users. (Previous timescale of 31/10/05 is partly met). DS0000004798.V291147.R01.S.doc 01/09/06 8. YA12 12,15,16 01/09/06 9. YA16 12 30/06/06 1 - 5 New Street North Version 5.1 Page 31 10. YA17 12(1)(a) 16(2)(i) To review and up date nutritional 01/09/06 screening and assessment tools to ensure that they more accurately describe the risks and control measures associated with service users’ individual needs. To ensure that a nutritional screening and assessment is undertaken for the latest admission to the home. To ensure that where service users are identified as having increased dietary needs due to health complications, that either specialist menu plans are established or this is reflected in the existing menu plan, which is closely adhered to, and that staff are more familiar with their dietary requirements. To ensure that there is more consistent recording of residents’ daily food intake. To ensure care plans contain service users’ preferences with regard personal support including getting up and going to bed and bath times. To review the practice of half hourly checks undertaken during the night for all service users. Outcomes and guidelines for staff to be documented in individual care plans. 11. YA18 12 01/09/06 12. YA19 12 13. YA20 13,17 To establish care plans with 01/09/06 regard to specific health care health care screening in respect of breast, testicular and cervical cancer screening. The issue of consent to 01/08/06 medication needs to be further explored, either with the individual or their representative, DS0000004798.V291147.R01.S.doc Version 5.1 Page 32 1 - 5 New Street North or as part of a multi disciplinary review. (Previous timescale of 31/05/06 is not met). To undertake a thorough review of all practices and procedures relating to the administration and control of medication. A detailed plan of action to improve existing practice must be forwarded to the Commission for Social Care Inspection. 14. YA23 13,18 Certificated evidence for all staff that have been provided with training in Adult protection is required to be held on staff files or training provided (previous timescale of 31/10/05 is partly met). To undertake an audit of all accidents/incidents in order to identify any potential adult protection issues and to forward findings and an action plan to the Commission for Social Care Inspection with regard to how measures will be implemented to safe guard service users from abuse and any retrospective action taken by 1 July 2006. (Letter of serious concern sent to provider on 5 June 2006). To improve practice regarding service users’ monies by:- reimbursing service users for any monies which have been spent on replacement meals whilst out in the community and to investigate discrepancy identified which occurred on 30.5.06 with written outcomes to the Commission for Social Care Inspection by 1 July 2006. 01/09/06 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 33 15. YA24 23 16. YA31 18(4) 17. YA32 18(1)(c) All of the environmental and premises issues identified in the sections of the inspection report as needing attention must be addressed, (i.e. general maintenance, décor, safety and infection control/laundry room. A detailed plan of action for each issue with dates for completion must be submitted to the Commission for Social Care Inspection. To ensure that all staff receive a copy of the code of conduct set by the General Social Care Council with staff signatures maintained to evidence that they have received individual copies. All staff must receive all mandatory and specific training to support their existing skills and knowledge of service users’ individual and specialist needs e.g. epilepsy, autism awareness, disability equality and Makaton. To ensure that all agency staff have received sufficient training in order to meet the needs of the service user group including nonviolent crisis physical intervention. Documented evidence to be held on the premises. 01/07/06 01/09/06 01/09/06 18. YA33 18(1)(a) The Manager must undertake an 01/08/06 up to date review of staffing ratios and service users dependency levels. To forward written proposals to the Commission for Social Care Inspection. Sufficient staff must be allocated on a daily basis to provide all service users with a range of stimulating activities and opportunities for personal DS0000004798.V291147.R01.S.doc Version 5.1 Page 34 1 - 5 New Street North development as well as meeting care needs. 19. YA34 19(1) To improve recruitment and selection procedures in order to safeguard service users from abuse and address issues identified within the inspection report National Minimum Standard 34. To ensure that induction (within 6 weeks of commencement) and foundation training (within 6 months of commencement) is delivered, and is in accordance with guidance issued by the `Skills for Care` Organisation (NTO) To ensure that relevant staff are registered on a `Learning Disability Award Framework` accredited training course. (previous timescale of 31/10/05 not met). 01/08/06 20. YA35 17,18,19 01/09/06 21. YA36 18(1)(d) 22. YA37 8,9 To continue to progress plans to ensure that all staff received structured and documented supervision (a minimum of six times per year). To establish and forward an individual personal plan for the manager of New Street to CSCI by the date given (which includes training such as the Registered Manager’s award or NVQ IV in management). The Acting Manager must produce an Annual Development plan, which is based on a systematic cycle of planningaction-review and reflects the DS0000004798.V291147.R01.S.doc 01/10/06 01/08/06 23. YA39 24 01/10/06 1 - 5 New Street North Version 5.1 Page 35 aims and outcome for service users (by 31/3/06) The service must adopt and evidence an effective system for Quality Assurance based on the outcomes for service users, in which standards and indicators to be achieved are clearly defined and monitored on a continuous basis. The home must explore ways in which the service users, staff and stakeholders can be included in the homes chosen quality assurance system. (Previous timescale of 30/6/06 is not yet met). 24. YA42 12,13, 23 The Acting Manager is required to ensure the health, safety and welfare of service users and staff in relation to safe working practices, (staff training (food hygiene, infection control etc), and associated routines in the home, in addition to deficiencies noted about the premises as detailed in the report. To improve accident reporting systems by ensuring that all accidents are more accurately detailed and to introduce a system for monitoring and analysis by the Acting Manager in order to identify potential adult protection, patterns and trends of accidents. 31/07/06 25. YA42 13(4)(c) 01/08/06 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations To ensure that all relatives, friends and advocates are made aware of and have access to inspection reports. The home should begin to consider how it can implement a system of Person Centred Planning or similar, such as Essential Lifestyle Planning or Life Story books. Menus could be made available in different formats with pictorial options produced using photographs to assist service users to make a choice. To obtain a copy of the Department of Health guidelines in respect of the Protection of Vulnerable Adult (POVA) scheme. To ensure more consistent daily auditing of residents’ finances is undertaken and recorded in compliance with the home’s financial policy. The home should continue to work toward meeting Sector Skills Workforce targets of 50 of care staff having achieved an NVQ level 2 or above. To ensure that there are opportunities for the acting manager to participate in the selection of new staff in order to assess compatibility and skills match with existing service user group and staff team. The Manager should commence working toward the NVQ IV/Registered Managers Award. It is recommended that the home be enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. 3. YA17 4. YA23 5. YA32 6. YA34 7. 8. YA37 YA41 1 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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: 0845 015 0120 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 - 5 New Street North DS0000004798.V291147.R01.S.doc Version 5.1 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. 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