Inspection on 21/05/08 for 1 Alexandra Street

This inspection was carried out on 21st May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Alexandra Street 06/06/06

1 Alexandra Street 01/11/05

1 Alexandra Street 01/11/05

1 Alexandra Street 07/06/05

1 Alexandra Street 07/01/05

1 Alexandra Street 28/06/04

1 Alexandra Street 19/01/04

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 27/09/2008.

CARE HOME ADULTS 18-65 1 Alexandra Street Stone Stafford Staffordshire ST15 8HL Lead Inspector Key Unannounced Inspection 21st May 2008 09:30 1 Alexandra Street DS0000005072.V364751.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 Alexandra Street DS0000005072.V364751.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 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Alexandra Street Address Stone Stafford Staffordshire ST15 8HL 01785 615510 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) RMP Care Miss Lorraine Paula Lawton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: 1-3 Alexandra Street is an end of terrace house and its adjoining neighbour, in a quiet residential district in the town of Stone. The two properties have an interlinking door on the ground floor, and provide a total of six single rooms, one of which is on the ground floor. The properties open onto the pavement at the front, but at the rear there are enclosed yards, with separate gardens across the communal backs, that serves several of the properties in this row. Both houses have their own communal facilities including kitchen, lounge and kitchen. There is a staff sleeping in room with a fireproof cabinet for secure storage. The service is registered for six younger adults who have a learning disability. The service seeks to meet their assessed needs in a domestic style of setting, with no outward signs that this is in fact a care home. The service user guide does not identify the fee levels stating that fees depended on each person’s needs. People would therefore need to contact the service to get information about fees. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection lasted over 6 hours. The service was told 2 days previously that we were coming. This was to make sure that people that live there, staff and the manager would be available to meet with us. During this inspection we spoke to several of the people that live there, some staff and the manager. We looked at the life people have at the service including looking at the activities they take part in, how their health and personal care needs are met, whether their choices and independence are promoted, how much they are involved in running the service and whether the service is keeping them safe. A sample of the accommodation was also looked at. Before we visited the service they sent us a document called an Annual Quality Assessment. This gives the service the chance to tell us about the service including the things they do well and areas they want to develop. We also received surveys about the service from some of the people that live. We also spoke to a social care professional to get their views about the service. Since our last visit we have received no complaints and they have been no safeguarding incidents. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes What the service does well: People that live at the service tell us that they like living there. Comments include ‘I like it here’ and ‘It’s good here’. There also tell us they get on well with the staff and we found that the staff know the support people need and about the things they like and dislike. Staff are well trained and a high number have and NVQ qualification. Staff also like working at the service and very few staff leave the service. Some have worked there for a number of years. The service has a good method of recruiting staff making sure all the checks are done so that people are protected. People are treated as individuals and supported to live the lifestyle they want. This includes supporting people to develop friendships, to meet their spiritual needs and to develop skills in such areas as cooking and domestic tasks. People do lots of activities both educational and social. They spend lots of time in the community using local resources including the local pub and local shops. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 6 The service listens to what the people that live at the service say and seeks their views about the service. People tell us that staff act on what they say. For example one person told us that he had requested a garden bench and this had been provided and another person wants to go shopping independently and the service is putting plans in place to help him to achieve this. The service is also listening to people that find it hard to speak their views with staff being are aware of methods to communicate with them including using pictures and symbols. The service takes concerns seriously and although there have been no complaints it keeps a record of minor issues that are resolved on the spot. The service provides people with a domestic and homely place to leave. Every one has a single room of that they can make their own with posters, pictures and ornaments. The service’s communal areas are comfortable and give people a pleasant place to relax. The service’s health and safety practices are keeping people safe. Staff are trained in health and safety issues including fire safety, first aid and food safety. What has improved since the last inspection? What they could do better: The service is providing some good and some excellent outcomes for people that live there. However there are areas that can be better. Whilst the service is managing most people’s monies effectively some changes to the system would reduce the possibility of errors occurring. Although a risk management system is in place we feel that there is scope for certain parts of this to be improved. Some assessments are very good whilst some others need to further developed to bring them up to the same standard. We also feel that parts of the way the service supports people with their medication could be improved. This will reduce the likelihood of any errors. The service’s environment could be improved through some minor repairs. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 7 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 Alexandra Street DS0000005072.V364751.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 Alexandra Street DS0000005072.V364751.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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before moving to the service people’s needs are assessed and they have the opportunity to visit and test the service. This makes sure that people are involved in the process and are only admitted if their needs can be met and they knew what the service offers. EVIDENCE: People living at the service tell us that they were provided with information about the service before they moved in. The surveys we received say that they had enough information about the service. This person said that they ‘knew lots of people before they moved in’. People are that live at the service have been provided with a Service User guide that shows what the service offers. This document can be provided in a range of different formats and the one we saw in a person’s file contains pictures of the service including bedrooms and communal areas. Those provided to people living at the service include the level of fees but the generic one we saw did not although it states that fees are based on each person’s needs. It included information about items the fees covers and items that need to be paid for in addition although the cost of transport is not included. The service’s Annual Quality Assurance Assessment (AQAA) states that they have a comprehensive assessment and admission process and we saw this is the case. Documentation shows that although there had been no recent 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 10 admissions an assessment of people’s needs is undertaken before a place is offered. The service has an admission policy that includes an assessment and a copy of an assessment was seen on file. People that live at the service confirm that they had the chance to visit the service several times before they moved in and one person told us that they visited lots of times and were involved in choosing the furniture at the service. 1 Alexandra Street DS0000005072.V364751.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 good This judgement has been made using available evidence including a visit to this service. The service’s care planning process involves the person concerned and provides the information needed to meet people’s needs and goals for the future. People’s choices are promoted and they have control over their lifestyle and have influence over the running the service. EVIDENCE: The service’s care planning process includes the person concerned and people we spoke to told us that they had access to their plans. One person showed us their plan and went through it with us. This shows that there are plans covering such areas as personal care, health, activities, financial needs and any spiritual needs. We also saw a communication plan in place for one person with specialist communication needs. Parts of the plans were in different formats with some being in easily accessible formats including pictures. These included issues relating to a healthy lifestyle. We would recommend that this type of accessible plan be expanded to include all areas of support. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 12 There is evidence that plans are reviewed through a person centred meeting. One example we saw included areas of achievement and goals and targets for the following year such as making drinks, shopping and going on holiday. Risk management systems are in place and we saw some good examples of risk assessments that identify areas of risk and actions in place to reduce and minimise risks. These included access to the community. We also saw that the service reviews and updates risk assessments with the people concerned. We did see some examples of risk assessments that are not based on current good practice and the service needs to consider whether all areas of risk are currently adequately covered. This was raised with the manager and she states that she intends to put all risk assessments in the same format. The service’s AQQA identifies that it is promoting people’s choice so that they can live the life they want. People that responded to our surveys tell us that they make choices over their daily life. People we spoke to tell us that they decide how and where to spend their time, what to eat, when to get up and go to bed and over the activities they take part in. For example one person told us they enjoy watching sport on television and had decided to buy themselves Sky facilities and choose to watch this in their bedroom. Another person said they decide if they want to go to the pub in the evening and decide when they want to go into Stone shopping. We also observed people be offered choices for their meals and being asked what they want to do in the evening. We also saw minutes of house meetings that show people have been asked about any things they want in the service. One person made a suggestion of a bench in the garden and when we spoke to this person they said this had been provided and took us to see it in the rear yard area. Also several people said they have chosen the colour of their bedroom and have helped to choose the new décor in the lounge of number 1. People are involved in aspects of running the service. As well as completing household chores such as cooking, cleaning and doing the household shopping, one person monitors the temperatures of the freezer and fridge and another person waters the plants. People living at the service also take part in fire training and have been involved in staff recruitment. House meetings also take pace where the views of people are sought. The service also undertakes annual surveys of people to gain their views of the service. 1 Alexandra Street DS0000005072.V364751.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 excellent. This judgement has been made using available evidence including a visit to this service. People living at the service enjoy a lifestyle based on their individual choices. This includes taking part in a range of educational and social activities, developing and maintaining relationships and being involved in making decisions about how the service runs. EVIDENCE: The service’s AQAA reports that people that live at the service live a varied lifestyle and take part in a range of educational and social activities. People we spoke to and records we saw confirm that this is the case. Everyone that lives at the service take part in some kind of educational activity. Several people attend Local Authority day services taking part in activities such as skill development, gardening and craftwork One person attends the Oak Tree Farm project, two others attend college and one person works at a football club in Stafford. Talking to people shows that they take part in a range of social activities both in the service and in the community. Some people regularly go to the pub, one being a good snooker 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 14 player, other activities include going bowling, out for meals, going to the cinema and theatre, playing and watching cricket, gardening and cooking. One person told us that he was regular at a local pub and said ‘I go and watch the football there’. Another person is involved with the local Lions organisation. The service tells us that people use community resources including leisure centres, local shops and the local barbers. One person regularly attends a local church. People are able to go on holiday. The service arranges holidays for people at a range of costs and people choose where they want to go. One person told us ‘I choose between several holidays and am going to Wales’ and ‘I am going with friends’. People at the service are encouraged and supported to maintain and develop relationships with friends and relatives. Several people regularly visit and stay with family. Friends are welcomed to the service and staff are supportive of people that may wish to develop intimate relationships. Staff we spoke to are aware of issues of consent and where to access specialist advice. People that live at the service enjoy an environment that is relaxed and with routines that are based around their needs. Independence and choice are promoted. People can spend time where the want – in their bedroom or in communal rooms, meals are at no set time and depend on people’s activities. People can have privacy in their rooms with all bedrooms lockable. There is relaxed atmosphere with staff and people that live there chatting freely together. The service fully involves people in meal preparation and menu planning. People that live at the service do the food shopping, are involved in cooking meals and in the laying and clearing of the tables. Meals are decided on a daily basis depending what is in stock. People are able to exercise choice over the meals they have with people having different meals. Staff are aware of techniques including visual methods to assist people with specialist communication needs top make choices over meals. Comments from people living at the service included’ there is a choice’ and ‘ I like the food’. Breakfast tends to be cereal and toast and during the week most of the people are out at lunchtime. The evening meal consists of a main meal such as spaghetti Bolognese or sausage casserole followed by a second course. There are also times when people go out for meals or have a take away brought in. Snacks are available throughout the day. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20.21 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at the service are having their personal care and health care needs met in a way that takes account of their wishes and respects their rights to privacy and dignity. The service’s arrangements for administering medication is making sure that people receive their medication although some improvements in the arrangements for people that self medicate would lessen the chance of any errors occurring. EVIDENCE: We looked in detail at 2 people that live at the service and saw that support plans identify the individual health and personal needs of the people that live at the service. Discussions with people living at the service confirm that they are involved and consulted about their care needs and one person showed us their file detailing their health care. The service’s AQAA states ‘each resident is registered with a local GP, dentist, optician and chiropodist. All clients are supported with access to health care services, including mental health services. Personal care support is provided for three residents.’ Our discussions and examination of records confirms this 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 16 is accurate. People tell us that they visit the dentist, have eye checks and see the chiropodist to have their nails cut. Examination of daily records confirms this to be accurate. Observation of people’s bedrooms shows that they have toothbrushes and toothpaste. People tell us that they go shopping to buy their own clothes and their own toiletries. We saw that people are welldressed and wearing age appropriate clothing. The health care needs of people are recorded in their support plans and we saw records to confirm people receive primary and specialist health care services. For example 1 person has regular appointments with the nurse for blood tests for a thyroid condition and another has psychiatric support. The service has links with the local Community Nurse. Staff, spoken to, are aware of people’s health care needs. For example they were aware that one person experience anxiety and knew how to provide them with support, and they were able to describe the treatment one person was receiving for a nail infection. Some staff have had specific training in epilepsy and dementia. People’s privacy is respected. We saw that locks, that can be overridden from outside in an emergency, are fitted to bedroom doors and bathrooms are lockable. We also observed staff speaking to people in a respectful manner and by their chosen name. The service is supporting people with their medication. Training records confirm that all staff are trained in the administration of medication. The service is administering medication for some people. Medication is kept in a locked cabinet in the staff sleep in room. Sampling of 2 people’s medication confirms that medication is being administered correctly. Records of medication received are recorded enabling medication administration to be audited. The service is supporting one people to manage their own medication. A monitoring system is in place and a basic assessment of their safety to self medicate in place. We would recommend that this assessment is further developed to clearly show how the assessment was completed, the areas it covered, any risks and any support needed and the regularity of reviews. The person self-medicating was spoken to and he was aware of the need to keep his medication secure. He told us he always took his medication and the monitoring system showed that there was never any medication left at the end of each monitoring period. A lockable box in which to keep the medication is provided although this is not secured to the wall and the person did not lock their bedroom. We would recommend that the service ensure that this medication is kept securely. People’s wishes concerning their death is on file and a discussion with 1 person confirms that this has been discussed with him. This person told us about his wishes and this is accurately recorded on file. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service has an open culture that encourages people to express their views and concerns and where people know that their views will be acted upon. The staff’s knowledge of safeguarding people is protecting people but the service’ s method of managing people’s money needs to be improved so that the likelihood of errors occurring is reduced. EVIDENCE: The service’s AQAA reports that it ‘listen to views of service users and acts upon these immediately. Provide the facility to suggest and grumble informally so that people are able to feel that they can suggest and be heard and listened to and where possible acted upon or discussed at the next staff or resident meeting.’ Information from the surveys and through talking to people at the service confirms that they feel that the service listens to them. Examples of this include regular house meetings and 1:1 meetings and annual surveys. The service is also making sure that the views of people with specialist communication needs are heard through for example using pictures. Looking at minutes and surveys shows us that if suggestions for improvement are made the service is responsive. For example requests for changes to the environment have been made following house meetings. These have included plants, a new carpet and new televisions. A complains procedure is in place and this is displayed in several rooms throughout the service. This provides information about the complaints procedure in both written and pictorial formats. We would suggest that this could be made even easier to understand. All the people that responded to 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 18 our survey said that they know who to talk to if they are unhappy and know how to make a complaint. Comments from people include ‘I tell the staff if I have a problem’ and ‘if not staff I tell staff at Canalside [day services] or my social worker’. Comments for a social care professional we spoke to confirm that the staff always respond to any concerns raised and said that there is a very good relationship with the service. As well as the complaints procedure in place there is a grumbles book in place to record any minor issues that are dealt with on the spot. No complaints have been received either by the service or by the Commission since our last inspection. Staff we spoke to are aware of issues relating to safeguarding and have received training. The training records confirm that all staff receive safeguarding training as part of induction and also regular updates. No safeguarding incidents have taken place. A spot check of the arrangements for managing and safeguarding people’s money was undertaken. The current system takes account of people’s individual abilities and wishes over how they manage their money. Several people look after their own personal allowance. In 1 instance records examined show that the person receives all their money and manages it themselves. The person concerned confirmed this was the case. For another person the service is completely managing their money and records are being kept of expenditure and receipts kept. In this case there was more money than the expenditure indicated and after investigation it appeared that some money had been set aside for costs associated with attendance at the day service. In another case there was some confusion over the level of support needed and a staff member was keeping some records although the person was in fact looking after and managing their own money. This meant that the records did not tally. We discussed these issues with the manager and are confident this will be addressed immediately. Since the inspection the service has informed us that new financial management procedures are in place including a system of double signing and weekly audits. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 19 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): 24,27,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The design, decoration and furnishing of the service enables people that use to the service to enjoy good quality domestic style accommodation that is safe and is clean and hygienic. EVIDENCE: The service is located in the town of Stone and is within walking distance of local shops. The premises are two three bedded terraced houses with an adjoining door although the houses run separately with 3 people living in each house. Externally the front doors lead straight off the street. At the rear of each house there is a small yard and a garden beyond. Three people live in each house. There is an ongoing programme of re-decoration and refurbishment for the service and the service informs us that it plans to improve the external gardens to make them more attractive. The service’s AQAA states that they ‘provide small homely environments for service users. Bedrooms are decorated to personal choice and suggestions on colour schemes are acted upon’ and that ‘ shared spaces compliment individual service users.’ 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 20 We confirm this to be the case. The premises provide people with domestic style accommodation that is generally well maintained with modern furnishings and decoration. The lounge of number1 has been redecorated and new furniture provided. Number 3 has had the hall, stairs, kitchen and landings decorated in line with people’s wishes wishes. We did notice that the carpet on the stairs was frayed and needed replacing and the floor in one bedroom needed some attention. Each house has its own lounge, kitchen and dining area or room and its own bathroom with shower on the first floor. The service has all single bedrooms. We did notice that one bedroom was smaller than others but the occupant said he liked his room and liked to lie in bed to watch his TV. The communal areas provide people with an attractive place to sit and to eat their meals. Looking at a sample of bedrooms show that they are well personalised with a range of ornaments, photos and personal belongings. People are positive about their bedrooms. Comments included ‘I like my bedroom’ and ‘ my bedroom is blue and white. I chose them because I like them’. The home is clean and tidy throughout. All the surveys we received said that ‘the service was always clean and fresh’. People that live at the service take part in domestic activities including helping to clean their bedrooms and the communal areas. This is done according to their abilities as part of their independent living plans. The service is aware of infection control issues and some staff have had specific training. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 21 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 excellent This judgement has been made using available evidence including a visit to this service. Staff are trained, skilled and are flexibly provided to make sure people have the support they need to live the life they want. The service has a robust recruitment process that is protecting the people that live there. EVIDENCE: The service’s AQAA reports that it trains its staff and provides adequate staffing in a flexible manner to meet people’s needs. Our inspection shows that the service provides sufficient staffing to support people. 1 person works in each house when required as on some days all people living at the service are out all day. The service’s roster confirms that staffing is flexible, for example more staff are on duty when people are going out socially and need support. The service provides 1 staff member sleeping in every night. As this person is located in 1 of the houses people have access to an emergency call system if they need this staff member. Talking to people shows that they are aware of this system and know how to use it. It is very clear that staff know the people living at the service very well. They could tell us about the individual needs of the people that live at the service 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 22 and how these are met. They are aware of equality and diversity issues including people’s specialist communication needs, spiritual needs and needs relating to disability. Staff and the people that live at the service relate well to each other and there is a relaxed friendly atmosphere at the service. People are treated with respect and have their rights promoted. A social care professional reported that staff are responsive to people’s needs and that they liaise effectively with their organisation. The service gives staff training a high priority. A high number of staff are qualified and all staff receive induction training and further training relevant to their role including health and safety training and training related to specific conditions such as dementia and epilepsy. Sampling of the service’s recruitment procedures confirms that service is undertaking all the necessary pre employment checks. All of the three files we checked had satisfactory Criminal Records Bureau and Protection of Vulnerable Adult checks. References were present, identify was checked and all staff had a formal interview. People that live at the service are involved in the recruitment process. The services provides staff with good support. Regular staff meetings are held. Staff told us and files confirm that the manager provides regular supervision and all staff have an annual appraisal to look at their progress and future development needs. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service has effective management systems in place that are making sure that the service is well led and is being run in the interests of the people that live there. EVIDENCE: The manager is suitably qualified and experienced to manage the service. She is currently undertaking a further management course to improve her knowledge and skills. The manager has daily contact with people that live at the service and staff. The evidence seen throughout this inspection demonstrates that the service is well led in the interests of the people that live there. Staff training, staff recruitment and staff deployment are all undertaken in the interests of 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 24 providing an effective and safe service. People living at the service are listened to and are involved in aspects of running the service. People’s choices, their independence and their rights are promoted. As the service’s AQAA states: ‘We want everything we do in the home to be driven by the needs, abilities and aspirations of our residents, not by what staff, management or any other group would desire. We recognise how easily this focus can slip and we will remain vigilant to ensure that the facilities, resources, policies, activities and services of the home remain resident-led.’ The service sent us an AQAA to tell us about the service. Although parts of this contains good information the document is too dominated by the company’s policies and procedures rather than identifying the outcomes people living at the service experience. We discussed this with the manager on our visit and gave advice of what the Commission expected a good AQAA to contain. The service has a system for monitoring the service in place. This includes keeping records to demonstrate changes and improved practices and includes information from people that live there . For example house meetings are held regularly and yearly surveys are completed. The service also undertakes audits on the environment and on health and safety issues. Information from these identifies areas for development. We would suggest that the service considers seeking the views of other significant people that have contact with the service. The service’s health and safety practices are keeping people safe. Regular checks are completed on fire equipment including the fire and smoke alarms. The service has a fire risk assessment in place. Staff receive health and safety training including fire safety, moving and handling, first aid and food safety. The AQAA also informs us that checks are completed on gas appliances and the heating boiler and that procedures are in place on a range of health and safety issues. At the last inspection it was identified that a radiator needed covering and we saw that this had been addressed when we visited this time. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 25 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 3 3 X 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 2 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 2 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 3 4 X 3 X X 3 X 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13(6) Requirement Where the service is supporting people with money management a clear and robust system must be in place that is known to all staff. This will reduce the likelihood of any errors occurring. Timescale for action 05/06/08 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 To include within documentation the range of fees charged for the service and all major items to be paid for in addition to the fees. This will show people the range of fees they can expect to pay for the service. To further develop the person centred plans in accessible formats. This will help people to be more fully involved in the care planning process. Risk management assessments should reflect current good practice and ensure that all risks are fully covered. This will make sure that people are supported to take risks as part of their chosen lifestyle. DS0000005072.V364751.R01.S.doc Version 5.2 Page 27 2. 3. YA6 YA9 1 Alexandra Street 4. YA20 5. YA24 When people are self– medicating a comprehensive assessment showing the process undertaken should be in place and secure storage should be provided. This will make sure that people are fully protected. The stairs carpet and flooring in one bedroom should be repaired. This will provide people with a higher standard of accommodation. 1 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Alexandra Street DS0000005072.V364751.R01.S.doc Version 5.2 Page 29 - 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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