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Inspection on 25/06/07 for 1 Great Wood Road

Also see our care home review for 1 Great Wood Road for more information

This inspection was carried out on 25th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The home should be congratulated for the `tenant profiles` that are in place. These are comprehensive and describe in detail what actions staff need to take to support individuals in areas such as daily living, personal care, communication and behaviour. Good efforts are made to involve residents in decision-making and participation. For example tenants profiles identify preferences, the use of large colourful photographs and pictures encourage residents participation in choices of activities and meals and staff complete detailed daily records for individuals that new staff can use to understand residents likes and dislikes. All staff that were interviewed demonstrated understanding of supporting individuals to make decisions, for example one person explained, "you get to know personalities, talk to other staff, if you consistently offer choice you get to know their wishes, just because someone can`t talk they still can make choices and its our responsibility to offer choices at every opportunity". Efforts are made to ensure people lead full and active lives based on their individual needs and capabilities. Records evidence that individuals attend various activities including day centres, public houses, the cinema, shopping centres, discos and church. Throughout the house there are numerous items such as board games, arts and crafts, DVDs, foot spas and sensory items, some of which were seen being used during the inspection.Two relatives surveys were received by the Commission for Social Care Inspection (CSCI), both stating that the home helps their relative to maintain contact and supports them to live the life they choose. Menu planning is good within the home, with individuals dietary and cultural needs catered for. An abundance of evidence indicates that person centred approaches are undertaken in this area. For example each person has their own food preferences recorded in large colourful picture formats as aids to communication, mealtimes are flexible with individuals able to choose when and where they eat and separate storage facilities are available to promote an individuals cultural dietary requirements. Three questionnaires were received by the CSCI from different health care professionals, all praising the home. For example comments include `relevant referrals are always made and the home always seeks advice if they are unsure about any aspect of heath care` and `The staff are open to being taught about anything that will empower or enhance a patients life at the home. The care service really does try to accommodate any changes or suggestions that would change the patients life, always open for suggestion`. The home has complaints procedures that are included in the service user guide, on display in each bedroom and are given to relatives who may wish to raise concerns on behalf of their relative. Relatives who completed questionnaires and returned them to the CSCI all stated they had been made aware of the homes complaints procedure and that the home always responded appropriately if they raised concerns. All staff that were interviewed demonstrated understanding of their responsibilities in relation to protecting residents from abuse. As one person explained, "all staff have policies on abuse that we must follow, if I saw something I would go straight to manager or if I heard something from another member of staff would question it. Would definitely do something, its my job because the people who live here can`t talk to sort themselves, its my job to support them". The physical design and layout of the home enables people to live in a safe, generally well-maintained and comfortable environment, which encourages independence. Staff spoken to during the inspection knew the needs of the residents and relationships between them appear good.

What has improved since the last inspection?

The admission policy has been reviewed and is included in the statement of purpose, informing people that emergency admissions are not considered by the home.Since the last inspection the home has started to develop support plans for individuals that will work alongside the tenant profiles to further enhance the care planning process within the home. Also the home has reviewed its care planning processes and linked plans to relevant risk assessments in order that they correspond with recorded needs. Action has been taken to address a previous requirement instructing that residents are individually supported to develop plans around their wishes in the event of illness and or dying. All those files sampled by the inspector contained evidence of letters sent to families in order that their views can be obtained in this area due to communication difficulties of individuals residing at the home. The manager confirmed that for some this process was still ongoing. Privacy screening has been put in the garden area, pathways levelled for wheelchairs and security fencing installed around the property encouraging the use of the outside space during good weather.

What the care home could do better:

Improvements to the management of medication must take place to ensure the health and wellbeing of residents is not compromised. These must include devising and implementing a policy for the disguising of medication that complies with relevant legislation, ensuring all prescribed medication is signed for when administered, maintaining a record of the amount of `as required` medication in stock and ensuring all medication is acknowledged as being received into the home on the medication records. Residents must be reimbursed for any items purchased from their personal allowances that are the responsibility of the home to provide in order that their rights are protected. An assessment by a qualified person must be undertaken in regards to a resident`s bed frame, mattress and bedrails with any recommendations acted upon in order that the risk of injury is minimised. Twice-daily checks of the bedrails, with records maintained must be undertaken until the assessment is completed. The registered person must ensure a quality assurance system is put in place, that supports service users to feel confident that their views underpin all selfmonitoring, reviewing and development of the home. Notifications in line with Regulation 37 of the Care Home Regulations 2001 must be completed to ensure effective monitoring of residents wellbeing is undertaken.

CARE HOME ADULTS 18-65 Great Wood Road, 1 Small Heath Birmingham West Midlands B10 9QE Lead Inspector Lesley Webb Key Unannounced Inspection 25th June 2007 09:00 Great Wood Road, 1 DS0000016922.V338095.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 Great Wood Road, 1 DS0000016922.V338095.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. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Great Wood Road, 1 Address Small Heath Birmingham West Midlands B10 9QE 0121 773 0017 0121 773 0247 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) Friendship Care and Housing Association Miss Samantha Slater Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 24th October 2006 Brief Description of the Service: 1 Great Wood Road is a two storey home offering ground floor accommodation to service users, with the top floor being used for office space. The home caters for 4 service users with learning disabilities and diverse needs, some experiencing mobility difficulties. All service users have their own individualised bedroom. There is a car park to both the front and rear of the property. To the front is a small garden and planted area equipped with seating, that residents could use in the better weather. The fees at the home are stated in the service user guide as being £326.44 per week for the standard cost of a placement. Fees are negotiated on an individual basis dependent on the service users’ needs. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this visit with the home being given no prior notice. During the visit time was spent talking to staff, examining records and observing care practices before giving feedback about the inspection to the registered manager. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking two individuals care provided at the home. For example the people chosen consisted of both male and female and have different communication and care needs. One relative of a resident was present during the inspection and two relatives questionnaires were completed and sent to the Commission for Social Care Inspection (CSCI) prior to the visit. Information from these and from documentation supplied by the home before the visit was also used when forming judgements on the quality of service provided by the home. The atmosphere throughout the visit was relaxed and welcoming and the inspector would like to thank residents and staff for their co-operation and assistance. What the service does well: The home should be congratulated for the ‘tenant profiles’ that are in place. These are comprehensive and describe in detail what actions staff need to take to support individuals in areas such as daily living, personal care, communication and behaviour. Good efforts are made to involve residents in decision-making and participation. For example tenants profiles identify preferences, the use of large colourful photographs and pictures encourage residents participation in choices of activities and meals and staff complete detailed daily records for individuals that new staff can use to understand residents likes and dislikes. All staff that were interviewed demonstrated understanding of supporting individuals to make decisions, for example one person explained, “you get to know personalities, talk to other staff, if you consistently offer choice you get to know their wishes, just because someone can’t talk they still can make choices and its our responsibility to offer choices at every opportunity”. Efforts are made to ensure people lead full and active lives based on their individual needs and capabilities. Records evidence that individuals attend various activities including day centres, public houses, the cinema, shopping centres, discos and church. Throughout the house there are numerous items such as board games, arts and crafts, DVDs, foot spas and sensory items, some of which were seen being used during the inspection. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 6 Two relatives surveys were received by the Commission for Social Care Inspection (CSCI), both stating that the home helps their relative to maintain contact and supports them to live the life they choose. Menu planning is good within the home, with individuals dietary and cultural needs catered for. An abundance of evidence indicates that person centred approaches are undertaken in this area. For example each person has their own food preferences recorded in large colourful picture formats as aids to communication, mealtimes are flexible with individuals able to choose when and where they eat and separate storage facilities are available to promote an individuals cultural dietary requirements. Three questionnaires were received by the CSCI from different health care professionals, all praising the home. For example comments include ‘relevant referrals are always made and the home always seeks advice if they are unsure about any aspect of heath care’ and ‘The staff are open to being taught about anything that will empower or enhance a patients life at the home. The care service really does try to accommodate any changes or suggestions that would change the patients life, always open for suggestion’. The home has complaints procedures that are included in the service user guide, on display in each bedroom and are given to relatives who may wish to raise concerns on behalf of their relative. Relatives who completed questionnaires and returned them to the CSCI all stated they had been made aware of the homes complaints procedure and that the home always responded appropriately if they raised concerns. All staff that were interviewed demonstrated understanding of their responsibilities in relation to protecting residents from abuse. As one person explained, “all staff have policies on abuse that we must follow, if I saw something I would go straight to manager or if I heard something from another member of staff would question it. Would definitely do something, its my job because the people who live here can’t talk to sort themselves, its my job to support them”. The physical design and layout of the home enables people to live in a safe, generally well-maintained and comfortable environment, which encourages independence. Staff spoken to during the inspection knew the needs of the residents and relationships between them appear good. What has improved since the last inspection? The admission policy has been reviewed and is included in the statement of purpose, informing people that emergency admissions are not considered by the home. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 7 Since the last inspection the home has started to develop support plans for individuals that will work alongside the tenant profiles to further enhance the care planning process within the home. Also the home has reviewed its care planning processes and linked plans to relevant risk assessments in order that they correspond with recorded needs. Action has been taken to address a previous requirement instructing that residents are individually supported to develop plans around their wishes in the event of illness and or dying. All those files sampled by the inspector contained evidence of letters sent to families in order that their views can be obtained in this area due to communication difficulties of individuals residing at the home. The manager confirmed that for some this process was still ongoing. Privacy screening has been put in the garden area, pathways levelled for wheelchairs and security fencing installed around the property encouraging the use of the outside space during good weather. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 8 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. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 9 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 Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 10 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 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people considering this home have the information available they need to make an informed choice about where they live. The assessment procedure ensures that staff know individuals needs and that the home can meet them. EVIDENCE: There have been no new admissions to the home for at least three years, however examination of the homes admission policies and procedures confirm that prospective people considering the service would have their needs assessed appropriately in order that the home can be confident of meeting them. Since the last inspection the admission policy has been reviewed and is included in the statement of purpose, informing people that emergency admissions are not considered by the home (meeting a previous requirement). The inspector sampled the records of two people living at the home and found both contained copies of the placing authorities initial assessment and contract. The manager explained that information such as the service user guide is kept in each person’s bedroom along with other information about the home in order that information is accessible to residents and their families. Upon touring the premises the inspector found this statement to be accurate. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 11 Through examination of records, discussions with the manager and staff and observations of care practices the inspector is satisfied that the home is meeting the needs of people living there. All staff that were spoken to demonstrated knowledge and understanding of the particular needs of individuals, including those relating to health, communication and mobility. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 12 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: Information supplied by the home prior to the inspection states that everyone who lives there requires help with personal care, communication, health care management and that three people have physical needs. It was also stated that all have care plans in place that describe the support required in these areas, including restrictions and longer term objectives and that all plans have been reviewed in the last 12 months with involvement of social workers or care managers. Examination of two peoples records confirm this information to be accurate. The home should be congratulated for the ‘tenant profiles’ that are in place. These are comprehensive and describe in detail what actions staff need to take to support individuals in areas such as daily living, personal care, kitchen, eating, housekeeping, Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 13 travelling, communication, social, relationships, mobility, finances, support during the night and behaviour. Since the last inspection the home has started to develop support plans for individuals that will work alongside the tenant profiles to further enhance the care planning process within the home. Where possible the home encourages families to be involved in the compilation of care plans to support individuals with communication difficulties. The manager explained that some families do not wish to participate in this process and that some individuals are not allocated social workers (an application has been made for one individual), but that the company that owns the home as an advocacy service that can be accessed. It is recommended that advocacy services be obtained for those individuals who have communication difficulties in order that their views and opinions are obtained when planning their care and support. For those families that do choose to play an active role in the care planning process both confirmed that the home supports them in this area, keeping them informed through meetings, telephone conversations and letters. In addition to the care planning documentation key workers complete monthly reviews, with changes in needs then reflected in care plans. The records of these were examined and found to be detailed and informative. It was however noted that in some instances these have not been completed on a monthly basis. It is recommended that reviews occur monthly for all individuals or that the home reviews the frequency that these should be completed in order that effective monitoring of care planning takes place and changes in needs are identified and acted upon. The home should be congratulated for its efforts to involve residents in decision-making and participation. Everyone who lives at the home has differing communication needs that could cause barriers to involvement however evidence indicates the home attempts to overcome barriers in this area. For example tenants profiles identify preferences, the use of large colourful photographs and pictures encourage residents participation in choices of activities and meals and staff complete detailed daily records for individuals that new staff can use to understand residents likes and dislikes. All staff that were interviewed demonstrated understanding of supporting individuals to make decisions, for example one person explained, “you get to know personalities, talk to other staff, if you consistently offer choice you get to know their wishes, just because someone can’t talk they still can make choices and its our responsibility to offer choices at every opportunity”. Requirements relating to risk assessments identified in previous inspections are now met. Since the last inspection the home has reviewed its care planning processes and linked plans to relevant risk assessments in order that they correspond with recorded needs. They also include strategies for behaviours that detail how these can be managed and are reviewed in line with the care planning process. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 14 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at this home are supported to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: Efforts are made to ensure people lead full and active lives based on their individual needs and capabilities. Records evidence that individuals attend various activities including day centres, public houses, the cinema, shopping centres, discos and church. Throughout the house there are numerous items such as board games, arts and crafts, DVDs, foot spas and sensory items, some of which were seen being used during the inspection. The home should be commended for the efforts it has made for one resident who is unable to leave their room due to ill health. This persons room contains an abundance of sensory items in order to offer stimulation and the manager explained that Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 15 they were looking to see if the window in this persons room can be altered into a patio door in order that they can access the garden area. Some improvements to activity records are recommended to ensure effective monitoring of activities takes place and to ensure the needs of all individuals are met in this area. For example each person has activity planners completed and a monitoring form that should be completed to detail if desired frequencies have been achieved, however the inspector found that not all activities are currently being recorded on the monitoring sheet. As the people who live at this home have communication difficulties, the home in many instances is reliant on its recording systems to evaluate if activities are effective, reinforcing the need for improvements in this area. The home supports individuals to maintain contact with families and friends. Two relatives surveys were received by the Commission for Social Care Inspection (CSCI), both stating that the home helps their relative to maintain contact and supports them to live the life they choose. Menu planning is good within the home, with individuals dietary and cultural needs catered for. An abundance of evidence indicates that person centred approaches are undertaken in this area. For example each person has their own food preferences recorded in large colourful picture formats as aids to communication, mealtimes are flexible with individuals able to choose when and where they eat and separate storage facilities are available to promote an individuals cultural dietary requirements. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Improvements to some medication practices are required to ensure systems safeguard residents. EVIDENCE: The principles of dignity and respect are promoted within this home. For example the inspector observed staff seeking permission to enter residents bedrooms before entering, talking to individuals in a friendly yet respectful manner and offering assistance with personal care discreetly. The management of health care at this home is good. All requirements identified in the previous inspection relating to health care have now been met. For example detailed care plans were found to be in place for individuals in relation to advice given by health care professionals and accident log sheets are completed that are also referenced in the daily diary and communication Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 17 book. Three questionnaires were received by the CSCI from different health care professionals, all praising the home. For example comments include ‘relevant referrals are always made and the home always seeks advice if they are unsure about any aspect of heath care’ and ‘The staff are open to being taught about anything that will empower or enhance a patients life at the home. The care service really does try to accommodate any changes or suggestions that would change the patients life, always open for suggestion’. The inspector examined medication systems and found that some improvements are required in order that systems safeguard individuals. The home uses a monitored dosage medication system with each persons medication stored in their individual rooms. Policies and procedures are in place for self-medication, obtaining medications, administration, recording, disposal, homely remedies and training of staff. It was noted that although the policy for administration of medication mentions invasive practices this is very brief and does not cover all aspects required when care staff undertakes invasive practices. It is recommended that the home obtains the CSCI guidance on invasive practices and ensures its systems are compliant with this to ensure the safety and wellbeing of residents. It was also noted that the home does not have a policy for the disguising of medication despite one person having medication disguised in jam (records do however confirm this has been approved by the General Practitioner). It was pleasing to find that competency assessments are completed for all staff that administer medication, with the manager confirming she completes these once a year and new staff have to complete three before giving medication. She also explained that if an incident occurs the member of staff cannot administer medication again until they have completed three more assessments. When looking at medication the inspector found a number of errors including a prescribed cream that has not been recorded as administered, medication administration recording charts missing for a prescribed spray, no recorded amounts for ‘as required’ pain relief and an error in recording a controlled drug. The inspector informed the manager that she would contact a CSCI pharmacy inspector regarding the issues and request that they visit the home. Action has been taken to address a previous requirement instructing that residents are individually supported to develop plans around their wishes in the event of illness and or dying. All those files sampled by the inspector contained evidence of letters sent to families in order that their views can be obtained in this area due to communication difficulties of individuals residing at the home. The manager confirmed that for some this process was still ongoing. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home are supported to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: Information supplied by the home prior to the inspection, discussions with staff and observations of care practices confirm that people living at the home are supported to raise concerns. The home has complaints procedures that are included in the service user guide, on display in each bedroom and are given to relatives who may wish to raise concerns on behalf of their relative. All staff that were interviewed demonstrated knowledge and understanding of supporting individuals in this area. For example one person explained, “when you work with people every day you notice changes in mood, e.g. one person will cry and he always laughs, another may be quiet, talk to other staff to see if they noticed changes, always monitor. Discuss concerns with other staff, speak to the manager and family”. This was reinforced further by relatives who completed questionnaires and returned them to the CSCI, all of which stated they had been made aware of the homes complaints procedure and that the home always responded appropriately if they raised concerns. A previous requirement to ensure the use of distraction and breakaway techniques as an intervention for a service user includes details of who authorised this is now met. The manager states this relates to a particular Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 19 individual who displays behaviour when out in the community. She confirmed that risk assessments are in place, the community nurse is involved advising of techniques and that symbols are used to communicate and manage situations with the individual. All staff that the inspector spoke to knew of the intervention policy relating to this person and confirmed they had received appropriate training. All requirements identified in the previous inspection relating to the management of residents finances have also been met, with personal allowances no longer being used to fund taxis for staff or for purchasing extra linen. When sampling the records and monies of two residents the inspector found some discrepancies. For example a member of staff had claimed bus fare from an individuals personal monies (this should be funded by the home) and another receipt indicates that the resident paid for the staffs drink. The inspector was concerned that a senior on duty had countersigned these transactions. It was also noted that a resident had paid for taxi fares to undertake swimming despite staff forgetting to bring swimming equipment resulting in the resident being unable to participate in the activity. The inspector instructed that residents must be reimbursed in all these instances to ensure the homes management of resident’s finances does not place them at risk of abuse. As with complaints all staff that were interviewed demonstrated understanding of their responsibilities in relation to protecting residents from abuse. As one person explained, “all staff have policies on abuse that we must follow, if I saw something I would go straight to manager or if I heard something from another member of staff would question it. Would definitely do something, its my job because the people who live here can’t talk to sort themselves, its my job to support them”. A copy of Birmingham city councils multi agency protection procedures is available within the home along with the home policy on the protection of vulnerable adults. The homes policy appears very detailed and informative. It is recommended that information instructing notifying the CSCI of all allegations of abuse be included in the body of the policy as this is currently only included in the flow chart at the back of the policy. If this is included in the body of the policy it should ensure staff are fully informed of action to be taken when abuse is suspected, offering greater protection to residents. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people to live in a safe, generally well-maintained and comfortable environment, which encourages independence. EVIDENCE: Information supplied to the CSCI prior to the inspection by the home states ‘1 Great Wood Road is a purpose built accommodation based on ground floor accommodation for people with complex needs. Open plan spacious communal areas with adequate space for aids and adaptations, specialist bathrooms meet service users needs, individual bedrooms that are well decorated. An environment that reflects the make up of the people living in the home’. The inspector undertook a tour of the premises and found this statement to be accurate. Since the last inspection privacy screening has been put in the garden area, pathways levelled for wheelchairs and security Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 21 fencing installed around the property encouraging the use of the outside space during good weather. All of the three requirements identified in the previous inspection have now been met. When looking at individual bedrooms the inspector found all to be tastefully decorated and furnished with personal items reflecting individual’s personalities. As mentioned earlier in this report additional efforts have been made to ensure the bedroom of a resident who is bed bound is furnished with an abundance of sensory items. Upon examination of another residents room the inspector was concerned to find an excessive gap between bedrails and even when the manager attempted to rectify this the rails became loose again resulting in a risk of injury to the resident. The inspector instructed that an assessment by a qualified person must be undertaken in regards to the bed frame, mattress and bedrails with any recommendations acted upon. The home was also instructed to introduce with immediate effect twice-daily checks of the bedrails, with records maintained until an assessment is completed and to expand the risk assessment currently in place in order that risk of injury is minimised. The home has two separate bathing facilities, both of which have aids and adaptations for ease of use. It was noted in the shower room that the shower chair, areas of grouting, drainage and shower curtain have what appears to be a mould substance. It is recommended that advice be sought from a relevant person such as an infection control advisor regarding this with any recommendations acted upon in order that resident’s health and safety is not compromised. During the inspection no offensive odours were present and the home presented as homely and clean. Ten staff have received training on the prevention of infection and management of infection control. When looking around the kitchen the inspector noted that windows were open but that fly screens are not present. As the kitchen is open plan, direct onto the dining area and lounge all of which have windows and doorways the inspector recommends that advice be sought from the Environmental Health Department for the management of possible insects in food preparation areas in order that health and safety is maintained. The home has a small laundry that contains all appropriate equipment including personal protective clothing. Upon examination of this facility the inspector found the extractor fan to contain dust and a build up of dust was seen behind the dryer. It is recommended that this be removed and included in a regular cleaning schedule to promote good fire safety management, as studies indicate the build up of dust behind dryers is a common cause of fire. It is also recommended that the home introduce a policy and procedure for the sanitizing and storage of mop heads to promote good infection control practices. Currently none are in place and some individuals living at the home are incontinent. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally staff in the home are trained, skilled and in sufficient numbers to support the people who live there. EVIDENCE: Staff spoken to during the inspection knew the needs of the residents and relationships between them appear good. Information supplied by the home prior to the inspection stated that four full time and ten part time staff are employed, with 312 care hours provided per week. In the main care hours appear to be sufficient to meet the needs of people living at the home. However it was noted that one individual no longer is able to access day care services, with no additional funding in place for the home to provide additional staffing to compensate for this. The manager confirmed that the home was liaising with the funding authority regarding this but as yet this has not been resolved. It is recommended that the individuals care package be reviewed in relation to support required to access the community, within a multi disciplinary forum in order that this persons needs are appropriately managed and met. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 23 Both relatives’ surveys completed and returned to the CSCI state that care staff have the right skills and experience to look after people properly. Information supplied by the home informs that ten permanent staff hold a national vocational qualification level 2 or above and that two other members of staff are working towards this. When discussing training with the manager she confirmed that all staff received learning disability award framework accredited training and that she ensures a regular member of staff is on shift with new starters who may not be qualified. A previous requirement to ensure all new staff undertake induction training in line with the specifications laid down by skills for care is now met, with all files sampled by the inspector containing evidence of this occurring. Despite the inspector finding evidence that person centred approaches to care are promoted within the home, not all staff understood the principles of this form of care planning when interviewed. It is recommended that staff receive training and guidance in person centred planning in order that they have sufficient knowledge to support care practices within the home and meet peoples needs. It is also recommended that greater numbers of staff receive training in autism, epilepsy and challenging behaviours in order that they have the required knowledge to support individuals living at the home as many that were spoken to felt further guidance in these areas would be helpful when caring for individuals. The records of four members of staff were sampled in order to assess the home recruitment and selection practices. All contained the required documentation to ensure people living at the home are safeguarded from harm or abuse. Work has been undertaken to address a requirement identified in a previous inspection to ensure regular supervision and appraisals take place and that during these process, staff roles and responsibilities are looked at in respect of the work they are doing on a daily basis to support service users with their needs. Of the four staff files sampled all contained evidence that they now receive formal supervision, however the amount of these sessions appears to vary. This was discussed with the manager who acknowledges further improvements can still be made. It was however pleasing to find that staff meetings occur monthly unless cancelled due to emergency situations. The records of staff meetings were viewed and found to be comprehensive, with discussions including resident’s needs, procedures and health and safety. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the management of the home is good, however quality assurance systems must be introduced based on the views of individuals in order that the home can measure if it is meeting its aims and objectives. Some improvements to the management of health and safety will offer further safeguards to individuals. EVIDENCE: The home appears to be appropriately managed, with the manager demonstrating understanding and commitment to her role throughout the inspection. It was pleasing to find that the majority of areas identified during the inspection of good practice and areas requiring improvement had already been identified by the manager when supplying information to the CSCI prior Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 25 to the inspection. For example as areas that the manager states the home does best ‘evidence peoples interest and hobbies through care planning process. Offer new opportunities to tenants and risk assess as required. Respect and respond to tenants individual wishes, maintain and support contact with peoples families and friends. Work with relevant professionals to ensure individual care and support. Offer a nutritious and culturally adequate menu’. The manager identifies areas for improvement as ‘monitor the range of activities, have a quality assurance system in place and continue completion of support plans’. The only area where the manager had not already identified requiring improvement is medication. The manager also confirmed that she is currently in the process of obtaining a national vocational qualification at level 4 in care, that she is hoping to complete this by the end of 2007 and then undertake the registered managers award. It is recommended that the manager prioritise time to complete these qualifications in order to maintain her knowledge and to ensure her qualifications are appropriate for the role of registered manager. As yet the home has still not implemented a formal quality assurance system (this requirement is outstanding from 2006). The inspector found evidence that monitoring of many aspects of the service takes place such as care reviews, health and safety audits and staff supervision. Also the home has a service development plan in place, however action must be taken to ensure monitoring systems are formalised and include the views of residents, relatives, staff and professionals to ensure all aspects of the service are evaluated and that the views of people form an integral part of this monitoring. In the main records required by regulation for the safeguarding of residents are in place. Work must be undertaken to ensure notification in line with Regulation 37 of the Care Home Regulations 2001 are completed as the inspector found on a number of occasions these have not be undertaken. For example there have been occasions when residents have been aggressive, people have visited the hospital and a theft occurred at the home; all of these instances should have been reported to the CSCI. It is recommended that the home obtain the latest guidance issued by the CSCI in relation to Regulation 37 notification in order that it fulfils its legal obligations and systems promote effective monitoring of residents wellbeing. Information supplied by the home prior to the inspection states that electrical circuits, portable equipment, hoists, fire detection and equipment, heating system and gas appliances have all been serviced in the past twelve months. A random sampling of records confirms this information to be accurate. A previous requirement to ensure remedial works on the electrical wiring in the home be completed is now met, however it was noted that since this work has been completed further testing has identified that the house now needs rewiring. The manager confirmed that as yet no date for this to be undertaken has been agreed. It is recommended that arrangements be made for this work Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 26 to be completed in order that the health and safety of residents is not compromised. When assessing COSHH products the inspector found that in some instances data sheets and risk assessments were not available. It is recommended that the home reviews its current records and ensures documentation is in place for all products in order that health and safety is not compromised. All other records relating to the management of health and safety that were viewed appear appropriate. It was however noted that the safe working practice risk assessments have not been reviewed since January 2006 and that some sections of the form (e.g. risk ratings) were incomplete. It is recommended that these be reviewed and completed in full to ensure the health and safety of individuals is not compromised. As mentioned in the environmental section of this report action must be taken to ensure bedrails do not pose a risk to resident’s health and wellbeing. Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 2 3 X Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 28 Yes. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The home must devise and implement a policy for the disguising of medication that complies with relevant legislation and ensures the health and wellbeing of residents is not compromised. Improvements to the management of medication must take place to ensure the health and wellbeing of residents is not compromised. These must include: All prescribed medication must be signed for when administered. A record of the amount of ‘prn’ medication must be maintained All medication must be acknowledged as being received into the home on the MAR charts. Residents must be reimbursed 29/06/07 for any items purchased from their personal allowances that are the responsibility of the home to provide in order that DS0000016922.V338095.R01.S.doc Version 5.2 Page 29 Timescale for action 01/08/07 2 YA20 13(2) 26/06/07 3 YA23 13(6) Great Wood Road, 1 their rights are protected. 4 YA29 13(4)(c) An assessment by a qualified person must be undertaken in regards to a resident’s bed frame, mattress and bedrails with any recommendations acted upon in order that the risk of injury is minimised. 13(4)(c) To introduce with immediate effect twice-daily checks of the bedrails, with records maintained until an assessment is completed and to expand the risk assessment currently in place in order that risk of injury is minimised. 24 The registered person must (1a,b)(2)(3) ensure a quality assurance system is put in place, that supports service users to feel confident that their views underpin all self-monitoring, reviewing and development of the home. (Previous time scale of 23/10/06 not met.) 37 Notifications in line with Regulation 37 of the Care Home Regulations 2001 must be completed to ensure effective monitoring of residents wellbeing is undertaken. 01/08/07 5 YA29 25/06/07 6 YA39 01/08/07 7 YA41 25/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA6 Good Practice Recommendations To continue developing support plans for individuals that will work alongside the tenant profiles to further enhance the care planning process within the home. That advocacy services be obtained for those individuals who have communication difficulties in order that their views and opinions are obtained when planning their care DS0000016922.V338095.R01.S.doc Version 5.2 Page 30 Great Wood Road, 1 3 YA6 4 5 6 YA14 YA20 YA23 7 YA24 8 9 YA24 YA30 10 11 YA30 YA32 12 YA32 13 YA33 14 YA36 and support. That reviews occur monthly for all individuals or that the home reviews the frequency that these should be completed in order that effective monitoring of care planning takes place and changes in needs are identified and acted upon. Improvements to activity records are recommended to ensure effective monitoring of activities takes place and to ensure the needs of all individuals are met. That the home obtains the CSCI guidance on invasive practices and ensures its systems are compliant with this to ensure the safety and wellbeing of residents That information instructing notifying the CSCI of all allegations of abuse be included in the body of the homes adult protection policy to ensure staff are fully informed of action to be taken when abuse is suspected, offering greater protection to residents. That advice is sought from the Environmental Health Department for the management of possible insects in food preparation areas in order that health and safety is maintained. That the build up of dust and lint in the laundry be removed and included in a regular cleaning schedule to promote good fire safety management. That advice is sought from a relevant person such as an infection control advisor regarding what appears to be a mould substance in the shower room, with any recommendations acted upon in order that resident’s health and safety is not compromised. That the home introduces a policy and procedure for the sanitizing and storage of mop heads to promote good infection control practices. That greater numbers of staff receive training in autism, epilepsy and challenging behaviours in order that they have the required knowledge to support individuals living at the home. That staff receive training and guidance in person centred planning in order that they have sufficient knowledge to support care practices within the home and meet peoples needs. That the individual who no longer is able to access external day services has their care package reviewed in relation to support required to access the community, within a multi disciplinary forum in order that this persons needs are appropriately managed and met. That further improvements to the frequency staff receive formal supervision take place in order that systems support staff to fulfil their duties and care for residents. DS0000016922.V338095.R01.S.doc Version 5.2 Page 31 Great Wood Road, 1 15 YA37 16 YA41 17 18 19 YA42 YA42 YA42 That the manager prioritises time to complete the NVQ level 4 and Registered Managers Award in order to maintain her knowledge and to ensure her qualifications are appropriate for the role of registered manager. That the home obtain the latest guidance issued by the CSCI in relation to Regulation 37 notification in order that it fulfils its legal obligations and systems promote effective monitoring of residents wellbeing. That arrangements be made for the electrical work to be completed in order that the health and safety of residents is not compromised. That the home reviews its current records for COSHH and ensures documentation is in place for all products in order that health and safety is not compromised. That the safe working practice risk assessments be reviewed and completed in full to ensure the health and safety of individuals is not compromised Great Wood Road, 1 DS0000016922.V338095.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45 – 46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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