Inspection on 04/06/08 for 1 The Slieve

This inspection was carried out on 4th June 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 The Slieve Handsworth Wood Birmingham West Midlands B20 2NR Lead Inspector Kerry Coulter Key Unannounced Inspection 4th June 2008 09:30 1 The Slieve DS0000071281.V366887.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 The Slieve DS0000071281.V366887.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 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 The Slieve Address Handsworth Wood Birmingham West Midlands B20 2NR 0121 515 4350 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) enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Ms Sonia Gordon Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only; Care Home Only (Code PC) To service users of the following gender Female Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 5 The maximum number of service users to be accommodated is 5. 2. Date of last inspection Brief Description of the Service: 1 The Slieve is a bungalow in a residential area of Handsworth Wood. Local shops are nearby. The One Stop shopping centre in Perry Barr is within a short distance from the home. There are five single bedrooms, a large lounge, dining room/kitchen, and adapted bathing and showering facilities. The home has parking spaces to the front of the property and ramped access is provided. To the rear of the premises is a large enclosed garden, again with ramped access. The garden affords a great deal of privacy for service users and is planted with mature shrubs, trees and rockery area. The accommodation provides a service to four women with learning disabilities and currently has one vacancy. The service users guide provided by the manager records that a fee of £1200.21 is charged each week for this service, however this is based on information dated 2005. The reader may want to obtain more up to date fee information from the care service. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the manager completed a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Survey forms were received from two people who live at the home and one relative, some of their comments are included in the report. Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home, the manager and staff on duty were spoken to. Time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. The home is owned by Bromford Housing Association and managed by Lonsdale (West Midlands). Previously Bromford were the registered providers however the home was reregistered in December 2007 and Lonsdale are now the registered providers. What the service does well: Staff treat each person as an individual and talk to people in a way that shows they respect them. Some staff have worked at the home for a long time so they know the people who live there well. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 6 Care plans are kept up to date, and person centred so that staff have the information they need to meet people’s needs. People can go on holiday supported by staff if they want to so they can see different places and have a break. People are encouraged and supported to maintain relationships with their families. People are offered a healthy diet that they enjoy. Everyone who lives at the home has their own bedroom that is well maintained and contains their personal items. Staff support people to attend health check ups and monitor each person’s health so their health is promoted. Checks have been done on staff to make sure they are suitable to work at the home. Staff have training to make sure they know how to support individuals in the right way and keep them safe. What has improved since the last inspection? What they could do better: The service user guide needs to be updated to make sure it reflects the current fees for living at the home, so that people have all the information they need. Some information within the care plans needs to be expanded so that staff know exactly what type of support each person needs. Individual fire risk assessments should be improved to take into account people’s mobility needs or ability to hear the fire alarm, to ensure they are kept safe should a fire occur. Where handwritten amendments to the directions on medication administration records, these should be signed by two staff to ensure the amendments are accurate. Some of the home needs redecoration and carpets replaced so that the home looks nice for the people who live there. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 7 A review of the staffing arrangements is needed to ensure there are enough staff on duty at all times to meet people’s needs. The area manager should visit the home monthly and write a report about the home, to make sure it is being well run. Fire doors should not be wedged open as this puts people at risk should a fire occur in the home. The arrangements for smoking within the home need review to ensure they are not putting people at risk of poor health from the smoke. 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 The Slieve DS0000071281.V366887.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 The Slieve DS0000071281.V366887.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 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have most of the information they need so they can make a choice as to whether or not they want to live there. Before people move into the home their needs are assessed to ensure they can be met and they have an opportunity to visit to see what it is like. EVIDENCE: People were seen to have a copy of the statement of purpose and service user guide in their bedroom. The service user guide included information about the home to include staffing arrangements, the environment and the complaints procedure. Some of the information was in picture form so making it easier for people to understand. The guide stated that the home has the facilities of a washing machine with a sluice cycle, however discussion with the manager indicates this is not the case. The guide also needs to include the arrangements for smoking so that people know what the rules are and if they can smoke in the home. A licence agreement detailing the fees to live at the home was included in the guide. However the information regarding fees was dated 2005 and so needs review to make sure that people have up to date information. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 10 There have been no new admissions to the home since it was re-registered. The home had one vacancy at the time of the inspection visit. The manager said there had been some enquiries about the vacancy. However initial discussions had shown the potential residents would not be compatible with people living at the home and so these had not been pursued further. The Annual Quality Assurance Assessment (AQAA) was completed by the manager before the inspection visit. This recorded that ‘The home operates a thourough admissions process, which spans over several weeks, from the initial referal through to the admission. The potential individual can expect an off site assessment, several visits to the home ranging from day to overnight stays and weekends experiencing a range of acitivites on each visit. We look at compatibility and consult and involve existing residents throughout the transition process. The individual can also expect a 4-6 weeks review to discuss how the individual has settled and get feedback from the staff, social workers and family’. 1 The Slieve DS0000071281.V366887.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have most of the information they need in care plans and risk assessments so they know how to support individuals to meet their needs whilst ensuring their safety and well being. The people living there are usually supported to make choices and decisions about their day-to-day lives. EVIDENCE: The care provided to two people was case tracked. Each person had a care plan that detailed how staff are to support the person to meet their needs. These included areas of supporting the person with their personal care, selfhelp skills, eating and drinking, mobility, health needs, finances, contact with their family, communication and leisure opportunities. Plans contained information about people’s likes and dislikes and personal preferences so that staff had information about how people like to be supported. Where people are able to they had signed their care plan to say that they agreed to it. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 12 Some information within the plans needed to be expanded for example where plans record ‘to be supported by staff’ so that staff know exactly what type of support is needed. Key workers had met with the individual monthly to consult with them about things they would like to do, records are kept of the meetings. Throughout the inspection staff were observed to encourage people to make decisions about things such as what they wanted to eat or drink. Care plans recorded some decision making by people. Group meetings had been held with the people living there on a regular basis. People had talked about activities, holidays, the home and meals. The AQAA completed by the manager recorded that ‘Caretech (Bromford) has a care planning focus group in the South East that currently works well and the company is seeking to start a focus group to have in the Midlands,where they will invite individuals to help develop plans. Two residents from No1 have been invited to participate and have agreed to attend’. One person has a monitor located in their bedroom so that staff can hear if they have a seizure and provide support. The care plan does record the use of the monitor but it was not clear if the individual had consented to its use, as it affects their privacy. A recent quality and performance report completed by the provider also recorded that consent was needed for the use of the monitor. Records included individual risk assessments that stated how staff are to support the person to take risks whilst maintaining their independence as much as possible. These are reviewed regularly and updated if the person’s needs have changed. Risks that had been assessed included manual handling, falls, bathing, using the kitchen and accessing the community. Each person had an assessment regarding fire but they were very similar for each individual. One persons assessment did not take into account their mobility needs or ability to hear the fire alarm at night when not wearing their hearing aid. The assessments should be reviewed so that they are more specific to the individual to make sure people are moved as quickly and as safely as possible should a fire occur. One person had guidelines for accessing the community, this included information that they were at risk of choking. A risk assessment for choking was not available. The manager said that this individual was not at risk of choking. This needs to be clarified and either the guidelines amended or a risk assessment completed. One person had a risk assessment completed that concluded they were at risk if not supervised when bathing or showering. However the assessment did not actually record why the person was at risk. 1 The Slieve DS0000071281.V366887.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. People are offered a varied and healthy diet so ensuring their well being. EVIDENCE: The two people who were case tracked had an individual activity programme, this had been written containing information from the assessments of needs, which did record their choices, likes and dislikes with regard to social occasions, pastimes and hobbies. Activities on offer to people include board games, college, walks, mobility sessions, karaoke, manicures, lunch out, swimming, knitting, visits to parks and shopping. People are going on holiday this year to Spain on a cruise, they 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 14 said they were looking forward to it. Staff said they had looked at brochures with people and they had chosen where they wanted to go. Most of the time the activities on offer meet peoples expectations. People said ‘they ask me about my activities what I want to do’ and ‘I do have meetings about my activity every Sunday to plan what I would like to do’. Two people said they were really enjoying doing IT at college, one described how she had recently started to attend an employment training unit. However one person said she sometimes gets bored and would like to do more activities, and that not much happens at weekends. One staff said the home would like to get people out more but if there are only two staff on duty this cannot always happen. On the morning of the visit a member of staff discussed with someone who lives at the home if they would like to go out as it was a nice day. The person indicated they would like to go out and staff said they would take them out for lunch when another staff came back to the home. The person was not taken out. Discussion with them indicates they had not been told why this had not happened. Discussion with the manager indicates it had been due to lack of staff availability and the fact that the outing had not been on the person’s activity planner. Arrangements for some flexibility in the activity planner need to be in place and people need to be told the reasons why any activity cannot be undertaken to try and reduce people’s disappointment. Records sampled and discussion with the manager and staff showed that staff support individuals to maintain contact with their family and friends through letters, visits and phone calls. One person had recently had an 80th birthday party at the home and the manager said that friends and family had been invited to this. The people at the home plan the weekly food menu at meetings with support from the staff. Menus seen offered a healthy and varied diet. Staff advised that the menu could be changed daily if the people at the home did not want what was on the menu for the day. One person has a medical condition which means they have to avoid certain food products, staff were aware of this persons needs. The cupboards, fridges and refrigerators contained a good supply of food so that options are available. There was a vast range of fresh fruit available to people this included kiwis, bananas, pears, apples, oranges and nectarines. One person spoken with said that ‘food is alright, we have a choice’. 1 The Slieve DS0000071281.V366887.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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place so that people generally receive health care support in the way they require so that their needs are met. EVIDENCE: All the people living there were clean, well presented and dressed according to their age, gender, the weather and the activities they were doing. People had individual styles of hair and dress and had their own personal toiletries in their bedrooms. Care plans sampled guided staff on the type of support people needed with their personal care. One person said ‘the staff do look after me and treat me well I like staff ‘. One relative said ‘they keep ‘x’ clean and well dressed’. Care plans sampled detailed how staff are to support people to meet their health care needs. It is good that plans have information on how people let staff know when they are unwell. When people are unwell records show that advice is sought from the GP or other health professionals as appropriate. Records kept are usually detailed about health appointments attended, however in March one person saw the nurse for a blood test. The record did 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 16 not record what the blood test was for or what the outcome of the test was. This was discussed with the manager who said that the results had not been received, given that the test was nearly three months ago the managers needs to follow this up. Personal files provided evidence that people living in the house are usually supported to access primary health care and are referred to other health professionals for specialist support as required. One person had a risk assessment in place for falls that had been reviewed in April. This recorded that the person needed to be referred to the falls prevention team. The manager said that this has not been done as the person has been seen by an occupational therapist instead. This information needs to be included on the assessment so that it is up to date. One persons health action plan records they have panic attacks when walking a care plan on how staff are to reduce the risk of this happening is in place to ensure their emotional health needs are met. It is good that people’s weight is monitored monthly as sudden weight loss or gain can be a sign of illness. However health care plans were unclear about what people’s ideal weight should be. It would be a good idea if this was included and would assist staff in knowing if people needed advice from a dietician. The home manages all medicines on behalf of the people who live there. Staff who administer medication have received training to do so, an assessment of their competence to administer medication is also undertaken. Each person had a medication administration record, detailing the name of their medication, when it is to be taken and how much. Staff had signed all medication administration records appropriately. On some occasions staff had made handwritten amendments to the directions on the records, these should be signed by two staff to ensure the amendments are accurate. Some people are prescribed PRN (as required) medication. Protocols were in place that stated when and why the medication should be given to the individual so it is not misused which could have a negative impact on the person’s health. These had been completed in 2006 so it would be a good idea if they were reviewed to make sure the guidance was still appropriate. Topical creams and ointments had not been dated on opening, this should be done so that staff know how long a cream has been in use and if it needs to be discarded and a new tube used. One person had a tube of cream that was very empty and there did not seem to be enough cream left for another application. There was no more of this cream in the home, staff said they would be getting a prescription that day so they could get some more cream. It is not ideal to leave getting new stocks of cream until the last one has run out. The home 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 17 should make sure that new stocks are obtained in plenty of time so that people are not put at risk of not getting the medication they are prescribed. 1 The Slieve DS0000071281.V366887.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. Arrangements ensure that the views of the people living there are listened to and acted on. The people living there are protected from abuse, neglect and self-harm. EVIDENCE: The commission has not received any complaints or concerns about this home since it was reregistered in December 2007. The complaint log and discussion with the manager indicates that the home has not received any complaints directly. The home has a satisfactory complaints procedure, this is in an easy read format with some pictures, making it easier for people to understand. People have their own copy of the complaints procedure as part of the service user guide in their bedrooms. One person who lives at the home said they had no complaints but if they did they would speak to the manager, one commented ‘When I am not happy I go to the manager for help with my problems’. Relatives said they were aware of the complaints procedure, they commented ‘never had to complain’ and ‘have not needed to complain’. Staff have completed training in adult protection and the prevention of abuse so they know how to protect the people living there from abuse, neglect and self-harm. Staff spoken with said they would always report any suspicions of abuse to the manager. The home has policies in place to protect people and also has a copy of the Birmingham multi agency adult protection guidelines. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 19 Systems are in place to safeguard the monies of people living at the home. Receipts for expenditure were available and numbered. Staff count and check the balance of monies held and checks of the money and records are also completed when a senior manager from Londsdale visits the home. 1 The Slieve DS0000071281.V366887.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, 26, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable, safe and clean environment that generally meets their individual needs. EVIDENCE: The home was generally in good decorative order and homely in style throughout. Some areas of the home to include bathroom, toilet and hallway have been redecorated recently. Some communal areas to include the dining room and lounge ceiling need decoration where there is some staining to the current décor. The manager said that it was hoped this work would be done soon. The lounge carpet needs replacement as it is worn and has a visible iron mark, this spoils the overall appearance of the lounge. The hall carpet has a worn area by the lounge that could become a trip hazard in the future if the carpet is not repaired or replaced. The manager said that a representative of the landlords would be visiting the home the week following the inspection and she hoped they would be agreeing to replace the carpets. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 21 One person who lived at the home let us look at their bedroom. It was personalised according to individual needs, culture, gender and preferences. Décor, furniture and bedding was seen to be in good condition so that it was a nice room to spend time in. They said they were happy with their room but they would like the windows sorting out. The windows were seen to be single glazed with metal frames, part of the frame had black grime that appeared to have stained the paintwork. The AQAA completed by the manager prior to the inspection said ‘Metal window frames would benefit from being replaced with UPVC and windows double glazed’. People have most of the aids they need to be as independent as possible. Staff call bells are fitted in bathrooms and bedrooms so that people can call for assistance if they need it. Grab rails are fitted by toilets and the bath can be raised or lowered so that people can get in and out safely. The chair on the bath was observed to be split and was covered in tape as a temporary repair, records showed a new chair had been ordered. As stated earlier in this report one person has a listening monitor in their bedroom so that staff can hear if they have a seizure and come to their aid. Consideration should be given to other types of equipment that would give the person more privacy and independence. It is recommended that staff consult with the epilepsy nurse to ensure they have the right equipment to meet the person’s needs. The home was clean throughout. Hand wash and hand towels were provided in all toilets and bathrooms to minimise the risk of cross-infection. The laundry has an industrial type machine but this does not have a sluice cycle. The manager advised that when the washing machine needs to be replaced a machine with a sluice cycle will be installed at that time. 1 The Slieve DS0000071281.V366887.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): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are usually sufficient to ensure that an effective and competent staff team work at the home who can meet individual’s needs support them. The people living there are protected by the home’s recruitment practices. EVIDENCE: Support to people is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Members of staff demonstrate that they have a good personal knowledge of the individuals in their care. The Annual Quality Assurance Assessment completed by the manager recorded that 100 of the care staff have an NVQ 2 in care and 60 have an NVQ3. This exceeds the standard and ensures staff have the skills and knowledge to meet the needs of the people living there. Minutes of staff meetings showed that these are held regularly. This ensures that staff are aware of any changes to individual’s needs or within the organisation that will affect them or the people living there. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 23 Discussion with the manager and sampling of staff records shows that people are supported by a staff team who know them well. No new staff have been recruited to the home since the home was reregistered. There are normally three staff on duty in the morning, two in the afternoon and at night one waking and one sleeping in to provide support to the people who live at the home. However it was not clear if two staff in the afternoon and evenings were enough to enable people too go out regularly. At the commencement of the inspection there was one staff in the home with two people who lived there. Another staff was at college with two people. Staff said that another member of staff was supposed to be on duty but was going to be late due to their child being unwell. The member of staff was later contacted and was unable to come into work. The deputy manager from another of Lonsdale’s home later arrived to ensure there were enough staff. It was not possible to look at staff recruitment records as they are kept in a locked filing cabinet. The manager has the keys to this and came to the home for the inspection direct from a training course and said her keys to the cabinet were at her home. However discussion with the manager and staff indicated that no new staff had started in the home for some time. An inspection to the home before it was re-reregistered found that recruitment procedures were robust. Two staff spoken with at this inspection confirmed that the provider had obtained references and a criminal records bureau check before they had started work in the home. Records of training that staff have received are kept and were generally up to date. Staff spoken with indicate they are satisfied with the training they receive. Staff have received training in food hygiene, manual handling, adult protection, infection control, first aid and fire safety. Some staff have also done training in epilepsy, healthy eating and dementia. Recently one person who lives at the home has been diagnosed with dementia and the manager said that training would be arranged for staff who need it. There is a rolling programme of training and records showed that some staff had been booked to do refresher medication training, epilepsy, hoist training, autism, diversity, bereavement and the Mental Capacity Act. 1 The Slieve DS0000071281.V366887.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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the people living in the home generally benefit from a well run home. EVIDENCE: The manager of the home is registered with the commission and has the necessary experience and qualifications. In addition to managing 1 The Slieve she also manages another small home on the same road. Staff spoken with did not think that the manager covering two homes had a negative impact on the home. One relative commented ‘happy with the way the home is being run’. The manager demonstrated a good knowledge of peoples needs throughout the visit. The annual assessment form (AQAA) was completed to an adequate standard by the manager and received on time. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 25 The home has quality assurance systems in place and these are being improved so that they involve people who live at the home more. The manager said that the provider is setting up a residents forum to involve people in getting their views of the service. Questionnaires are also being sent out to people who live at the home and their relatives. The provider has completed a quality and performance report for the home identifying areas where improvements are needed. The manager said that no action plan had been completed as yet as a result of the assessment report but that it was intended to do this. The manager said that an area manager for Lonsdale visits the home regularly. However since the home was reregistered in December 2007 there was only one report for April available. Monthly monitoring visits of the home should take place with a report available so that the provider ensures it is being well managed. Staff at the home complete regular health and safety audits to make sure that people are safe. Staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained and in good working order. A fire drill to ensure staff know how to respond in the event of a fire occurring had taken place in February. On arrival at the home the door to the laundry was observed to wedged open, this could put people at risk should a fire occur in the home as it would not give people any protection from fire. A person who lives at the home was later observed to be smoking in the laundry and the door was still wedged open. As the door was wedged open when the person was smoking the smell of smoke spread down the corridor, this could put people who live and work at the home at risk of the long term effects of cigarette smoke. Discussion with the manager indicated that the person used to smoke in the homes dining kitchen but now smoked in the laundry since the new smoking legislation came into force. The use of the laundry room may not comply with the new legislation and the manager will need to ensure smoking arrangements in the home do not put people at risk. The landlord’s gas safety certificate was in date to show that gas appliances are safe. Certificates were available to show that portable electrical appliances had been checked. The electrical hard wiring certificate showed that electrical installations were safe. Staff test the water temperatures weekly to make sure they are not too hot or cold and so people are not put at risk of being scalded. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 26 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 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 X 2 X 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Not applicable as first inspection since home reregistered. 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 YA9 Regulation 13(4)(c) Requirement Timescale for action 30/08/08 2 YA20 13(2) Risk assessments should be further developed to ensure they are clear about what the actual risk to the person is. Clarification is needed within one persons guidelines regarding the risk of choking. The home should make sure that 30/08/08 new stocks of medication are obtained in plenty of time so that people are not put at risk of not getting the medication they are prescribed. 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 The service user guide needs to be updated to make sure it is accurate about the facilities provided and reflects the current fees for living at the home, so that people have all the information they need. Some information within the care plans needs to be expanded so that staff know exactly what type of support DS0000071281.V366887.R01.S.doc Version 5.2 Page 28 2 YA6 1 The Slieve 3 4 YA7 YA9 5 YA12 6 7 8 9 10 YA20 YA24 YA29 YA33 YA39 11 12 YA42 YA42 each person needs. The use of the listening monitor should be agreed with the person and a record kept of their agreement in their care plan. The individual fire risk assessments should be improved to take into account people’s mobility needs or ability to hear the fire alarm, to ensure they are kept safe should a fire occur. Review the arrangements for activities to ensure they meet people’s expectations and the risk of people being disappointed by activities that do not take place is reduced. Where handwritten amendments to the directions on medication administration records, these should be signed by two staff to ensure the amendments are accurate. Some areas of the home need redecoration and the lounge and hallway carpet require replacement to ensure the home looks nice for the people who live there. It is recommended that staff consult with the epilepsy nurse to ensure they have the right equipment to meet the needs of one person who has epilepsy. A review of the staffing arrangements is needed to ensure there are enough staff on duty at all times to meet people’s needs. The registered provider’s representative should do monthly monitoring visits of the home so that they can form an opinion about the standard of care provided to people and produce a report on the outcome. The report of the visit needs to be available in the home. Fire doors should not be wedged open as this puts people at risk should a fire occur in the home. The arrangements for smoking within the home need review to ensure they comply with smoking legislation and are not putting people at risk of poor health from the smoke. 1 The Slieve DS0000071281.V366887.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office 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. 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