CARE HOME ADULTS 18-65
1 Whitehall Road, Cradley Heath West Midlands B64 5BG Lead Inspector
Mr Jon Potts Unannounced Inspection 27th February 2006 13:56 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 1 Whitehall Road, Address Cradley Heath West Midlands B64 5BG 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) 01384 357933 NONE info@Inshoresupportltd.com Inshore Support Mr Adam Webb, Mr Ian Forrest-Jones Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6/12/05 Brief Description of the Service: 1 Whitehall Rd is an adapted terraced property that was refurbished for the purpose of providing long term care for three younger adults with a learning disability. The house is positioned in an established residential area within walking distance of the centre of Cradley Heath. Accommodation briefly comprises of three single bedrooms (two which are ensuite), bathroom, two lounges, dining room and kitchen. The building has a small rear garden area. The home is managed by Inshore support, a company that has a number of small homes that have similar aims and objectives to Whitehall Road. The staffing in the home consists of a manager, senior support and support workers. The staffing ratio is at least one staff member to one resident at day and night, although this is higher for support within the community. The home has an appropriate car allocated for the transport of the residents. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out between 1.56pm and 3.15pm and involved the acting manager and one senior. The inspector met two residents during the course of the visit. Information/evidence was drawn from limited case tracking, sight of case files, documents, training information, policies and procedures, a limited tour of the building and through discussion with the manager and senior. What the service does well: What has improved since the last inspection? What they could do better:
There is a need to develop personal care planning in the form of resident’s individual books, although to enable staff to be able to commence this work appropriate training needs to be provided. There is also a need to provide additional NVQ level 2/3 training to more staff. The home needs to send out questionnaires for stakeholders such as social workers, health authority staff and such like in addition to those completed with residents and sent to relatives, as well as continuing to improve systems for self monitoring. Records to evidence staff involvement in fire drills and training need to be better documented. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 7 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 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Residents’ individual aspirations and needs are assessed on an ongoing basis with the home supporting involvement of varied disciplines within these assessments. Each service user has an individual written life style agreement with the home. EVIDENCE: The home was seen to have detailed pre-admission assessment information in place from the purchasers of the service (local authorities), and there was evidence seen at this inspection of the home confirming its ability to meet residents needs, based on assessment information. The home was seen to have completed its own assessments, these detailed and updating original pre admission assessments. Whilst not all residents had received a multidisciplinary review in the last twelve months it was stated by the acting manager that dates had been arranged with social workers but then cancelled by the latter. New dates were stated to have been arranged for the near future. There was evidence in case files of residents having a contract (called a lifestyle agreement) this setting out terms and conditions as well as costings in respect of the individual service users care. Whilst the actual contract is not at this time in pictorial format there is a pictorial summary of the tasks the staff are to complete for the service user, and the resident’s representatives have now signed all the contracts.
1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Residents assessed and changing needs are reflected in their individual plans. EVIDENCE: Care plans are in place for all residents, all these examined at the time of the inspection. Some of the plans (in respect of managing behaviours and daily routines) were very detailed and information from reviews and assessments had influenced the update of these documents. All care plans had been subjected to recent and on-going review and it was noted had been expanded upon since the time of the last inspection. All contradictory information was seen to have been removed. There was also clear information in case files as to the limitations placed upon the residents due to risk assessment. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were fully assessed at the time of this inspection EVIDENCE: Whilst a full assessment was not carried out on any of the above standards the activity plans for individual residents are now set out in a clear weekly format, this partly pictorial. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents physical and emotional health needs are met as far as practicably possible without causing residents undue stress. EVIDENCE: There was clear evidence that the residents were assisted to access health services whether specialised or pertaining to routine health not associated with their learning disability. Issues identified previously as to the need for one resident to have an in depth sight examination have been explored and the reasons for this not been carried out clearly documented. The acting manager stated that the optician had also stated that they would write to the home to confirm these reasons. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at the time of this inspection. EVIDENCE: See above. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29, 30. 1 Whitehall Road is a comfortable and overall safe environment that is suitable for the residents accommodated, with communal and private space suitable for the needs of their lifestyles. Overall the house was seen to be clean and hygienic. EVIDENCE: The home is sited in a suitable position and presents as a homely environment in keeping with the provision of ‘normal’ domestic style living. There is no indication that the house is anything other that a domestic home, this ensuring that it blends into the immediate community. The home has a redecoration and refurbishment programme identifying works for the next twelve months, although there has been a sustained programme of works over the previous twelve months that has greatly improved the physical standard of the property, inside and out. The house presents as very comfortable and provides residents with a good standard of accommodation, this including bedrooms which are well appointed. One bedroom is slightly undersized but this is compensated for as the house has more communal space than required in the two lounges and dining room.
1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 14 The other two bedrooms, which are also ensuite are also well over the required size. Suitable arrangements were in place in respect of infection control, with the one previous concern as to one bedroom presenting an odour now addressed. The purchase of carpet cleaners for use at the home has assisted with management of any possible retained odours in carpets. There had been some recent difficulties with the temperature of the water in one bathroom, although a central heating engineer was seen to be on site at the time of the inspection. There is no adaptation currently required to allow the home to meet the resident’s physical needs. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The home’s training plan identifies where there is input needed in respect of staff training. EVIDENCE: The home was seen to have a training plan that clearly identified training staff held, what was booked and what was needed. There were areas where training that is still needed for some staff has been identified within the plan. The home is still to achieve 50 of staff trained in NVQ 2 or 3, there having been difficulties with training providers in respect of this area, this stated to be the subject of on-going negotiation between the providers and training companies. Whilst there is training input needed in some areas the home has clearly identified where and for whom this training is required, with the manager having some awareness of the timescales for when it would be provided. The home was seen to have a structured induction programme in place with an external training company providing input into accredited induction training. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 The running of the home has improved since the last inspection. The views of residents and relatives are taken into account by management. Self-monitoring of the service is also improving. EVIDENCE: The acting manager only officially commenced work at 1 Whitehall Rd on the 13/2/06 having been registered by the CSCI in respect of one of the companies other small homes. Despite this the manager and senior clearly had a grasp of important issues in respect of the homes management, this evidenced by the number of requirements addressed since the last inspection. The acting manager is at present awaiting confirmation of his professional qualification and needs to submit an application to the CSCI in respect of his registration as Manager for 1 Whitehall Rd. The home was seen to have a system for monitoring where by a manager from head office visits the home on a monthly basis to carry out an audit on a
1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 17 number of standards. This has shown to be effective in identifying a number of issues and indicates that the organisation is moving towards better selfmonitoring although the standards that are currently assessed would benefit from expansion (this a matter in respect of which a senior manager has consulted with CSCI). The home was seen to have regular consultation with residents and relatives via questionnaires although this would benefit from expansion to include the full range of stakeholders for the service such as social services departments, health personnel and so on. Overall findings of these consultation exercises need to be made available in a format that is accessible to the public. There was a clear business/development plan available, although this does need to be reviewed by the acting manager with his only having moved to the home recently. Whilst safe working practices were not fully assessed it was noted that the documentation of fire drills/training was lacking and needed to be recorded more accurately. Other issues raised in respect of safe working practices have been addressed since the previous inspection. 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 18 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 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 X 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X 2 X 2 X X X X 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 19 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 YA32 Regulation 18 Requirement The registered provider must ensure that support is provided to staff to allow them to achieve NVQ level 2 training and allow the home to reach a ratio of 50 of staff so trained. This is a repeated requirement. 2. 3. YA35 YA37 18 8,17 To provide staff with appropriate training in person centred care planning. The registered provider must ensure that there is an application for registration for the manager’s position submitted to the CSCI. This is a repeated requirement. 4. 5. YA39 YA42 24 18 To continue developing the homes systems for selfmonitoring. To ensure staff involvement in fire drills/training is fully documented. 30/06/06 28/03/06 30/06/06 28/03/06 Timescale for action 30/06/05 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 20 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 YA3 Good Practice Recommendations The registered providers must continue to liaise with the social services departments (who have placed residents at the home) in respect of organising multi disciplinary reviews for residents, these at least annually or when changes occur. To continue with the training detailed within the homes training plan, this including the provision of equality and diversity training to staff. To seek the views of any stakeholders for the service through such as questionnaires and make these views available to others in a public report. The acting manager should also review the homes business plan. 2. 3. YA35 YA39 1 Whitehall Road, DS0000004843.V285151.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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