Inspection on 10/08/05 for 429 Warwick Road

This inspection was carried out on 10th August 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

429 Warwick Road 13/09/07

429 Warwick Road 05/09/06

429 Warwick Road 16/02/06

429 Warwick Road 11/02/05

429 Warwick Road 28/04/04

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Polesworth Group Friary Road

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Polesworth Group 70 Long Street

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Warwick Road, 429 429 Warwick Road Solihull West Midlands B91 1BD Lead Inspector Kerry Coulter Unannounced 10 August 2005 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 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 Stationary 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. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Warwick Road, 429 Address 429 Warwick Road Solihull West Midlands B91 1BD 0121 704 4563 0121 704 4563 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Mrs Sue Kiely Care Home 7 Category(ies) of Younger Adults, Learning Disability [7] registration, with number of places Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11 February 2005 Brief Description of the Service: 429 Warwick Road is registered to provide accommodation and care for a maximum of 7 adults with learning difficulties. The home is situated on a main road with it’s own small car park at the front of building. The home is a large attractive modern building in keeping with the design of other houses in the neighbourhood. Bedrooms are situated on both the ground floor level and the upper floor of the home. Whilst the dimensions of the hallways and the staircase to the first floor make the house unsuitable for wheelchair users, the bedrooms on the ground floor levels provide a suitable living situation for some service users with minor / moderate mobility related needs. The home provides a service to male and female residents, primarily in the middle age range. During the week residents are encouraged to make use of Day Service provision although residents often spend sometime at home. The home is situated within reasonable distance of shops and local amenities and the service has it’s own vehicle to support residents to access the community. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one afternoon. Conversations with some of the service users were limited due to their verbal communication abilities but some service users were able to comment on the home. Time was spent observing care practices, interactions and support from staff. A tour of the building and garden was made. Service user care plans and risk assessments were inspected. Staff training and health and safety records were examined. The Inspector had the opportunity to talk with the Deputy Manager and several care staff. During this visit the Inspector did not have opportunity to speak with relatives and other professionals. What the service does well: There is a clear and consistent care planning system in place to provide staff with information they need to meet service user needs. The systems for service user consultation are good. Staff try hard to encourage service users to live as independently as they are able. They give support with warmth, friendliness and patience and treat people respectfully. A number of people are encouraged and supported in going on holiday and are consulted regarding the location. A wide range of activities are on offer, in line with individual needs. Staff at the home seek input from other health and social care professionals to assist in meeting individual need. Service user bedrooms are well maintained and personalised. Service users spoken with commented that they liked the food provided and confirmed that choice was available. Minutes of service user meetings evidence consultation on menu planning. Satisfactory systems are in place to ensure the health and safety of service users. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: 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. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 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 standard(s) N/A EVIDENCE: These standards were not assessed at this inspection. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 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 standard(s) 6, 7 and 9 There is a clear and consistent care planning system in place to provide staff with information they need to meet service user needs. The systems for service user consultation are good. People are supported to take responsible risks, but improvement is needed on the ways in which this information is presented to ensure service user safety. EVIDENCE: Two service users plans were sampled. The home has a service user plan for each individual, which includes detailed profiles, activity plans, and daily recording. In addition, some service users have individual support strategies and guidelines, in some cases devised by professionals working in partnership with staff in the home. As required at the last inspection in February 2005 the behaviour management guidelines for one individual had been expanded to include guidance to minimise the risk to other service users of being hit or slapped. Plans sampled had been reviewed in the last six months. Service users records indicate that residents’ needs are reviewed, using Individual Programme Planning (IPP) paperwork, involving day services staff and relatives every 12 months. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 10 Service users are encouraged as far as possible to make decisions about their lives, this is done through regular residents meetings, attendance at reviews and 1:1 consultation. Sampling of resident meeting minutes indicate that topics of discussion include choice of activities, menu planning, CSCI inspection outcomes and staff recruitment. Risks had been identified, assessed and regularly reviewed. Generally risks were found to be well managed. However further work needs to be done to ensure service user risk assessments directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. One of the outcomes for completing risk assessments and care plans should be that the finished article is a simple and effective working document, in which essential information can be easily found. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13, 15, 16 and 17 The home actively encourages and supports individuals in developing social skills and in continuing their educational needs and preferences. Intergration within the community and pursuit of leisure activities are integral elements of the ethos of the home. Staff respect peoples’ rights and seek to promote their independence. Service users enjoy a healthy and nutritious diet and exercise choice about what they eat. EVIDENCE: All service users attend day service provision provided by Solihull Borough Council, including Parkview day centre. Encouragement is provided for service users to take part in many aspects of daily living, such as cleaning and tidying and shopping for personal items. It is an area of good practice that staff at the home complete a monitoring form at the end of each month regarding the type and frequency of activities participated in by service users. Records sampled and discussions with service users indicate that people who live at the home participate in the local community. Activities include a trip to Birmingham to celebrate VE day, pubs, bowling, golfing, cinema, church and Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 12 Crufts. In addition to using the home’s vehicles service users also have the opportunity to use public transport. Three service users have been on holiday to Spain this year and plans are being made for the remaining service users to have a holiday. It was evident from talking to both service users and staff that service users are supported to maintain contact with their family and friends. Records evidence that relatives are invited to annual reviews and kept informed of the receipt of CSCI reports. Information for visitors to the home was observed to be on display in the hallway, this was in both a written and symbol format. At the last inspection it was identified that the kitchen is often locked at night times thereby restricting service user access. The manager was advised to complete a written rationale re this practice, ensuring it is reviewed on a regular basis. This has now been done. The Inspector had the opportunity to observe the evening meal. Food looked appetising and nutritious. Staff were observed to offer appropriate support to service users. Food stocks were observed to be satisfactory. Two service users spoken with commented that they liked the food provided and confirmed that choice was available. Minutes of service user meetings evidence consultation on menu planning. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19 and 20 The health needs of service users are well met. The systems for the administration of medication are generally good with clear and comprehensive arrangements being in place, only minor improvement is needed to ensure service users consistently receive the medication they need. EVIDENCE: A sample inspection of service users’ health records indicates that service users are receiving routine access to general health services, such as well person’s checks, dentist, eye tests, flu vaccinations and chiropodist. One service user is currently receiving input from health professionals to include the Speech and Language Therapist and Psychologist. Evidence of the regular weight monitoring of service users was observed. One service user had been unwell on the day of the inspection, this individual had been taken to see the GP. The home needs to consider how health action plans for service users can be introduced. This is something that the Government paper, ‘Valuing People’ recommended that each person with a learning disability had by 2005. This is to ensure individuals receive all the care they need to stay healthy. It may be that this is an opportune time to engage with the local Community Nurse (Learning Disability) Service in order to move this forward. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 14 The systems for the safe storage, handling and administration of medication were generally well managed. The home utilises a monitored dose system for medication. Records that medication had been received, administered and where appropriate returned had been made. The majority of records for medication received into the home were satisfactory. However, on some occasions staff had ticked that the medication had been received rather than record the actual quantity. The home retains copies of prescriptions and audits are undertaken for non blistered medication. As previously required a protocol on the use of ‘as required’ Gaviscon medication has been completed since the last inspection. This requires some minor improvement to detail how staff know when the service user is in discomfort. For example, is the service user able to tell staff or do they need to rely on visual cues. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22 and 23 The home has a satisfactory complaints procedure. Adult protection procedures show that service users are being protected from abuse and that their welfare is being promoted. EVIDENCE: At the inspection in February 2005 the homes complaint procedure was observed to be satisfactory. At this visit the Inspector discussed with one service user what he would do if he had a complaint about the home. The service user said he did not have any complaints but if he did he would speak with the Manager. The CSCI have not received any complaints about this home since the last inspection. The training matrix for the home indicates that the majority of staff have received adult protection training. Arrangements need to be made for the new member of staff to complete this training. The home has a written prevention of abuse policy that is robust. At the last inspection the CSCI was concerned about the number of incidents in the home where a service user had slapped other service users. Since that inspection the behaviour management guidelines have been expanded. Incidents have reduced and the CSCI have been notified of incidents as required. Discussion with the Deputy Manager indicates that this service user is more settled and staff consistency has contributed to the reduction in incidents. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24, 26, 27, 28, 29 and 30 The standard of the environment within this home is generally satisfactory. Some décor, fixtures and fittings require attention to ensure the home continues to present as a homely and comfortable environment for the people who live there. EVIDENCE: Overall 429 Warwick Rd is an attractive and well maintained home, providing accommodation on a large domestic, scale in a comfortable modern environment. The rear of the home has been extended to provide an attractive dining area overlooking the garden. This provides a comfortable area that benefits from good natural sunlight, in which residents can dine or relax. Communal areas were observed to be generally well decorated and equipped with modern furnishings of a satisfactory quality. Some attention is required to the dining room. The ceiling is stained and requires repainting and the chairs at the dining table did not match, there were three different types. Two bedrooms were sampled. These were observed to be personalised and there is plenty of evidence of personal effects and possessions. People can do their own thing, watching television or listening to music, and so on, whenever Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 17 they wish. Service users spoken with said they were happy with their bedrooms and had everything they needed. At the last inspection it was observed that the radiator in the shower room was quite rusty. This has since be repainted but the rust is again starting to show through. This will again need repainting or replacing in the near future. Some service users accommodated have mobility difficulties. Grab rails were observed to be provided in the ground floor shower room. Staff meeting minutes for July recorded that grab rails were also needed for the front and kitchen door. These were observed to have been fitted. The home was found to be maintained in clean condition with no unpleasant odours apparent. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 Current staffing arrangements meet the needs of the service users. EVIDENCE: It was noted that both staff and service users appear comfortable in each other’s company and enjoy a good general rapport. An examination of the home’s records confirmed that staff meetings are routinely taking place on a monthly basis. Rotas indicated, that typically two care workers staff the home during the day, and at night there is one sleep in member of staff on call. Numbers of staff on duty during the day increase to three when additional staff are needed to meet service user needs. This includes three staff on a Thursday evening when extra support is needed for service users to attend a local club. As required at the last inspection a review of night time staffing needs have been completed. The outcome of the review was that sleep in support continued to be appropriate. Staff spoken with agreed that sleep in shifts at night were appropriate to individual need. The Manager has completed a training matrix, this details the training staff have received and the training required. The matrix indicates that the majority of staff have received the training they need to meet the needs of service users. Some training in the areas of first aid, fire, epilepsy, adult Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 19 protection and medication needs to be completed by a new member of staff and a staff who has been on maternity leave. Milbury employs a training coordinator and a rolling program of training is offered to staff. The Deputy Manager stated that training places had been booked for staff for any training due. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Satisfactory systems are in place to ensure the health and safety of service users. EVIDENCE: An examination of the home’s fire safety records indicate that routine testing of alarms and lights is being carried out at the appropriate frequencies. The records also show that fire drills are being routinely carried out. Prior to the CSCI inspection the Fire Officer from West Midlands Fire Service visited the home and made several requirements. During the CSCI inspection the maintenance engineer was in the home carrying out some of the required work. The COSHH cupboard was checked and found to be secure. A chair in the lounge was observed to be broken, this was immediately removed for repairs when brought to the attention of the Deputy Manager. The hot water monitoring log confirmed that water temperatures are checked weekly and a hand test carried out at this inspection confirmed that water was of a comfortable and safe temperature. Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Warwick Road, 429 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 5 Regulation 5 (1) (b) Requirement Make arrangements for service users contracts to be agreed and signed by service users and their relatives / representatives. Previous requirement, not assessed at this inspection. Ensure service user risk assessments cross reference to the care plan and vice versa. (A numbering system is recommended). Medication. Records of medication received into the home must detail the actual quantity received. The PRN protocol on the use of Gaviscon needs to detail how staff should establish if the service user is in discomfort. Further attention is required to the rusting radiator in the shower room, consideration should be given to installing a new radiator. The dining room ceiling requires repainting. Ensure service users are provided with adequate seating in the dining room. The home needs to consider how health action plans for service users can be introduced. Timescale for action 30/10/05 2. 9 13(4) 30/10/05 3. 20 13(2) 30/9/05 4. 24 23(2) 30/10/05 5. 19 12(1) 30/11/05 Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 23 6. 7. 8. 9. 10. 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 Good Practice Recommendations Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Warwick Road, 429 E54 S4512 Warwick Road 429 V245009 100805 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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