Inspection on 23/02/07 for 10 Beeches Road

This inspection was carried out on 23rd February 2007.

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

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

Other inspections for this house

10 Beeches Road 10/02/06

10 Beeches Road 31/10/05

10 Beeches Road 01/03/05

10 Beeches Road 16/11/04

Similar services:

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 10 Beeches Road Rowley Regis West Midlands B65 0BB Lead Inspector Mr Jon Potts Key Unannounced Inspection 23rd February 2007 10:05 10 Beeches Road DS0000040084.V325353.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 10 Beeches Road DS0000040084.V325353.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. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 10 Beeches Road Address Rowley Regis West Midlands B65 0BB 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) 0121 559 4384 N/A info@inshoresupportltd.com Inshore Support Limited Bhanisha Patel Care Home 2 Category(ies) of Learning disability (2) registration, with number of places 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10/2/06 Brief Description of the Service: 10 Beeches Road is home for two physically able younger adults who have a learning disability with additional mental health needs. The home is an extended two bed roomed terraced property near the centre of Blackheath, sited in an established residential area. The house offers a choice of lounge areas, a reasonably sized kitchen/dining area and two large single bedrooms, one a full en-suite. The property is generally well presented and is furnished in a domestic style. There is a staff group that consists of a manager, senior support and support workers. There are waking staff available 24 hours per day. The manager is responsible to a service manager and directors of Inshore support who have a number of homes of similar size and purpose. The staffing ratio is currently at least one staff member to one resident at day (in house) and one to two at night. The home only accommodates long stay placements and does not accept emergency admissions. The residents are currently male but the home will accept referrals from either gender. The home does not cater for adults with mobility difficulties. The mission statement of the home is to support the individual to attain personal independence, choice and responsibility in a homely environment which expresses unconditional acceptance and tolerance and is committed to friendship and growth The current charges range between £2699.55 to £2803.28 per week, with the only additional charges relating to personal requirements such as hairdressing, clothing etc. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day and involved the inspector assessing the homes performance primarily against the key national minimum standards for younger adults. Evidence was drawn from a number of sources and including case tracking the care for one of the two residents (this involving looking at all the documentation in respect of their care and cross checking this with outcomes), observation of practice, discussion with the registered manager, staff and review of management records. There was limited discussion with the residents. Information was supplied pre inspection by the home. The residents and staff are to be thanked for their assistance with the inspection. What the service does well: What has improved since the last inspection? The most significant improvement is the homes introduction of a robust tool for self-monitoring, this clearly allowing the home to identify where the service performs well and where improvement is needed. Routine and robust monitoring by the company forms an integral part of this quality tool. There has been improvement in the some of the homes documentation in respect of staff information and training targeted to specific staff needs has been provided, this ultimately to the benefit of the residents with staff becoming more skilled. There has been some on-going works to maintain the presentation of the environment. It was also noted that the development of person centred plans (that are more image and picture focused) is a positive step to further involving residents in planning their day-to-day care. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 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 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information on the service, sufficient to allow potential residents or their representatives to choose a home that meets their needs, is available, but not always in appropriate formats. Prospective people looking to use a service have their needs and aspirations assessed, and are able to ‘test drive’ the service prior to admission. EVIDENCE: The home has not admitted any service users since the time of the last inspection although the manager was involved in the admission of a service user to another inshore home for which she has line management responsibility, this giving her a practical insight into the homes practices and as to how they would apply to Beeches Rd. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 9 The manager clearly understands the importance of having sufficient information available for a prospective service user when choosing a care home. There was information available although it was not clear as to how much of this could be clearly understood by the residents, this as the statement of purpose/service users guide were only available in written English. It was stated that thought is been given to developing these documents in other formats (such as pictorial) although it is acknowledged that in some instances support would need to be given through the assessment process to explain important information verbally in a manner appropriate to the residents needs. Admissions are not made to the home until a full needs assessment has been undertaken. All the residents accommodated are funded through care management arrangements and there were assessments available for all current residents in addition to social services reviews for one resident (updating the original assessment’s information) and the homes own assessments processes. Any assessment for a new service user would be conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Such an assessment would be carried out by an experienced member of the management and involve members of the staff team, this at the service users present location with staff working alongside them. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment/care plan. The manager stated and the procedures confirmed that prospective individuals are given the opportunity to spend time in the home with day visits extending to overnight stays. Practice and information giving is informed by the services written procedures. New residents are provided with a Statement of Terms and Conditions/Contract (called a lifestyle agreement); this sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This is clear, jargon free, easy to understand and gives a very clear understanding of what residents can expect and there was evidence that some work has been taken to present this in a number of pictorial images, although again time would need to be taken to explain the document at the service users pace and understanding. Communication needs are clearly recognised as critical by the home based on the input around this area in their care plans. The manager stated that opportunity for discussion and clarification would be promoted. It was however noted that the one residents lifestyle agreement was not signed by the resident or their chosen representative, this to evidence their involvement and agreement. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 10 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 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents individual needs are reflected in care planning documents and their ability to make safe decisions are measured though the assessment process. The residents are encouraged to take a degree of risk as part of a lifestyle that would reflect their individual abilities and choices. EVIDENCE: The key principle of the home is that people using the service are in control of their lives and they, as far as possible, direct the care they receive. Staff in discussion expressed a commitment to supporting individuals to lead purposeful and fulfilling lives as independently as possible, this partly evidenced by the practice observed by the inspector during the visit. People using the service are assisted to make their own decisions and have the right to take a degree of risk in their daily lives, this within a risk assessment framework. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 11 The care plan is developed with, and to a degree owned by, the individual, based on a full and holistic assessment, although there is potential to better recognise the residents achievements on the plans review (for example the reviews are documented but residents achievements over the preceding period were not clear). There was evidence that the staff are developing person centred plans and there was some consistency found between these and the care plans used to inform staff of the individuals needs and choices. The care plan seen was detailed and covered the full range of the service users needs from behavioural strategies through to personal preferences and communication. Discussion with the staff and the manager evidenced that they were aware of the requirements of the care plan and observation of the staff interacting with the residents provided further evidence that it is used to inform planned and positive practice. Due to difficulties with communication the home has employed varied assessment tools to identify where residents are able to be independent and where the service may limit their choices. Where there are limitations these are recognised through the homes risk assessment processes. The recognised limitations to the one service user had been clearly documented and drew from the aforementioned assessment tools although there was no signature for the resident to acknowledge agreement, despite their signing to agree other documents. The use of a multidisciplinary review with the resident, this to discuss and agree these limitations would be acceptable. It is acknowledged that such reviews are due and the home has attempted to catalyse this process with the funding body. It was not clear to the extent the resident understood the information in the care plan, although the continued development of the individuals own person centred plan (PCP) with use of images and photos will not doubt assist. The PCP seen contained contributions in the resident’s own handwriting. The plan will usually include photos, pictures and is written in plain language. There is however no doubt that the care plan is an up to date working tool used by the individual through their involvement with all staff. The care plan can be easily used by people who are not familiar with the individual, to deliver a personalised quality service when necessary, this as it is broken down in to easy to understand step-by-step instructions/information. Audits of the care plan are assisted by identification within the plan as to where information to support its implementation is to be found. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 12 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): 12,13,15,16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and are supported to maintain and develop their life skills. Social, educational, cultural and recreational activities are provided in accordance with the individual’s known needs, choices and expectations. EVIDENCE: Central to the home’s aims and objectives is the promotion of the individual’s right to live an ordinary and meaningful life, both in the home and in the community appropriate to their peer group, and to enjoy all the rights and responsibilities of citizenship. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 13 The staff and manager in discussion understood the importance of enabling the residents to maintain their independence and exercise their choices. This allows them to achieve their goals, follow their interests and be integrated into community life and leisure activities in a way that is directed by the person using the service, this based on assessing their likes and dislikes through assessment and reactions to situations. Residents at the home are able to enjoy a full and stimulating lifestyle with a variety of options to choose from, this summarised in an activities plan that is available in a written/pictorial format. The plan is available to the residents within the home and reflects activities that combined leisure, exercise and involvement in domestic routines. Routines are flexible and resident’s choices are reflected in the care plan (such as for example the times they get up which was seen to be consistent with said plan). The activities and plans are resident focused, and can be quickly altered to meet individuals changing needs and the effect of such as the weather which would impact on external activities. Ways in which staff communicate with residents is clearly detailed in plans and is understood by staff and followed as was seen to be the case through observation. The home actively encourages varied opportunities for people using the service to maintain social contact, this through supporting contact with family (as a part of the residents weekly routine) and others through such as weekly discos. The development of person centred plans are seen to be key in focusing on the involvement of residents in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. The service actively supports people who use services to be independent and involved in all areas of daily living in the home, with staff seen to encourage residents to make choices and complete tasks as opposed to doing these for them. This includes where appropriate, having involvement in laundry, cleaning, shopping and planning meals. Keys are not currently provided for residents, this reflected in risk assessments, although there was one risk assessment that made reference to the fact one resident was a keyholder, this not the case. Meals are very well balanced and highly nutritional and cater for likes and dislikes of the residents at the home with an emphasis on balancing what is a healthy diet against the resident’s favourite foods. The staff have completed nutritional assessments in respect of the residents with outcome as to actions needed detailed. All meals taken by the residents are documented and their likes and dislikes were reflected within the choices documented in these records. The home does use pictorial menu cards to assist with choices, these however in black and white. The use of colour photos would assist in making images clearer and more attractive to residents. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 14 Mealtimes are flexible and relaxed, staff were seen to be patient and helpful, and allow individuals the time they needed to finish their meal comfortably and in accordance with their individual needs and plans. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs and in accordance with care plans. Staff promote the principals of respect, dignity and privacy and the overall management of medication is efficiently carried out. EVIDENCE: Personal healthcare needs including specialist health and dietary requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Discussion with staff and observation indicated that personal support is responsive to the varied and individual needs and preferences of the residents, in accordance with care plans. This means that the delivery of personal care is individual, flexible, consistent, reliable, and becoming more person centred. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 16 Staff were seen to treat residents with dignity and were aware of the need to be sensitive to changing needs. The staff team is diverse in terms of culture and gender and there is scope to reflect the gender of the carer in terms of the resident’s personal choices. Staff spoken to were clear that promoting independence was an important aspect of the service, and this was seen to be carried out through observation of staff interacting with residents. Residents are encouraged to be independent and take responsibility for their personal care needs as far as possible, the environment assisting in the provision of single rooms and ensuite facilities. People who use services have access to healthcare and remedial services, and staff make sure that those residents who are fit and well enough are encouraged to have regular appointments at the local health care services. The health care needs of residents when unable to leave the home are managed by visits from local health care services. Staff have access to training in health care matters and are encouraged and given time to attend training on specialist areas of work, although it was felt by staff that the provision of foot care training would be advantageous as they are involved in cutting toe nails. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance although there was one instance where an entry had been handwritten on a medical administration sheet and there was no signed evidence of the G.P’s instructions for administration of the cream in question in the form of such as a copy of the prescription, or typed label from the pharmacy on the cream. The staff had documented in daily records the G.P’s verbal instructions but should in future ensure they have clear documented instruction from the prescriber as to how any prescription medication is to be administered. People who use services are risk assessed as unable to administer their own medication, although the home has obtained clear consent to manage these on their behalf. Thought has been given to providing safe but appropriate facilities for keeping medication, based on the domestic nature of the home. Staff that administer medication have completed and passed an appropriate accredited medication course. In addition the manager carries out assessments to ensure each member of staff is competent to handle, record and administer medication properly. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Stakeholders in the service are made aware of the complaints procedures and invited to express their concerns through a robust, effective complaints procedure. Staff are aware of the need to be vigilant to resident’s expressions of dissatisfaction and there are strategies in place to protect them from abuse. EVIDENCE: The service has a complaints procedure that is up to date, very clearly written, and easy to understand. It is also available in a pictorial format and the written version of the procedure is sent to parents annually with questionnaires in respect of their views of the service provided. Staff spoken to were aware of the need to monitor residents behaviour for signs of dissatisfaction and all those spoken to were aware of the homes and the local authorities procedures in respect of adult protection, and the steps they should take if concerned as to practices within the home. There has been one complaint since the last inspection, this fully investigated by the responsible individual and registered manager. There were no outcomes for the homes practices. The policies and procedures regarding protection of individuals are of a high quality and are reviewed annually and updated. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 18 Training of staff in the area of protection is regularly arranged by the Home and the majority have received training recently. There are a low number of referrals made as a result of lack of incidents (none have occurred since the last inspection), rather than a lack of understanding when incidents should be reported. The home employs behaviour strategies that may involve restraint as a last resort and the majority of staff (9 out of 10) have training in MAPA (Managing Actual or Potential Aggression). All restraints are fully documented on ABC charts and also within incident reports that detail events leading to restraint and the exact actions taken. Any injuries are fully documented on body maps. The strategies employed are in accordance with detailed care plans related to behaviour management and in the first instance the emphasis is on the use of redirection techniques rather than physical restriction. It was however noted that some of the risk assessments in respect of these strategies still refer to positive approaches rather then MAPA, the former the previously used method of management of aggressive behaviour at the home. Based on discussion with the manager and staff the residents are supported by an organisation that has resident’s protection and safety as a priority. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28 & 30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the residents who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable. Residents are encouraged to see it as their own home. It is overall well maintained, attractive home, which is accessible to community facilities and services. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 20 There were some areas where improvement is needed to maintain the home, such as repainting the kitchen, replacing dining room chairs etc, but these were issues the manager was aware of and were seen to have been identified by the homes responsible individual in her monthly visits. The home was seen to have a plan for the review and audit of the premises over a 12-month period with more urgent repairs documented in a repairs log and reported to head office for action. The home is designed to provide small group living where residents can enjoy maximum independence in a discrete non- institutional environment that resembles a domestic dwelling. Residents were stated to be involved in decisions about the décor and any changes to the accommodation, and bedrooms were clearly individualised with the presence of many personal items. The home provides only single room accommodation, and these rooms were furnished in accordance with the needs of the individual. The rooms are very well planned and there is easy access to toilet and bathing facilities. The fixtures and fittings are of a good quality and usually well maintained. The residents at the home are physically able so adaptations are not needed to meet their physical needs. Residents are not provided with keys to rooms, this based on decision made following risk assessment, although one risk assessment was found to be contradictory referring to a resident holding a key when this was not the case. There are two communal areas, this meaning that residents have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen is of a domestic scale and does not prevent the involvement of residents in domestic tasks, or developing and maintaining self-help skills. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 & 35 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Staff in the home are well trained, skilled and motivated as well as available in sufficient numbers to effectively support the people whose home they work in. EVIDENCE: Residents appeared comfortable around the staff that care for them and observation indicated they were treated with respect by staff and in accordance with care plans. Rotas showed that staffing levels are maintained so as to ensure staff to resident ratios are not compromised, this consistent with the numbers of staff seen to be present on the day of the visit. Staff spoken to were aware of the required staffing ratios necessary based on assessments carried out and contractual arrangements. The resident group is currently all male and the gender mix of the staff group does reflect the need for male staff to allow for the residents choices. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 22 The company does not use agency staff, but where necessary may offer overtime to support staff from other inshore homes this meaning that if staff were used from outside the home’s staff team they would be familiar with the companies aims, policies and procedures. Staff members sometimes undertake external qualifications beyond the basic requirements; this targeted and focussed on improving outcomes for residents. Based on the homes training plan and some sampling of certificates the staff are well trained with those identified as needing input in specific areas those more recently employed. The majority of staff have undertaken Equality and Diversity training although it was stated that four are due a refresher, with discussion with some staff showing that they held a positive value stance in respect of recognising the negative effects of labelling for individuals with a disability. There has been a significant input into NVQ training with 4 staff now holding either a level 2 or 3 qualification and four awaiting verification, which would lead to the home having well above the minimum expected proportion of qualified staff. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. There was evidence from observation and discussion with staff that they are skilled in their role, and are consistently able to meet resident’s needs in accordance with set down strategies. The service uses external providers to deliver this training if they do not have the appropriate skills within the organisation. This training can be small scale and individualised if necessary in order to promote the delivery of person centred services. The service has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services. Whilst the residents are not involved directly in the recruitment of staff there is a robust process for regular supervision of new starters that would consider their performance and interaction with residents. There was evidence that staff new to the service received supervision in accordance with the companies induction policies, although direct evidence of the staff involvement in the induction standards was not available, but was confirmed by staff as held by them within their training and development portfolios. There was however evidence of the newer staff having attended a weeks external training giving an induction into all the necessary core skills required, this via certification of the same and through confirmation of a staff member that had attended such training. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent provider. Robust safe working practices protect the residents. EVIDENCE: The home has a registered manager that has experience from working within the provider’s homes for a number of years at a senior level and is currently working to complete her NVQ 4 qualification prior to enrolling for her Registered Managers Award. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 24 The manager was however aware of and worked to the basic processes set out in the NMS, and was aware of the need to promote equal opportunities, and understood the importance of person centred care and effective outcomes for people who use the service. The responsible individual for the company provides supervision for the manager, and there is evidence of regular management audits of the home in addition to this. The manager, with the support of the company, trains and develops staff that are competent and knowledgeable to care for younger adults. The service is planned to be user focused, and generally works in partnership with other professionals. The home has policies and procedures that set out the aims and objectives of the service, with staff having copies of the key procedures given to them in the form of a staff handbook. The manager is improving and developing systems that monitor practice and compliance with the homes plans, policies and procedures, this in conjunction with the services responsible individual. Whilst progress is ongoing, there has been significant improvement seen in this area since the last inspection with clear identification of the services strengths and weaknesses, use of stakeholder feedback, and since the last inspection anonymous staff questionnaires. The home has developed a health and safety policy that generally meets health and safety requirements and legislation. The home has a good record of compliance and regular random checks are carried out by the company to identify any shortcomings in standards they set themselves, although these would be influenced by local and national priorities. Safeguarding is given high priority and the home’s policies and guidance underpin good practice. 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 2 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 4 25 4 26 4 27 4 28 4 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 x 2 X 3 X X 3 x 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement Where the directions for administration of any prescribed creams or medications are handwritten on the medical administration records, there must be clear evidence that these agree with the exact instructions of the prescribing doctor, such as a printed label issued by pharmacy, or a copy of the relevant prescription. This is to ensure that residents are safeguarded from incorrect administration of medication. Timescale for action 15/05/07 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations To continue developing key policies and procedures such as the service users guide in pictorial or alternative formats that allow easier understanding by the residents. Reviews of care plans should clearly recognise where residents have made achievements towards meeting set goals in their care plans. Where possible evidence of the resident’s agreement with the lifestyle agreement, care plans and any limitations should be obtained so as to demonstrate participation. To use colour images of meals in stimulating resident’s choice of foods, preferably photographs of meals prepared at the home, this to assist the home communicating meal choices to residents and reviewing their likes and dislikes. To provide staff with training in foot care so as to ensure they are more aware of the implications of such as cutting resident’s toe nails. All relevant documentation should carry directions for staff that refer to the current strategies for dealing with challenging behaviour. (i.e. MAPA as opposed to positive approaches) so that it is intervention techniques are clear. The manager should continue with her training in respect of NVQ 4 in management and then enrol on her Registered Managers award to assist her to further improve outcomes for residents through management. 2. YA6 3. YA7 4. YA17 5. YA19 6. YA23 7. YA37 10 Beeches Road DS0000040084.V325353.R01.S.doc Version 5.2 Page 28 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: 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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