Inspection on 29/07/08 for 10 Chapel Street

This inspection was carried out on 29th July 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

10 Chapel Street 28/02/07

10 Chapel Street 07/02/06

10 Chapel Street 01/03/05

10 Chapel Street 31/01/05

10 Chapel Street 11/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 07/11/2008.

CARE HOME ADULTS 18-65 10 Chapel Street Quarry Bank Dudley West Midlands DY5 2DN Lead Inspector Lesley Webb Unannounced Inspection 29th July 2008 11:30 10 Chapel Street DS0000024960.V368827.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 Chapel Street DS0000024960.V368827.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 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 10 Chapel Street Address Quarry Bank Dudley West Midlands DY5 2DN 01384 411153 01384 560210 chapel-manager@btconnect.com 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) Black Country Housing and Community Services Group Elaine Beardsmore Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user (male) identified in the variation report dated 16.12.04 may be accommodated at the home in the category of PD. This will remain until such time that the service users placement is terminated. 28th February 2007 Date of last inspection Brief Description of the Service: 10 Chapel Street is a purpose built detached property sited in Quarry Bank and within walking distance of a range of facilities including shops, health services and churches. The building is within its own grounds and has wheelchair access to the ground floor. There are two communal areas (lounge and dining room) and all residents have a single room. Some aids and adaptations are present as needed for the current resident group. The registered provider, a not for profit social landlord, offers long stay accommodation at Chapel Street to adults with a learning disability. The provider does not offer short term or emergency care at this home. The home does have its own minibus although there is access to local public transport links through the nearby shopping centre. Whilst the home only has limited parking there is a car park sited opposite for public use. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels were provided in December 2006 by the manager, which are between £328 - £335.50 per week. There are additional charges for hairdressing, chiropody and toiletries. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this inspection over one day. The home did not know we were coming. Time was spent examining records, talking to a resident, members of staff and observing care practices, before giving feed back on our findings to the registered manager. People who live in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI) in the form of its Annual Quality Assurance Assessment (AQAA). Information from this was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example the people chosen consisted of both male and female and have differing communication and care needs. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: Staff support residents to make choices about their lives. For example one person explained, “they are all different, you get to know individuals. X will say no. X can’t communicate so look at facial expressions, taps tambourine when happy, if smiles we take that as agreement, use picture formats to offer choices”. Monthly key worker meetings take place to support residents to make choices. People lead stimulating and interesting lifestyles. As one resident explained, “staff take us a ride out, bowling, picnics, to town shopping. I’ve been on holiday. I go club on Wednesday and I like to go to bed early. I always look nice, I had jewellery on today but took off, staff help me buy it from Merry Hill”. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 6 Staff treat residents with respect and courtesy. Meals that residents have are varied and well balanced. The health needs of residents are monitored by staff and access to appropriate treatment is sought when necessary. This means residents receive help when they need it. The building is decorated and furnished to a good standard. This means residents live in a comfortable and safe place. Infection control standards are good, promoting the wellbeing of residents. Staff that we spoke to all demonstrated good understanding of supporting residents and acting on their behalf if they are unhappy and protecting them from harm. What has improved since the last inspection? Information about the home and the services it provides has been expanded. This means people considering moving into this home have the information needed to decide if it will meet their needs. Care planning and risk management processes have improved greatly, ensuring residents needs are met and monitored safely. Good progress has also been made to ensure plans are reproduced in formats that residents understand. A pictorial activity folder has been devised that aids communication and a monitoring implemented to ensure activities meet residents’ individual preferences and needs. There has been good progress to ensure residents with needs that impact on them making decisions have their best interests protected. Since the last inspection the practice of hourly checks undertaken during the night for all residents has stopped, promoting peoples rights to privacy. Medication systems have been much improved, ensuring greater protection to residents. The majority of the home has been redecorated and new flooring provided throughout, making it a nicer place to live. Staff have received a lot of training that helps them understand the different needs of residents. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 7 Supervision of staff has improved. This means staff are informed about the changing needs of people, changes within the organisations philosophy and have an opportunity to influence how care for people will be delivered in the future. What they could do better: further work must be undertaken with regard to records when PRN (as and when required) medication is administered for behaviour. This must happen to ensure the home can evidence this is not used as a form of chemical restraint. Recruitment records do not show that a robust procedure is being followed that protects people living in the home. Improvements must be made in this area to offer further safeguards to residents. Information about what is not included in the fees charged for living at the home should be included in the service user guide and tenancy agreements so that people are fully informed and their rights protected. Medication competency assessments should be undertaken on a regular basis to ensure staffs’ practices are monitored and to ensure residents receive their medication safely. Alternative storage facilities should be sought for wheelchairs as these are currently stored in the ground floor bathroom and this practice does not promote good infection control. An analysis of questionnaires should be incorporated into a development plan for the home in order that people can be confident these underpin quality monitoring and development of the service. A procedure should be introduced with regard to accidents resulting in head injuries instructing that medical advice is sought in all instances. This would offer greater protection to residents. Bed rail protectors should be purchased and put into place to reduce the risk of entrapment. Greater numbers of staff should undertake refresher training for fire to offer further safeguards to residents in the event of a fire. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 8 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 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into this home have the information needed to decide if it will meet their needs. Assessment processes ensure people’s needs are identified and met. EVIDENCE: By examining documentation and talking to members of the management team we found evidence that good progress has been made to address the requirements and recommendations made in previous inspections. For example the homes statement of purpose now includes information about the qualifications of staff and the service user guide now includes the address of the Commission and informs the reader where they can obtain copies of our inspection reports. Tenancy and support agreements contain information about fees charged for living at the home and what is provided as part of these. None of these documents contain information about items not covered within the fees such as contributions to transport fuel, toiletries and personal affects. As we explained to the registered manager this information should be included to ensure people are fully informed. The service user guide now also includes a form that is used to obtain residents views. It is recommended that once the views of residents have been obtained this information be included in the service user guide rather than the blank form. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 11 This would evidence residents’ views on the service provided by the home. We also recommended that an audit of records be undertaken with any containing out of date information being removed as we were presented with several documents some of which contained old information. This would ensure interested parties have access to accurate information. Chapel Street remains fully occupied. There have been no vacancies at the home since 1996 with no new people moving into it. Progress continues to be made to ensure current residents needs are reassessed. For example there is a tool for assessing resident’s tissue viability, nutritional needs and a general assessment tool. The general assessment gives basic information on personal care, mobility, communication, medical, medication, mental health and food, diet and weight. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make decisions about their lives and be involved in planning the care and support they receive. EVIDENCE: We examined the care records for 2 residents, talked to staff and indirectly observed practices and found that care planning processes have improved greatly, ensuring residents needs are met and monitored. For example multidisciplinary reviews are now taking place on a regular basis, families and residents are being encouraged to be involved in the compilation of care plans. Good progress has also been made to ensure plans are reproduced in formats that residents understand. These include communication books and support plans that include the use of colour photographs and large print, both of which encourage residents to understand the contents of plans. In addition to these we were shown pictures that are used to aid communication, for example if a resident feels unwell and wishes to see a doctor or nurse. Plans include residents likes and dislikes, risks, health support, meals and preferences, 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 13 activities, preferences with regard to times of rising and going to sleep, communication and finances. All care plans that we viewed were detailed and informative, giving staff good information with regard to supporting residents and meeting their needs. Plans are in place for the specific needs of residents and include those of continence management, tissue viability, nutrition, support to manage finances, epilepsy and autistic spectrum disorder. All staff that we spoke to demonstrated good understanding of the key worker role and support needed for individual residents. As one member of staff explained, “Main role is taking the persons interests forward, that they are recognised by everyone, whether social or health wise”. Staff also demonstrated a good understanding of involving residents to make choices about their lives. For example one person explained, “they are all different, you get to know individuals. X will say no. X can’t communicate so look at facial expressions, taps tambourine when happy, if smiles we take that as agreement, use picture formats to offer choices”. Monthly key worker meetings are also used to support residents to make choices. Topics discussed include outings, health and wellbeing, communication and person centred plans. As with care planning, risk assessment processes have improved, with assessments now in place for various aspects of residents’ lives. These include areas such as wheelchair use, challenging behaviour and bed rails. This means risks to residents are being identified and where possible reduced. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices about their life style. Social, educational and recreational activities generally meet residents’ expectations. EVIDENCE: We talked to a resident, staff and examined records and found people lead stimulating and interesting lifestyles. We looked at activity records and these demonstrate that residents attend various day centres, undertake independent living skills and activities in the wider community. Good progress has been made to action the requirements and recommendations identified at the last inspection. For example a pictorial activity folder has been devised that aids communication and a monitoring and evaluation system for activities has been implemented to ensure activities meet residents individual preferences and needs. Monthly key worker meetings take place where residents’ activity preferences are discussed. We suggested to the registered manager that further work be undertaken to ensure the home can evidence requests made 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 15 by residents are acted upon. For example one residents records detail an expressed wish to go on a train and go on buses more but records do not demonstrate if these have been undertaken. The resident we were able to have a conversation with confirmed their approval of activities arranged on their behalf. As they explained, “staff take us a ride out, bowling, picnics, to town shopping. I’ve been on holiday. I go club on Wednesday and I like to go to bed early. I always look nice, I had jewellery on today but took off, staff help me buy it from Merry Hill, can’t go by myself because the roads are busy”. Records and discussions with people now demonstrate residents are provided more flexible opportunities to participate in the local community through outings and activities. For example an extra member of staff is put on shift once a month in order that residents can go swimming and a resident now attends a weekly disco (again with additional staff support put into place). However everyone that we spoke to said that further work could be undertaken in this area if staffing levels were increased. At the last inspection the home was instructed to ensure that residents are meaningfully involved where possible in choosing and planning their annual holiday and that this is evidenced. We were shown minuites of a residents meeting where this subject was discussed and agreed upon. There has been good progress to ensure residents with needs that impact on them making decisions have their best interests protected. For example the home has ensured meetings take place with relevant parties such as families, social workers and general practitioners in order that assessments of capacity can be agreed and care plans implemented that ensure residents rights are upheld. Throughout our inspection we observed that daily routines are flexible and geared towards residents’ individual needs and preferences. Residents were greeted warmly by staff upon their return from their day centres and staff were seen to spend time with all residents, treating them with respect and courtesy. Meals that residents have are varied and well balanced. We observed the evening meal being taken and saw that staff sit and eat with residents, which promotes an inclusive atmosphere. All residents appeared to enjoy their meal. The meal served that evening was pasta bake, salad and garlic bread. We were offered this and found it to be tasty and well presented. There is only one choice depicted on the menu per lunch and evening meal. However, examination of resident’s individual food records and the menu plan demonstrates that residents are able to have alternatives if they wish. Since the last inspection care plans now include information regarding residents’ preferred likes and dislikes with regard to food items and food 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 16 records evidence these are being catered for. It was also pleasing to be informed that residents are now offered opportunities to plan, shop, prepare and serve meals. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: As already mentioned in this report there has been a good improvement with care planning documentation. This also includes plans for the management of residents health needs. Plans now include personal preferences such as times of rising, routines with personal care and opposite or same gender care. This means personal and health care is given in a person centred way. We observed that staff had paid attention to each person’s personal care; people were wearing clothes in good condition suitable to their age and gender. Since the last inspection the practice of hourly checks undertaken during the night for all residents has stopped, promoting peoples rights to privacy. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 18 As at the previous inspection there was ample evidence to confirm that the health needs of residents are monitored by staff and access to appropriate treatment is sought when necessary. For example, there was a good system for recording routine health checks required through out the year. These demonstrated that residents receive regular appointments with dentists, doctors, community nurses, psychiatrists and ophthalmologists. Specialists are accessed as and when required. Since the last inspection one resident has been assessed by a suitably qualified person due to decreased mobility and a mobile hoist provided. This ensures they are moved safely. Medication systems have been much improved, ensuring greater protection to residents. For example written consent with regard to administration of medication has been discussed and agreed as part of multi-disciplinary team meetings, medication received into the home is checked and the quantity now recorded and the key holding procedure and practice has been reviewed. We checked the medication records and stock for all residents and found all generally to be accurate and in good order. We did note that a prescribed cream for one resident had not been dated when opened neither did it include instructions as to what part of the body it should be applied to. It is recommended this information be included to ensure the medication is administered safely. The drugs cupboard was clean and tidy with no overstocking. Staff have received accredited training in the safe handling of medication. There have been 2 medication errors in the past twelve months, both of which were reported to us by the home. When discussing these with the registered manager she confirmed staff competency assessments are undertaken as part of their induction to the home. We recommended that competency assessments be undertaken on a regular basis to ensure staffs’ practices are monitored with any shortfalls identified at an early stage. This would offer greater protection to residents. We also suggested the home obtain the Commission for Social Care Inspections (CSCI) guidance regarding competency assessments as this reflects current good practice guidelines. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to raise concerns. Staff have a good understanding of protecting residents from abuse. Some records require further expansion to offer further safeguards to residents. EVIDENCE: No complaints have been received by the home during the last twelve months. In addition the CSCI have not heard from any complainants. There is a pictorial complaints procedure and information regarding complaints is contained with the service user guide and statement of purpose. The resident we were able to speak to confirmed they understood their rights to complain, informing us, “I like all staff, especially X and X my key worker. They talk to me and if I want to know anything they tell me. If I was unhappy I would talk to my key worker or somebody”. Staff that we spoke to all demonstrated good understanding of supporting residents and acting on their behalf if they are unhappy. As one explained, “We reinforce the complaints procedure at every residents meeting, sort small issues to stop becoming big and they know they can trust you to do what you say you going to do”. There have been no allegations of vulnerable adult abuse. Staff have received training in vulnerable adult abuse awareness and in understanding and managing challenging behaviour. Staff that we spoke to demonstrated a good understanding of protecting residents from abuse. As one member of staff 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 20 explained, “we have had good training, know what’s wrong and right, listen and watch, look out for signs such as if withdrawn, stop eating, behaviour. Tell the manager straight away”. We examined the behavioural support plans for one resident who needs assistance in this area. These were detailed and informative, giving good instructions to staff on how to support the resident. The plans have been developed with the involvement of the operations manager, intensive support team, speech and language department and the registered manager. They give good instructions on triggers, diversion tactics, forms of behaviour, frequency, use of PRN (as and when required medication) and approved physical interventions. In addition to this the registered manager has completed an analysis of incidents that has been used review behaviour guidelines. It was pleasing to find that the guidelines have now been agreed within a multi disciplinary forum. This offers greater protection to the resident. We found that further work must be undertaken with regard to records when PRN medication is administered for behaviour to ensure the home can evidence this is not used as a form of chemical restraint. The medication records for one resident detail PRN medication given on 3 days in July 2008. the first recorded reason states ‘crying biting of hand’, the second time it was administered records state ‘anxious, pacing’ and the third ‘appeared very unsettled’. As we explained to the registered manager records do not evidence that the behaviour support guidelines for this person have been complied with, as there is no record that diversion tactics were used before the PRN was administered. Discussions with staff did not clarify if PRN is being administered in line with behaviour guidelines adding to our concerns. We discussed this with the registered manager who agreed action would be taken to address this to ensure the resident is safeguarded. At the previous inspection the home was instructed to review the wording with regard to a physical intervention for a named resident. We discussed this with the registered manager as this does not appear to have taken place. She confirmed the home had sought advice but that further clarification was needed to ensure the written guidance does not place the resident at risk of injury. As at previous inspections there are good systems in place for supporting residents to manage their finances. For example, there are records maintained of all financial transactions and a running balance maintained. A sample of records examined balanced accurately. It was noted that residents are charged a weekly rate towards the cost of fuel for the minibus. We found evidence that this has been agreed within a multi-disciplinary forum, ensuring residents rights are protected (and meeting a previous requirement). However this information is not included in the service user guide or tenancy agreements, neither of which detail any items not included in the fees charged for living at the home. As we explained to the registered manager information 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 21 regarding additional charges should be in both these documents to promote peoples rights further. Recruitment records sampled showed that a robust procedure is not being followed for the protection of people living in the home (detailed further in the staffing section of this report). Improvements must be made in this area to offer further safeguards to residents. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment. EVIDENCE: We toured the premises and found it to be decorated and furnished to a good standard. The lounge is homely in style with ornaments, pictures and photographs of people who live or have lived at the home. Since the last inspection the majority of the home has been redecorated and new flooring provided throughout. All bedrooms are decorated and furnished to a high standard and individualised with personal possessions such as photographs, televisions, sensory and stereo equipment. There is a large, enclosed garden to the rear of the premises that is very well maintained. This is accessible to residents and includes a patio area and an abundance of potted plants, shrubs and garden furniture. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 23 Infection control standards are good, promoting the wellbeing of residents. The premises were clean and hygienic throughout with no offensive odours. The laundry area was tidy and clean with a washable floor and part tiled walls. Since the last inspection the home has obtained a copy of the Department of Health’s infection control guidelines for care homes to ensure its practices reflect current good practice recommendations. In addition to this all recommendations that we made previously have been acted upon, promoting good infection control and information supplied by the home prior to our visits indicates that all staff have undertaken infection control training. We did note that alternative storage facilities should be sought for wheelchairs as these are currently stored in the ground floor bathroom and this practice does not promote good infection control. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 24 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 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a competent and well-qualified staff group providing support to residents. Staffing levels should be reviewed in order to meet all residents’ needs. Recruitment and selection procedures must improve to ensure residents are not placed at risk of harm. Staff are well supported to understand their roles and responsiblities. EVIDENCE: During our visit staff were observed to give support with warmth, friendliness and patience and treat people respectfully. The one resident we were able to hold a conversation with confirmed that they have a good relationship with staff. Training information supplied to us indicates that the majority of staff hold a National Vocational Qualification level 2 or 3. This ensures a qualified staff team who are aware of their roles and responsiblities support residents. We viewed the staffing rotas. These show 2 care staff on duty during day and early evening and 1 person during the night with a sleep-in person available for emergencies. In addition to this the registered manager undertakes 37 hours per week, all of which are supernumery to care. The deputy manager is 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 25 also allocated some shifts separate from care hours but these vary depending on care staff shifts that need covering. A requirement was made at the last inspection that the manager must undertake an up to date review of staffing ratios and residents dependency levels and that sufficient staff must be allocated to provide residents with more flexible opportunities for community based activities and to meet personal support needs. Progress has been made with regard to this requirement. The registered manager informed us she is in discussions with the placing authority and is currently compiling evidence to present to them. She confirmed that the needs of 2 of the residents have changed and that further staffing hours are needed in order to meet these. Additional staff are allocated in order that residents can go swimming and for a resident to visit a weekly disco but further increases will ensure all needs are met safely. All staff that we spoke to gave the opinion that increased staffing levels would be of benefit to residents. for example one person explained, “More staff would mean residents can get out and about more. I think the residents would agree if they could say so. Needs have changed and there is only so much you can”. Due to the progress with this area the requirement is now changed to a recommendation. The organisations human resources department undertakes recruitment. They undertake a number of checks to make sure that staff are suitable to work with vulnerable people. We examined the recruitment records for two permanent members of staff employed at the home with neither containing all of the required documentation that demonstrates the home recruitment practices safeguard residents. For example one persons file did not contain an application form and neither persons records include proof of identification. The registered manager contacted the organisations Human Resource department on our behalf to request a copy of the application form to be faxed to the home but was informed that no application form was available as this person had been employed by your organisation via an agency. We examined the staff rotas for May, June and July 2008. These detail twenty shifts undertaken by five different agency workers. Some of these shifts were undertaken as the sole person on shift, for example supporting a resident whilst in hospital and a wake night shift within the home. A staff profile was in place for one of these people but this had not been completed in full. No recruitment information for the remaining four agency workers was available for inspection at the home. We were informed that this had not been obtained from the agency. The people who live at 10 Chapel Street have complex needs that have the potential to impact on them being able to say if they were to be harmed and the homes recruitment practices place them at undue risk. We issued an immediate requirement form during our visit instructing that action must be taken to reduce the potential risk to residents Staff receive training in order to meet residents individual needs. Since the last inspection efforts have been made to ensure staff receive guidance and information with regard to Autism. The registered manager informed us that a 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 26 senior occupational therapist attended a staff meeting to discuss sensory integration and that staff have also been given an information sheet regarding autism. The registered and deputy manager are attending an autism workshop in August and if this is found to be of use arrangements are going to be made for the remaining staff to attend. It was also pleasing to find that all staff have undertaken equality and diversity training and all new staff received induction training to the required standard. Also 3 staff have now undertaken Makaton training with the remaining staff due to undertake this November 2008. This ensures staff have a good knowledge base to support residents. Since the last inspection supervision of staff has improved. They now receive regular formal one to one meetings as well as regular group staff meetings. This means staff are informed about the changing needs of people, changes within the organisations philosophy and have an opportunity to influence how care for people will be delivered in the future. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 27 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): 37,38,39,41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well run home with the manager and staff demonstrating an awareness of their roles and responsibilities. Quality assurance systems ensure the home can measure if it is meeting its aims and objectives. The health and safety of residents is promoted and protected. EVIDENCE: Since the last inspection Ms Elaine Beardsmore has become the registered manager. She is hold a NVQ level 4 and is currently in the process of completing the Registered Managers Award. Throughout this inspection the registered manager demonstrated understanding appropriate for her position. The number of requirements and recommendations acted upon by the registered manager since she took up position at the home evidences her commitment to ensuring residents receive a quality service. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 28 All staff we spoke to were positive about the management of the home, praising the registered managers style of management. As one person explained, “they are brilliant, I have been getting all the support I need, don’t have to think twice, can ask anything”. On arrival at the home the deputy manager informed us that the registered manager was on leave and that we would have no access to staff files, as the registered manager is the only person allowed to hold the keys where these are stored. She telephoned the registered manager who came to the home and stayed for our inspection. We suggested that a system for safe key holding is introduced in order that all records required by regulation are accessible at all times. Quality assurance systems continue to be implemented. These include a number of quality audit checks including health and safety, resident meetings, environment and care planning. Questionnaires have been sent to residents, stakeholders and families. The analysis of these now need to be incorporated into a development plan for the home. Prior to this inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. The contents of this were brief in parts and give minimal information about the service provided to residents. We discussed this with the registered manager, advising greater detail is included when next requested by the CSCI. A sample of maintenance and service records were examined and found to be up to date. For example, there is regular testing of the fire alarm system equipment. Accident reporting is good with a system in place for monitoring accidents by management in order to identify any patterns or trends. We did recommend to the registered manager that a procedure be introduced with regard to accidents resulting in head injuries as some accident records we viewed indicated that medical advice had not been sought. As we explained, this should happen for all head injuries to offer greater protection to residents. At the last inspection the home was instructed to ensure that full COSHH assessments are drawn up from data sheets available for all Hazardous substances used and stored in the home. At this visit we were shown a general risk assessment for health and safety that includes information regarding COSHH but this relates to staff only. As we explained to the registered manager this should be expanded to include risks to residents and visitors in order to promote the health and safety of everyone who may come into contact with products. All other health and safety requirements and recommendations identified at the last inspection have been met in full. For example the 2 hydraulic height adjustable beds are now routinely serviced and records are maintained for safety checks to bedrails and wheelchairs. When looking at these we did note that risk assessments for bedrails do not make reference to the use of rail 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 29 protectors. We discussed this with the registered manager who confirmed these are not used. We recommended these be purchased and put into place to reduce the risk of entrapment. The training matrix identifies a high proportion of staff have received training in manual handling, food hygiene, health and safety and first aid. Greater numbers of staff should undertake refresher training for fire as training documentation indicates this has expired for a high proportion of staff. This would offer further safeguards to residents in the event of a fire. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 30 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X 3 2 X 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 YA23 Regulation 13(7)(8) Requirement The home must maintain records that demonstrate PRN medication for managing behaviour is given in line with the contents of the behavioural support guidelines and is not used as a form of chemical restraint. The home must be able to demonstrate that any person who undertakes a shift has had the required recruitment checks to make sure they are suitable to work with vulnerable people. Timescale for action 31/08/09 2 YA34 19 06/08/09 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 Information about what is not included in the fees charged for living at the home should be included in the service user guide and tenancy agreements so that people are fully informed and their rights protected. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 32 Once the views of residents have been obtained this information should be included in the service user guide rather than the blank form. This would evidence residents’ views on the service provided by the home. An audit of records should be undertaken with any containing out of date information removed. This would ensure interested parties have access to accurate information. Further work should be undertaken to ensure the home can evidence activity requests made by residents are acted upon. That the date when prescribed creams are opened is recorded and instructions as to what part of the body it should be applied to. This information should be included to ensure the medication is administered safely. Medication competency assessments should be undertaken on a regular basis to ensure staffs’ practices are monitored and to ensure residents receive their medication safely. The home should obtain the CSCI guidance regarding competency assessments as this reflects current good practice guidelines. further clarification should be sought with regard to the wording in a named residents behaviour guidelines for physical intevention to ensure the written guidance does not place the resident at risk of injury. Alternative storage facilities should be sought for wheelchairs as these are currently stored in the ground floor bathroom and this practice does not promote good infection control. The manager should continue to pursue funding for additional staffing in order that to provide residents with more flexible opportunities for community based activities. A system for safe key holding should be introduced in order that all records required by regulation are accessible at all times. The analysis of questionnaires should be incorporated into a development plan for the home in order that people can be confident these underpin quality monitoring and development of the service. A procedure should be introduced with regard to accidents resulting in head injuries instructing that medical advice is sought in all instances. This would offer greater protection to residents. the COSHH risk assessment should be expanded to include 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 33 2 3 YA14 YA20 4 YA23 5 YA30 6 7 8 YA33 YA41 YA39 9 YA42 risks to residents and visitors in order to promote the health and safety of everyone who may come into contact with products. Bed rail protectors should be purchased and put into place to reduce the risk of entrapment. Greater numbers of staff should undertake refresher training for fire to offer further safeguards to residents in the event of a fire. 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 10 Chapel Street DS0000024960.V368827.R01.S.doc Version 5.2 Page 35 - 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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