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Inspection on 02/12/08 for 112 Wellington Road

Also see our care home review for 112 Wellington Road for more information

This inspection was carried out on 2nd December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The organisation has responded promptly and robustly taking action to make improvements. It is difficult to change engrained culture, custom and practice but this has been achieved in a short time scale. The home has moved from having an oppressive to a cooperative and pleasant atmosphere in the four months since we last inspected, creating positive foundations upon which to rebuild. Staff are now committed to providing people with opportunities and activities are being provided well. It is important that this is kept under review to ensure that all residents enjoy equal opportunity to engage with the community. New staff are recruited safely and are supported well to understand and adapt to their role.

What the care home could do better:

We found medication to have partly improved. It is now better organised and staff again are more aware of their role and responsibility for the safe and accountable administration of medication. Errors and omissions however have continued. We were notified prior to inspection of the loss of 12 ibuprofen tablets and inspection identifed a number of other occasions where different medications could not be accounted for. This does not assure that people are receiving their medication as it is prescribed. Therefore the requirements issued previously to ensure medication management improves have not been met and have been carried forward. Given the level of improvement overall and the evidenced committment to improvement, we did not seize evidence on this occasion to use to issue Statutory Requirement Notices. We agreed with the manager that she would refer the matters identified by our Pharmacy Inspector to Social Services under Safeguarding Procedures for consideration at a forthcoming meeting. We will however closely monitor medication practice. The manager is aware that subsequent breaches in medication management will be subject to enforcement action. The service is recording food that people eat at meal times. We have advised that where there are concerns about appetite or intake generally, these records should state the quantity of food eaten to help the service and any supporting health professionals to make a judgement about the sufficiency of the diet and nutritional value.

Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: 112 Wellington Road 112 Wellington Road Bilston Wolverhampton WV14 6AZ The quality rating for this care home is: The rating was made on: zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Deborah Sharman Date: 0 2 1 2 2 0 0 8 Information about the care home Name of care home: Address: 112 Wellington Road 112 Wellington Road Bilston Wolverhampton WV14 6AZ 01384410418 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Inshore Support Limited care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability 3 Over 65 0 Conditions of registration: The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 3 The maximum number of service users to be accommodated is 3. Date of last inspection Brief description of the care home 112 Wellington Road is based in the Bilston area of Wolverhampton and is registered as a care home providing personal care and accommodation for 3 younger adults with learning disabilities. It is part of the Inshore Support Ltd group of housing whose main office is in Halesowen. The home is located close to the centre of Bilston on the main A41 road with good local amenities including access to the metro tram within a twominute walk. It opened in 2007 and consists of a two-storey domestic style terraced property. Each person living at the home has a single room with washbasins. Bathroom and separate toilet facilities are available for shared use. There is a private pleasant garden with patio seating area at the rear of the property. Residents need to be able to Care Homes for Adults (18-65 years) Page 2 of 13 access stairs as bedrooms are on the first floor with no lift facilities. The two bedrooms are both for single occupancy with bathrooms and toilets close by. There are two lounges, a kitchen and dining area. There is a small-enclosed garden to the rear of the house. When we inspected in July 2008, the fee charged was not available publicly as it should have been in the Service user Guide and therefore it could not be reported. As this was a random inspection we did not enquire about fees on this occasion as this was not the purpose of this inspection. Fees will be discussed and reported at the next key inspection. In the meantime queries about fees should be addressed to the provider or Registered Manager. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: We last inspected this service as part of a key or full inspection on 22 July 2008. It was at the last inspection that we identified serious concerns about how the service was being managed and we rated the quality of service provision as poor. Since then we have received an improvement plan from the provider and we have met with them to discuss our concerns and how they intend to make sure the service improves. The purpose of this random and unannounced inspection was to assess the progress made in significant areas that affect the health and welfare of people living there. We therefore focussed on looking at health provision, risk management, protection, staffing levels and the management and administration of medication. Two Inspectors, including a Pharmacy Inspector carried out this inspection between 10.00am and 6.30pm. The pharmacist inspector visited the home to establish what progress 112 Wellington Road had made in meeting the requirements made during the key inspection on the 22nd July 2008 Since the last inspection we have received anonymous complaints from one person most of which we passed to the organisation to investigate. None of the concerns, which were believed to be malicious, were upheld. We chose to look at one element of the complaint ourselves in relation to how staff are checked to ensure their suitability to work with vulnerable adults. We were also keen to assess how the staff team is functionning as we identified major concerns at the last inspection which were affecting morale, the atmosphere and impacting on the lives of the people who live there. We were able to make a judgement about progress in a number of ways. We looked in detail at the care provided to two of the three people who live at 112 Wellington Road. We did this by looking at plans of care, written risk assessments, care records, medication records, accident and incident records, by observing and by talking to five of the staff on duty in some detail. The Manager has been registered with us since the last inspection and although she was on annual leave on the day, she came in to support the inspection process. We found the service to have made remarkable progress in the short time since we last visited and the proprietors, manager and staff are to be commended for this. Particularly positive is how steps have been taken to manage changes within the staff team. This appears to have radically affected morale, staff cooperation, the atmosphere and the effectiveness of the team for the benefit of people living there. For example, all staff on this occasion were happy to talk to Inspectors, were visible, cooperative, busy and were actively engaging in interaction and activities with the people living there. The atmosphere was very pleasant as the home was filled with laughter and music at different times during the day. We didnt plan to assess activities at this inspection but it was impossible not to as the evidence was so apparant. When we arrived we found staff and residents preparing to Care Homes for Adults (18-65 years) Page 4 of 13 go out bowling. Arrangements were made to support us, without compromising the planned activity. Later in the day we saw one resident enjoying a head massage and culturally appropriate music was being played too. All staff told us they try now to go out at least every day and written records supported this. We could see that people are now enjoying a wide range of trips out including visits to different towns, meals out, visits to the park and the Black Country Museum. We could see too that effort is being made to provide activities at home including participation in some domestic tasks and pampering sessions. It appears from the evidence available that the person who requires less staff support in the community is benefitting the most from community access. However, on the whole opportunities have improved for everyone. All the staff agreed that in part the improvements are the result of improved staffing levels. We were told this has relieved the pressure, has promoted a calmer living environment and is enabling people to do more. Four staff were on duty when we arrived. All staff and the manager told us that there are now usually 4 staff on duty from 9am til 4pm with three before and after this. We randomly sampled a number of days on the rota and the written evidence tallied with what we had been told and had observed. The provision of four staff effectively doubles the staffing levels that we found to be in place at the last inspection. Health action plans are not yet available. However progress is being made. Staff need to attend training about the health action plans before they are implemented and two training days have been booked for this. Staff described the people living at 112 Wellington Road as being in good health with no current concerns. With the exception of dental screening, we could see that residents have received a range of health screening appointments including psychiatric, chiropody, optical and hearing. We could also see that people had been taken to the Doctor on a number of occasions for advice in relation to identified health changes or concerns and follow up tests had been carried out. It is disappointing that dental screening has not been arranged for two of the three residents as this was identified as a significant long term omission at the last inspection. Talking to a staff member showed her to be aware of the need to organise this. Over previous months a number of matters affecting the safety of residents have been subject to investigation by Social Services under Safeguarding Procedures. Some of these matters have been resolved and closed, some continue to be under investigation and several more, largely connected with medication matters have been newly referred to Social Services for investigation. The provider has worked cooperatively and has taken action to minimise risks identified. We were interested in assessing steps taken to safeguard people from the risk of absconding and associated risk from the road, risks from medication and those arising from the management of behaviours. At the last inspection discussion with staff did not assure us they had sufficient knowledge or awareness to take the required steps to keep people safe. At this inspection we were more satisfied that staff are working more accountably and that they are aware of their role and responsibilities. We found a range of updated and relevant recorded risk assessments to be in place. We found that staff were aware of the risks and how they are expected to control them and we found measures in place that tallied with the risk assessments, such as an audible alarm on the front door and new locking systems on the rear gate, which we found to be secure. Staff are aware of the need for a second staff member to secure the door and systems are in place to ensure residents are supervised at night, if for any reason waking night staff need to Care Homes for Adults (18-65 years) Page 5 of 13 leave the premises momentarily to put bins out for example. One staff member told us everyone is trying to do their best, alot of things have changed and staff are more aware. We spoke to a new staff member who is impressed with the standard of care, describing it as very one to one. She had enjoyed a thorough four day induction which included training in abuse as well as food hygiene, health and safety, first aid, customer care, risk assessment and moving and handling. She said she had observed nothing of concern and felt confident that residents are safe. She was looking forward to attending a 4 day behaviour management or MAPA training which was booked for the following week. All current staff have received adult protection training. Other new staff have also either received it or are booked to attend. We found that the home had changed their supplying pharmacy and with the change had received some training on how to safely use the monitored dosage system. As a consequence, the staff at the home appeared to be more confident in the management of the medicines. We found that the receipt of medicines were being recorded, but the home was still not recording the quantities of medicine that were carried forward from the previous month at the point when the quantities were carried over into the new monthly cycle. Fortunately, the home was carrying out audits on a twice weekly basis and from these audits we were able to determine what quantities had been carried forward. We recommended to the home that an audit of the medication should be carried out at the monthly change over, so that they have an accurate figure of the medicines held within the home at the start of the montly cycle. We found that there were some issues with the accuracy of the recording of the quantities, particularly around liquid medicines. We also found that these audits were being done at different times of the day, and the staff were not recording when the audit was carried out, which again affected the accuracy of the information. We found that although the audit of medicines was being carried out on a regular basis, the audit was failing to identify issues of missing medication and medication that had not been administered as prescribed. We found during the inspection that some vitamin capsules were missing and a contraceptive pill had not been administered for one day. Also, there was more antipsychotic liquid present than calculated through the records, suggesting that the correct dose had not been administered. The rest of the medication audited appeared to show that this medication was being administered as prescribed. We also found that one of the people who use the service had been on holiday for a number of days. We found that the home had recorded what medication had left the home but had failed to record the quantity of each medicine taken. Upon return the home had also failed to record what quantities had been brought back. We found that the home had drawn up a number of protocols about the administration of when required medication to some of the people who used the service. A sample of the protocols were examined and the findings were mixed. We found one protocol that clearly stated when the medication should be administered but on another protocol we found no information about what symptoms to look out for and what triggers would trigger the administration of medication. We also found a when required protocol in a persons care plan for medication that had been discontinued. We also found that these protocols had not been viewed and accepted by the persons general practitioner Care Homes for Adults (18-65 years) Page 6 of 13 We found that the staff who were responsible for the administration of medication had undertaken training in the safe handling of medicines and as mentioned previously had also been involved in learning the safe procedures for the new monitored dosage system. We also found that the manager had assessed each member of staffs competency to handle and administer medication safely and correctly. We found that the homes policy was for these competency assessments to be carried out every three to six months. We looked at behaviour incident records and could see that escalating behaviours appear to be managed well by the use of diffusing and calming techniques. On one occasion we could see behaviours had been triggerred when one person could see the other two residents going out for the day without her. Given the staffing levels, even with the improved ratios it is not possible given the high dependencies of two people, for everyone to go out at the same time. This is clearly limiting. However, if behaviour records are up to date they indicate that peoples negative behaviours have significantly reduced in the second half of 2008. Staff agree with this. The Manager told us that the people living there are happy and are calmer and are beginning to communicate their wishes more. A staff member also described people living there as having calmed down alot. Following receipt recently of an anonymous complaint alleging some staff were working without Criminal Record Bureau checks, we looked at this for all staff employed, not including agency staff. We are satisfied that all staff have a current up to date Criminal Record Bureau check. We looked in more detail at how two new staff had been recruited and were fully satisfied that all steps had been taken to ensure their suitability before they started work. We could also see that in a two month period a new staff member had received supervision on three occasions which is good practice. We talked with the registered manager. She described herself as happier and calmer. She feels she is receiving sufficient support and is pleased with the progress being made. She is disappointed that additional supernumerary time made available to her to manage the services she is responsible for has reduced but can see the benefit to her management role of working with staff in a care capacity. We have deleted the requirement that relates to the management of the home on the basis of the improved outcomes overall. However, the improvement needs to be sustained and developed. Therefore the hours available to the manager to manage should be kept under close review. Surveys have been sent out recently by the organisation to assess satisfaction levels amongst independent professionals who work alongside the home and relatives. The results tell us that seventy five percent of professionals think standards of care have improved in the last year. Eighty seven percent think staff treat people living there with dignity and respect. All the professinals who responded said they felt they could discuss their concerns with the new manager. The results of relatives surveys tell us that fifty eight percent feel care has improved in the last year with seventy one percent believing all staff treat people with respect and dignity. Nine recommendations were in the report of the last key inspection, some of which were new and some had been carried forward from previously. At this inspection some were not assessed and some were assessed as not having been met. We have deleted Care Homes for Adults (18-65 years) Page 7 of 13 recommendation number nine about ensuring good personal and professional relationships are maintained between all parties. The first eight will be carried forward to the next key inspection. Technical difficulties mean that recommendations are not accurately represented in this report, but this should be resolved by the next key inspection. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 3 12 Steps must be taken to 22/07/2008 ensure that the care home is conducted with due regard to the religious persuasion, racial origin and cultural and linguistic background of service users. Requirement made at first inspection October 2007. Original target date for compliance was 30.11.07. Not met at July 2008 inspection. Not assessed at random inspection 2.12.08 2 20 13(2) Staff who administer 15/09/2008 medication must be competent and their practice must ensure that residents receive their medication safely and correctly. New requirement arising from inspection July 2008. Not met at random inspection December 2008. 3 20 13(2) Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when 15/09/2008 Care Homes for Adults (18-65 years) Page 9 of 13 required and as directed, medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. New requirement arising from inspection July 2008. Not met at random inspection December 2008. 4 20 13(2) The records of the receipt, 15/09/2008 administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. New requirement arising from inspection July 2008. Not met at random inspection December 2008. 5 20 13(2) Medication practice must be 22/07/2008 reviewed to ensure its safe administration in accordance with prescribed direction and that medication records accurately reflect medication administered. This will better promote the health and safety of service users. Requirement made at first inspection October 2007. Original target date for compliance was 31.10.07. Not met at Key July 2008 inspection. Not met at December 2008 random inspection Care Homes for Adults (18-65 years) Page 10 of 13 6 24 16(2)(k) Steps must be taken to keep 22/07/2008 the care home free from offensive odours to ensure that the premises provide a pleasant living environment for all where risk of infection cross contamination is minimised. Requirement made at first inspection October 2007. Original target date for compliance was 31.10.07. Not met at July 2008 inspection. Not assessed at random inspection December 2 2008. Care Homes for Adults (18-65 years) Page 11 of 13 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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