Inspection on 18/02/08 for 114 Douglas Road

This inspection was carried out on 18th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

114 Douglas Road 25/03/09

114 Douglas Road 24/08/06

114 Douglas Road 09/11/05

114 Douglas Road 13/07/05

114 Douglas Road 06/10/04

114 Douglas Road 29/06/04

114 Douglas Road 25/02/04

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 08/07/2008.

CARE HOME ADULTS 18-65 114 Douglas Road Newcastle under Lyme Staffordshire ST5 9BJ Lead Inspector Wendy Jones Key Unannounced Inspection 18th February 2008 13:00 114 Douglas Road DS0000028866.V350721.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 114 Douglas Road DS0000028866.V350721.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. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 114 Douglas Road Address Newcastle under Lyme Staffordshire ST5 9BJ 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) 01782 711041 01785 711041 Staffordshire County Council, Social Care and Health Directorate Mrs Caroline Brenner Care Home 13 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (3), Learning disability (13), Learning disability of places over 65 years of age (6), Mental disorder, excluding learning disability or dementia (3), Physical disability (4) 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 learning disability 16-18 yrs on admission Date of last inspection 25 August 2006 Brief Description of the Service: The home in Douglas Road is a purpose built local authority respite care unit catering for up to 13 persons, originally only younger adults with a learning disability, but now the categories have been extended to also cater for both younger and older adults with Dementia, and younger adults with both Mental Health problems, and Physical Disabilities. It offers short stay respite accommodation to both male and female service users, and can accommodate couples in either of its upstairs rooms with double beds, or two who wish to share in a room that can have a second single bed installed. Like the doublebedded rooms this is upstairs, so like them would only be available to service users who can manage climbing stairs, as currently there is no passenger lift. The four ground floor bedrooms have been adapted to take wheelchair users. The home is conveniently situated to access a wide variety of community facilities, with the town of Newcastle approximately one mile away. A supermarket is within walking distance. It is located in its own extensive grounds with a safe bounded rear garden containing a patio and a fountain. Communal space on the ground floor comprises two dining rooms with kitchenettes, two sitting rooms, and a separate games and activities room housing a pool table. The fees and cost of this service are not included in the service user guide. Prospective guests or their supporters should approach the provider for this information. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection site visit of this service undertaken on 18 February 2008 and included formal feedback to the senior member of staff on duty. In total the visit took approximately 07:00 hours. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. This is a respite service for people with learning disabilities, mental health problems and people with physical disabilities. The visit included checking that any requirements and recommendations of the previous inspection site visit have been acted upon; looking at information the service provides for prospective clients, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity records and the information available relating to the menu’s, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The staff and clients were spoken to during the site visit and a brief tour of the building was undertaken. An expert by experience and mentor were also involved in the inspection site visit. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience supports the inspection process by seeking the views and experiences of people who use services. Before the visit began, the service provided it’s own assessment of its performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent out to residents, relatives and staff and any professional that has involvement in the service. We received 5 staff surveys, 11 client surveys, 12 relative surveys and 2 health professionals. Comments from the surveys are included in this report. The expert by experience said, “Overall the centre seemed nice, some staff welcomed us. People said they enjoy their time here. I think mealtimes need to improve and some staff could improve the atmosphere within the home. People’s activities during the evenings and weekends also need to improve to enable people to have choices.” 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Areas identified for improvement include, admissions procedures to ensure that the service has up to date information about each guest for each period of respite. That guests have up to date information about the service, including the costs and fees they can be expected to pay and that staff check that everything that guests need to make their stay as comfortable as possible, is in good working order. The service should also ensure that guests have access to and are involved with care planning and risk assessment and know who their key worker is. That reviews and care plans are regularly reviewed. That guests are fully consulted and involved in day-to-day decision making and their independence is promoted at all times. That further efforts are made to arrange activities and outings in the community including developing approaches that encourage and promote guest choice. There should also be more choice in the meals and snacks that are available. Information about how to make a complaint and who to go to should be available in a form that is meaningful to guests, and all staff should receive up to date training in recognising and reporting suspected abuse. The management arrangements at the home must be resolved to provide a permanent manager for the service. All mandatory training must be up to date and all staff should be involved in fire drills. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 7 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. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 8 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 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 9 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 and 5 Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that they will receive an assessment of their care needs prior to the service agreeing it can meet their needs, but cannot always be sure that the service has up to date information about them, this potentially puts them at risk. EVIDENCE: The service has stated it has a Statement of Purpose and at previous inspections this has been the case. On the day of this site visit the staff did not know where a copy of the Statement of Purpose was kept. They did find a copy of the resident guide and said that copies of these are in each of the guest bedrooms, it was noted that the Resident Guide is not up to date and only 1 out of the 3 seen had a copy of the charges for the service, but these were not for the 2007-2008 period. Of the 3 guests asked, none were aware of the guide. It is noted that the guide has been produced in a format that is more user friendly. In the surveys received prior to this site visit the majority of relatives and guests stated that they had received a contract, 1 person said “I probably have,” and 2 said that they hadn’t received one. Most of the guests and their relatives confirmed that they had received enough information about the home, before they received respite care. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 10 Prior to each period of respite the service sends out an admission details form for the carers/ families to complete, this ensures that the service has the most up to date information about the individual. This is particularly important if there have been any changes since the last period of respite. In a sample of 3 files only one had this form completed for this period of admission. The senior on duty stated that if the form isn’t returned prior to the period of respite the form should be completed by the staff at the point of admission, or the families/ carers are contacted by phone, but this had not been done in the 2 samples mentioned. During discussion with one guest, we saw that the television wasn’t working in her bedroom, when we checked this, we saw that the TV ariel hadn’t been put into the back of it. When this was done and it worked, we couldn’t change the channels, as the batteries in the remote control were also not working. This was really disappointing as the individual had been in the home for week. The staff team should be more proactive in ensuring that each guest has everything they need and that it is in good working order. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 11 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 adequate This judgement has been made using available evidence including a visit to this service. People who use the service have care plans and risk assessments but cannot be confident, that all the information is up to date, reviewed regularly or that they are made aware of them. They also may not know who their allocated key worker is. This means that they cannot be involved with care planning and some decisions made on their behalf. EVIDENCE: In a sample of care records, each guest has “my plan” where individual needs are recorded. When a significant need is identified a risk assessment will be completed, these are subject to regular review. But due to the issues raised in the previous section of this report, the service may not have up to date information, therefore there may be unknown areas of risk. In addition, in one example, a risk assessment review should have been carried out every three months the records show that it was last carried out in July 2007. In a second a risk assessment regarding the vulnerability of a guest had not been competed, this was discussed with the senior in charge. The service must take 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 12 action to ensure that risk assessments are in place for all areas identified, are up to date and are subject to regular review. The expert by experience said, “I asked someone if they have a care plan, he said yes and told me it’s kept in the office and he can see it when he wants to. He said he has a key worker but not sure who it is. People should be encouraged to play an active role with their key worker and keeping their care plan up to date. I spoke to one gentleman who said he really enjoys staying here and likes to be involved in doing his own laundry and cleaning his bedroom. The person did say the only change he would make was to be able to do some cooking, although he said the food was good here. Although some people here are happy to have a cook it’s a shame for those who do want to get involved, as they are unable to.” Of the 3 guests asked, none knew who their key worker is and of these only 1 knew they had care plans and said they were kept in the office, the other individuals didn’t. Information in the care records does not show how guests are involved with the care planning process. It is accepted that due to the nature of the service many of the guests will have key workers and care plans in other services and may not recognise that they also have them at Douglas Road. When talking to staff about the key worker role they said that some work had recently been done on promoting the role of the key worker, but it was evident from this visit that further work is needed. Relatives surveys gave positive accounts of the care their relative receives at the home. “I am more than satisfied with the care my relative receives.” “My relative always looks forward to going to Douglas Road, and we are relaxed and never have to worry about his well-being.” 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is (poor) This judgement has been made using available evidence including a visit to this service. People who use the service cannot be confident that they will have the opportunities to be actively involved in activities in and out of the home. This limits their independence and choice, fosters dependence and doesn’t value them as individuals. EVIDENCE: Since the last inspection the service has made further efforts to improve the social opportunities for guests. Staff said that they have recently introduced a weekly meeting with guests to plan activities and also research local events regularly, they also said that they have changed some of the staff rota’s to provide enough staff in the evening to provide availability for more social opportunities. Yet guests continue to comment that at times there are not enough staff to take them out and in guest, relative and staff surveys this is an area that they all say could be improved. Comments received in surveys include, “There are insufficient staff to take my relative out socially. When I’ve queried this I’m told that there aren’t enough staff.” “I am told that there are 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 14 insufficient staff to take my relative out during his stay.” “More staffing would help with taking people out while they are staying at the home.” As stated previously, a weekly meeting of guests is arranged, usually on a Monday, to discuss what they want to do during the following week and also to discuss menu choices, fire procedures, door keys. We were involved in the meeting on the evening of the site visit and noted the content of it. While there were positive areas there were areas where staff could be more proactive, for example staff asked guests what they wanted to do, but didn’t offer choices, the result was that apart from one person asking to go to the local supermarket nothing was arranged. Staff said one of the problems is that guests don’t always have a lot of money when they come in; this limits the type of activities that can be arranged. The expert by experience commented on this area saying. “We arrived at similar times today as people were arriving back from their day centres. The shift leader and a person who is staying here showed us around the centre. The centre has one kitchen, two dining rooms, a games room and a smoking room on the ground floor. They have some bedrooms on the ground floor but most upstairs. I asked what activities people like to do on the weekends as during the week people attend a day centre. People said they like to watch TV, play on computer games and play snooker. One gentleman said when they have enough staff on he likes to go out for a walk, out to the pub or fish and chip shop. Others agreed that they like to go out but there is not always enough staff. This needs to be addressed, as people should have the opportunity to go out on the weekends and access the community. I got the impression some people see their stay here as a holiday, a break, and staff should really ensure they have a good time in the home and the chance to go out. A member of staff said people choose not to go out in the evenings, as often people are tired when they return from their day centre. I don’t agree with this, as many people tend to be back around 3pm and still have much of the day left. I noticed one lady came in, had a little sleep on the sofa until dinner at 5pm. I’m sure this lady would like the opportunity to do something in the evening after dinner, as she’d had a good rest. When people don’t have many choices people will sleep more, people need to be encouraged to be active. I asked a lady what she likes to do in the centre, she said she likes knitting and showed me her scarf she is making. The lady then went on to say she is staying here, as her relative is on holiday and she normally lives with her. The lady then showed me a pack of cards and her knitting again. The lady then went and gave a kiss on the cheek to another person staying at the centre sitting next to her and walked round to give me a kiss. A member of staff then walked in and the lady went to kiss the staff member, I was pleased to see the staff responding to the lady by asking her to shake her hand instead. I was pleased she was encouraging the lady to shake hands and not kiss people.” 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 15 The main meals are prepared and cooked in the main kitchen which guests do not have access to. The service employs cooks from 2pm-6pm for 4 days, 1pm-6pm for 1 day and 9am-3pm at the weekends the exception to this is when the community based day services are closed. The kitchen is well equipped and organised a recent Food hygiene inspection made two recommendations, but gave a good report. In terms of meal choices the service does offer a choice of two meals per meal time, the cooks devise the menu based upon the known likes and dislikes of the guests expected that week. The cook said that they listen to the choices made at the Monday meetings as well. One guest commented that he didn’t always like the food choice on offer, but said he could have something else if he wanted to. A health professional said, “I am not sure that the service is the right place for a guest I have been supporting, as I feel she could be de-skilled if they do not encourage her to be independent. She used to live at home and is able to care for her self including cooking meals.” The expert by experience said, “We sat down with 4 people who spoke with us in the dining room. We were offered dinner with everyone and had a choice of 2 meals, either beans on toast or hot dog and chips. Everyone staying this evening was offered the same. I was really pleased to be offered dinner, staff were kind. I found out the centre has a cook who prepares and makes the meals. One gentleman said he likes having someone else preparing his meal, as he does his own at home. I was a bit disappointed to hear the 2 meal options as they were not very healthy meals offered, I’m aware people have a cooked meal at lunch time. But I would imagine people might want something a bit lighter or healthy if they’ve had a main meal earlier in the day. I asked people what happens at breakfast time, I was told staff put out breakfast ingredients and people help themselves to cereal and can make toast. As people don’t access the kitchen I was pleased to see in the dining room, a fridge, toaster and kettle. Whilst I was sat in the dining room a lady who was staying for the first time came in and made herself a cup of tea. I was pleased to see the lady feeling relaxed and helping herself to hot drinks when she wanted. I asked if people can have a cooked breakfast on the weekends, people said no. I think people should have the opportunity to have a cooked breakfast on the weekend, like so many other people do. I asked a person what and if they have any supper, I was told they have toast. I asked if they had any choice but they only have a choice about what ingredients to put on the toast. People should have more choice other than toast every night for supper; it’s unfair to have the same every day.” 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that their health care needs are known and the service will take action to ensure they receive any treatment or medical intervention they need. But they must be sure that the service will be more pro active in promptly seeking medical advice in some instances to reduce the chance of a crisis occurring. This ensures that guests and their supporters have confidence that health and personal care needs are met. EVIDENCE: Guests said they were happy with the care they receive and commented on the support that they get. A relative said, “I am more than satisfied with the care my relative receives.” In the AQAA the service has stated that it has, “ experienced and trained staff, to meet the varied and diverse needs of guests.” They also comment that, “ guests are able to continue receiving service from their own GP while receiving respite care at Douglas Road.” While this is positive, it has in the past been a cause of some problems when a GP service has been required out of hours, but the service has worked hard to try to over come this, and now has the 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 17 support of Community based “health care facilitator” to support them if difficulties arise. There is also a local GP practice who will take guests on “temporary residence,” if necessary. Health care professionals made comments such as, “There does not appear to be an issue in terms of equality and diversity. There are people with a diverse ranges of skill and diasbilities and background, cultural and ethnic.” “I have no concerns with the standard of care.” They also said, “ In the past I sometimes have not been informed when a difficult admission has occurred, or the hospital/Doctors/Service are experiencing problems. Instead they have waited until a crisis is unavoidable or more difficult issues have to be dealt with.” “The service always responds to advice and guidance, one area of concern is around diabetes, included staff reluctance to observe a service user self administer her pre pen insulin dose (epipen). They say they are not able to do this.” Some of the issues raised were historical issues and not fully explored at this visit as they did not relate to a current guest. But it is noted that that some staff have received training in diabetes care, and all the seniors have received training in the use of an (epipen). The evidence in the 3 care records looked at indicates that health needs are known and recorded. Medical histories are also in each of the files. There are completed parental permission forms for administering medication and confirmation of current medication regimes. Medication protocols are in place for those guests who are prescribed medication on an irregular basis “ as required.” This means that the staff team has clear guidance about when this medication should be given. Since the last inspection site visit the service has reported 2 incidents when medication has not been properly administered, on both occasions appropriate action was taken to safeguard the guests. Records of medication show that the service now has robust systems in place for monitoring all medication coming into the home and leaving. Records are signed on each occasion they are administered. Storage facilities are suitable for the purpose. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. People who use the service and their supporters can be sure that the service will listen to and manage any complaints, but they should receive the procedure in a more meaningful format to ensure that they know who to go to and to have confidence in the procedure. People must be sure that their welfare is safeguarded, by being certain that all the staff team are trained to recognise and report suspected abuse. EVIDENCE: Information in the AQAA states that the service has not had any complaints, in staff surveys they indicated that they know what to do if they receive a complaint. Relatives have said that they know how to make a complain but have also commented that they haven’t needed to, and guests said, “ I’d go to the staff if I had any problems.” A health professional said, “I dont feel that there are any concerns about the service other than those I have mentioned relating to the individual I currently see.” Another said, “I have no concerns with the standard of care.” We have not received any complaints about this service. The expert by experience said, “I noticed a complaints booklet on the notice board and asked if people had seen it before. The gentleman said he hadn’t seen it. Looking at the booklet it tells you to fill it in, but as it’s laminated it would be very difficult for a person to fill in. The booklet talks about a person called Nicola you can contact about your complaints, I asked people who Nicola was and no one knew. I think its important to remind people they can 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 19 complain and make it easier for people to do so and ensure they know who they can talk to. No one knew who Nicola was and I would not like to tell someone I didn’t know if I wanted to complain, as its very difficult to do. I did ask if people are upset whom could they talk to. One person told me that they talk to the manager, as she is really nice and listens to people. It’s good people felt comfortable to talk to a manager.” In terms of protection most staff have received Adult Abuse training in 2004 and 2006, but some haven’t, this should be organised. The service has copies of the safeguarding procedures agreed locally and we have not been involved with any safeguarding referrals since the last inspection visit. But during this visit a guest made a disclosure, which has been referred to the local authority under Safeguarding Procedures. This disclosure did not relate to the care the individual received while at Douglas Road. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that the service is well maintained clean and tidy and can meet their individual needs. This affords them confidence that their safety and well-being is protected. EVIDENCE: The environment is clean and tidy, feedback from surveys confirmed that this is usually the case, one person said,” the standard of cleanliness is very high,” another said, “ my relative always comments on the cleanliness of the home.” Guests and staff commented that the small lounge at the east of the building is no longer available for them to use as it has been changed into a smoking room. It is understood that it can be used when there aren’t any smokers in the home, but in practise the room smells strongly of smoke, which is off putting. This area should be looked at again. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 21 The service caters for a guest group of varying ability and has adaptations to enable it to meet these diverse needs. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that staff team is generally well trained, and the service has robust recruitment procedures. This gives them confidence that their needs can be met by them. EVIDENCE: Relatives commented that staffing levels could be improved at times; feedback from staff supported this comment. Staff surveys also indicated that the staff have felt the impact of having a number of temporary managers for along period of time and it is clear from the comments that this has caused some difficulties in maintaining routines and adjusting to new management styles. But there were also positive comments about the role of the assistant managers at the home and how they had supported staff during this difficult period. This issue has been raised with the operational manager for the service on a number of occasions since the last key inspection visit. It is understood that a resolution is being discussed. This will be of benefit to both guests and the staff team. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 23 In the AQAA, we are told that the service has 20 permanent staff of whom 14 have an NVQ qualification at level 2 and 4 are working towards this. 3 staff have NVQ level 3 and 1 is working towards it. This exceeds the minimum recommendation. Staffing on the day of this visit included 2 support staff plus a manager in the morning and 3 plus a manager in the afternoon and evening. There were 8 guests in total. These levels do not support the concerns about staff shortages, referred to earlier in this report, but it is accepted that there may have been occasions since the last inspection site visit where this has the case. Issues around staffing include, 1 person dismissed, and 2 staff transferred to another home. Standards of staff supervision have been difficult to maintain, with some staff only receiving 2-3 sessions last year and only 2 receiving the recommended six sessions, but most staff have received one supervision session during 2008. Staff said that they plan team meetings every 2 months, records show that the last night staff meeting was held on the 5th December 2007 and the last senior meeting on 04/11/07. Most staff surveys stated that they are satisfied with the training opportunities they receive, one commented that they couldn’t always get on the training courses they wanted. Training records show, that most staff training is up to date, with the majority receiving mandatory training, areas that are outstanding include manual handling up dates and vulnerable adults training. All the senior staff team has First aid training and all staff is reported to have received training in equality and diversity. A sample of recruitment records provide evidence of general good practice in terms of recruitment procedures, there was one file of the 6 looked at that didn’t have sufficient information, staff said this was probably because that person had recently transferred from another home. This should be looked into. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. People who use the service, can be sure that the service has appropriate systems and records in place to ensure their safety, but the management arrangements of the service are a cause of concern and potentially place people at risk. EVIDENCE: In the AQAA the service says,” the home is well run with resident needs a priority and their views acknowledged and at the centre of all planning.” The service has had a number of temporary managers for a period of approximately 20 months. This has been commented on in the staff surveys as a source of low staff morale, “the service would benefit from a permanent full time manager, during the last inspection we had a temporary manager in place but she had to return to her own unit, we now have another temporary 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 25 manager.” We have spoken to the operations manager on a number of occasions to ensure that we are kept informed of the situation. It is hoped that an early resolution is achieved as this inspection has identified areas where the service has not maintained its standards, in relation to admission practise, care planning and risk assessment, community activities and promoting independence since the last inspection visit. The service lets us know of any incidents or reportable accidents in the home, since the last key inspection 8 notifications of this type have been received. We have also received reports of the monthly visits to the service undertaken by a representative of the provider, these tell us how the service is performing. The service sends out questionnaires to guests and reviews these to inform future planning. Future developments including the installation of a ground floor shower room are scheduled. Fire safety matters and health and safety issues are generally well maintained, although regular fire drills have been arranged, not all staff have received the minimum of 2 per year. Information in the AQAA indicates that servicing of equipment is up to date and policies and procedures required by regulation and good practice are in place. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 26 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 2 3 x 4 x 5 2 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 4 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x 2 2 x LIFESTYLES Standard No Score 11 x 12 2 13 1 14 1 15 4 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 1 x 2 x x 2 x 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 27 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. 2 Standard YA9 YA2 Regulation 13(4) 14(2) Requirement Risk assessments must be in place and up to date. Timescale for action 08/04/08 18/05/08 3 YA6 4. YA13 5 YA42 6 YA23 7 YA37 The registered person must take action to ensure that assessment information for guests is up to date, for each period or respite. 15(1)(2) The registered person must take action to consult with guests about their care plans and make the plans available to them. 16(2)(m)(n) The registered person must consult guests about activities, and provide opportunities for guest to participate in them. Both in and out of the home. 13(5) The registered person must take action to ensure that all staff have received training up dates in Manual Handling 13(6) The registered person must take action to ensure that all staff have received training or updates in Adult protection. 9 The registered person must take action to recruit a suitable manager for the service. 18/05/08 18/05/08 18/05/08 18/05/08 18/05/08 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 28 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. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard YA1 YA1 YA5 YA17 YA3 YA6 YA7 YA22 YA42 Good Practice Recommendations A statement of purpose should be easily available in the home. The resident guide should contain up to date information about the fees and the costs of the service. All guests should receive a copy of their contract with the service. The service should consider reviewing the way in which guest’s are involved in menu planning, and take action to ensure that guest can choose the food they want. The admissions procedures for the service should be reviewed, to ensure that all guests have everything they need. Further work should be undertaken to ensure that guest know who their key worker is. The service should be more proactive in promoting guests independence. The service should ensure that all guests have access to a complaints procedure that they understand. The service should ensure that all staff are involved in fire drills. 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands 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 114 Douglas Road DS0000028866.V350721.R01.S.doc Version 5.2 Page 30 - 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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