CARE HOME ADULTS 18-65
126 Castle Lane 126 Castle Lane Olton Solihull West Midlands B92 8RW Lead Inspector
Joe O`Connor Unannounced Inspection 11th January 2006 01:45 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 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 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 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. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 126 Castle Lane Address 126 Castle Lane Olton Solihull West Midlands B92 8RW 0121 743 1110 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) Robinia Care West Midlands Limited Miss Christine Higgins Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Should the standard of the care within the home deteriorate due to the manager being responsible for two other homes, then an individual manager will be required. 16 August 2005 Date of last inspection Brief Description of the Service: 126 Castle Lane is located along a quiet residential road in the Olton area of Solihull. The service is close to local bus routes for Solihull and Birmingham. It is within reasonable walking distance to local amenities. It is currently registered to provide accommodation and support for three adults with a learning disability. The current group of service users are three women. The premises consist of three single bedrooms one of which is located on the ground floor as part of a garage conversion and has a wash hand basin. There is a separate lounge and dining room with a fully equipped kitchen. On the first floor is a bathroom with a bath, shower cubicle, toilet and wash hand basin. There is also an office that is used as a sleep in room. There is a toilet on the ground floor. To the rear of the property is a large well maintained mainly lawned garden and there is limited roadside parking. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out during the afternoon and early evening. Two service users provided some of their views on life in the home. The Inspector spoke to a member of staff and the Registered Manager. Service users care plans and risk assessments were inspected. A number of health and safety records were also examined. For an overview of the performance of this service the report should be read with the unannounced inspection report of 16 August 2005. What the service does well: What has improved since the last inspection?
The manager has worked hard in addressing the requirements from the previous inspection. The complaints procedure on display in the hallway had been developed into large print format. Service users meetings are now available in typed format that will hopefully provide clearer information about what choices service users had made. The service user had all gone on holiday together to Minehead since the last inspection, which they enjoyed very much.
126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 6 The manager has developed service users care plans into a more personalised document that includes the use of pictures and large print format. One of the care plans seen showed how staff should support the service user when she became anxious or upset while another referred to the time they got up and go to bed. A rail had been installed by the patio window in the back garden to assist one service user in getting into the garden when the weather is fine. The manager has introduced a picture board that assists service users in identifying which staff member is on duty and the activities taking place for that day. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Service users needs continue not to be fully met due to inappropriate levels of staffing. EVIDENCE: At the time of this inspection one service user was about to go out with her boyfriend and stated she spent Christmas day with her boyfriend. She was about to go out with him to see the latest Harry Potter film. Another service user said she too had a nice Christmas but was not feeling well and had decided not to go horse riding today. The third service user who has no verbal communication was observed to have a range of soft multi sensory equipment and appeared relaxed. The service users were dressed appropriately for the climate of the day for their age. One member of staff spoken with during the inspection was able to demonstrate appropriate knowledge around the needs of the current group of service users. A re-assessment for one of the service users had been underway since the last inspection. This was to address ongoing concerns over the individual’s changes in behaviour that was difficult to manage with the current levels of staff during the evening. There was some documentary evidence indicating a Social Worker had visited the service. The manager stated the social worker had recognised that the service user required additional staff support and would be 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 9 made a funding application but the outcome of this application would not be known until the end of January this year. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9 Service users have care plans that are developed in a style reflecting a more person centred approach with references to specific likes and dislikes. Service users are involved in weekly meetings as part of being involved in running of the service. Service users risk assessments are reviewed ensuring these reflect their current circumstances. EVIDENCE: Since the last inspection the manager has made improvements to service users person centred plans that developed in a large print format including the use of pictures. It was suggested to the manager that some of the photographs included those of actual people involved in the life of the service user such as their keyworker, relatives and friends. There had been improvements in setting out service users likes and dislikes. One person centred plan referred to how staff should support the service user when she became anxious or upset. It also referred to her specific likes such as listening to eighties music. Another person centred plan also referred to a service user’s daily routine including the time getting up and going to bed. Further examination of the care plans indicated service users had progress reports completed every month. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 11 Service users have regular meetings every Sunday and since the last inspection the minutes for these have been available in a printed format. Among the topics covered were activities and menu choices. It was suggested to the manager that each meeting ended with an action plan as to who would for example be making arrangements for new activities. The manager stated that all three service users now have their own individual bank accounts. When examining service users records there was evidence that their individual risk assessments had been reviewed since the last inspection. There was a risk assessment for one service user for when they were crossing the road and how many staff were required. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 17 Service users have access to leisure activities in the community with support from staff depending on their interests and abilities. Service users food records do not adequately reflect a variety of nutritious meals. EVIDENCE: A sample of two service users records indicated they had been involved in choosing a holiday of their choice, which, was in Minehead. One service user stated she enjoyed the holiday and hoped to go on holiday this year. Further examination of the records indicated service users had gone out on activities such as horse riding and going to the cinema, as well as trips out to Walsall illuminations. Service users are also involved in shopping for food at stores such as ASDA and Tesco. One service user attends college during the week participating activities such as flower arranging and health and beauty. Another service user goes to multi sensory centre known as Relaxaway a form of relaxation therapy. An examination of the records for foods eaten by service users indicated the records were not always completed daily. It was also noted that some of the
126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 13 meal choices tended to be repetitive with chips being served sometimes three times during the week. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 Service users healthcare is appropriately arranged and managed by staff promoting and maintaining good health. Medication management was found to be of a good standard promoting service users’ good health. EVIDENCE: An examination of two service users’ care records indicated service users were supported to access local healthcare services including GP, Dentist, Optician and Chiropodist. A record of these visits were maintained outlining any action to be taken. Each service user has an annual health care review plan that provides information setting what input from healthcare professionals the service user has received during the year. A monthly record was being maintained of service users weight. One service user’s record confirmed they were receiving specialist support from a Psychologist within the specialist Primary Care Learning Disability Trust. There was documented evidence to confirm that the psychologist had visited the service to discuss how staff should support one service user who has bouts of aggressive behaviour. There was a detailed set of guidelines in place written by the Psychology that staff were to adhere to. The manager stated that she would be developing individual health action plans during the coming months in a similar style to the person centred plan. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 15 The management of medication was to a satisfactory standard. There were no gaps in the recording of the Medicines Administration Records or MAR sheets. The organisation’s medication procedure had been amended to state any medication errors were to be notified to the CSCI. There was written evidence confirming each service user had a letter signed by their GP authorising the use of homely remedies. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Service users have access to an improved large print format complaints procedure. EVIDENCE: The Commission has received one complaint since the last inspection that had been investigated by the organisation and all but two elements of the complaint had been unsubstantiated . There is a complaints procedure on display in the hallway as is a photograph of the Inspector. It was noted the complaints procedure had been developed in a large print format. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Service users live in premises that is maintained to an acceptable standard providing a clean, tidy and homely environment with improvements made to accessing the garden from the lounge. EVIDENCE: At the time of this inspection the premises was warm, clean and tidy. A rail had been installed by the patio door to assist one service user with mobility difficulties, access to the garden. There are policies and procedures in place for the control of infection. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 Service users do not receive continuity of care due to inadequate levels of staffing that does not meet their needs and potentially places them at risk. EVIDENCE: An examination of the staff rotas for the previous four weeks indicated staffing levels were still unsatisfactory during the evening and at night. There not always two staff on duty during the day. One member of staff is currently on sick leave while another had been transferred to another service at 18 Aqueduct Road. As previously mentioned the manager stated the service user who required additional staff support had recently been re-assessed by a Social Worker who has agreed that an increase in staffing levels is needed. However, a decision as to whether additional funding will be available would not be made until the end of January 2006. The Commission will undertake enforcement action if there is no satisfactory resolution to what has been a long outstanding requirement. Since the last inspection the manager has developed a picture board that assists service users in identifying which staff are on duty and what activities are occurring during the day. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 Service users are supported by a manager who is committed to improving and maintaining good practice. The organisation is more frequent in ensuring service users and staff views about the service are heard. The organisation has a range of policies and procedures that are reviewed to reflect current practice. Service users’ interests are adequately protected through appropriate maintenance and storage of their records. Service users health and safety is promoted and maintained to an acceptable standard. EVIDENCE: The Registered Manager was present during the inspection and has worked hard to address the requirements from the previous inspection. The manager commented that the last few months had been difficult but the staff had worked hard to support the service users when staffing levels had been low. Comments received from one member of staff referred to the manager as being supportive and always available for advice. The member of staff also stated that she enjoyed working with the current group of service users. Since the last inspection the frequency of the visits made by a representative from the organisation had improved in their level of frequency with reports for these
126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 20 sent to the Commission’s local office. Generally the records were up to date and locked in a secure facility. The manager had made amendments to a number of key policies and procedures including complaints, adult protection, physical intervention, medication, whistle blowing and accidents. These had contact details of the local office for the CSCI. An examination of health and safety records found these were satisfactory. There was evidence that the mains operated smoke detector system had been tested on a weekly basis. A fire drill had occurred since the last inspection. There was also evidence confirming the water tank on the premises had been inspected and tested for the prevention of Legionella. The gas equipment had been inspected and tested with an up to date Gas Landlords Safety certificate issued. Evidence was seen of consultation with a service user to look at moving her bed away from the uncovered radiator to reduce the risk of scalding. An examination of the accident book indicated only three had occurred since the last inspection. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 N/A 2 N/A 3 2 4 N/A 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 N/A ENVIRONMENT Standard No Score 24 3 25 N/A 26 N/A 27 N/A 28 N/A 29 N/A 30 3 STAFFING Standard No Score 31 N/A 32 N/A 33 2 34 N/A 35 N/A 36 N/A CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 N/A 3 3 N/A LIFESTYLES Standard No Score 11 N/A 12 N/A 13 3 14 3 15 N/A 16 N/A 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score N/A 3 3 N/A 3 N/A 3 3 3 3 N/A 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA3 Regulation 18(1)(a) Requirement The Registered Person must ensure the needs of the current group of service users are met with appropriate levels of staff during the evenings and at night. Outstanding Requirement Timescales 15 March 2005 and 16 November 2005 not met. The Registered Person must ensure it maintains adequate staffing levels giving service users greater choice and flexibility in their daily living activities, enabling them to access a wider range of social activities and address any changes in their needs. Outstanding Requirement. Timescales 15 March 2005 & 16 November 2005 not met. The Registered Person must ensure the food intake records are completed in full. These must also demonstrate service users are receiving healthy eating options. Timescale for action 31/01/06 2. YA33 18(1)(a) 31/01/06 3. YA17 Sch 4(13) 11/02/06 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 23 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 YA27 Good Practice Recommendations It is recommended that consideration be given to providing an en-suite shower room in the garage conversion in preparation for if the mobility of the service user occupying the room deteriorates to the point where she can no longer safely negotiate the stairs to get to the bathroom. 126 Castle Lane DS0000043658.V275837.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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