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Inspection on 12/01/06 for 127 Longdon Road

Also see our care home review for 127 Longdon Road for more information

This inspection was carried out on 12th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

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

127 Longdon Road is warm, clean and comfortably furnished. The home is well placed for a number of local services such as shops, public transport and health care facilities.

What has improved since the last inspection?

Handrails have been fitted to the ramp at the front of the home to make it safer for the people that use it. Records which show that checks are made of new staff before they come to work in the home have improved.

What the care home could do better:

Medicine management is poor and is in need of development. Care plans and risk assessments need to be reviewed and made clearer so that staff know how to meet service users needs. The way the home manages service users finances on their behalf is poor and urgent work is needed to create better systems to reduce the risk of service users experiencing financial abuse. Poor staffing levels mean service users cannot stay at home if they are ill and do not have the opportunity to go out unless everyone in the home wants to.

CARE HOME ADULTS 18-65 127 Longdon Road 127 Longdon Road Knowle Solihull West Midlands B93 9HY Lead Inspector Julie Preston Unannounced Inspection 12th January 2006 12:30p 127 Longdon Road DS0000004533.V278189.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 127 Longdon Road DS0000004533.V278189.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. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 127 Longdon Road Address 127 Longdon Road Knowle Solihull West Midlands B93 9HY 01564 775979 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) Sunny Mount (Knowle) Limited Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th March 2005 Brief Description of the Service: 127 Longdon Rd is a 5 bedroom, semi-detached house owned by the organisation responsible for the provision of care and support to the people living there. The home is situated approximately ¾ mile from the centre of Knowle. The house is domestic in scale but has been extended and adapted to meet the needs of the residents. Accommodation and support is currently provided for 2 people with learning disabilities. All the people living there have their own single bedrooms and there is a room for one member of staff, providing sleepin night time cover. Downstairs there is an open plan lounge / dining area and additional dining facilities in a fairly spacious kitchen. One resident’s accommodation is also situated on the ground floor level. There is a ramp to facilitate access to the front of the house. However, the house is not adapted to the needs of people needing to use a wheelchair. With the exception of one individual’s accommodation, people living in this house need to be able to manage stairs. There is a private garden situated to the rear of the property. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over three hours. There were no service users present during the visit as they were both out taking part in day centre and work placement activities. The inspector met with the registered manager from Sunny Mount, a care home situated close to Longdon Road. The registered manager is currently managing both homes until a suitable manager can be found to manage Longdon Road. The inspector looked at records that describe how service users needs are assessed and met and risk assessments that state how service users safety is managed. Financial records were observed for both service users currently living in the home. A tour of the premises was conducted and some staff training and recruitment records were sampled. Medication storage and records were also looked at. What the service does well: What has improved since the last inspection? 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. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 6 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 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 7 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): 2 The home does not have a system to fully assess people prior to them moving in to ensure that the home can meet their needs. EVIDENCE: The registered manager from Sunny Mount stated that two service users have recently moved from the home as their needs had changed to such an extent that the home was unable to provide them with effective care services. It was explained that two new service users were due to move into the home over the next week, both of whom were moving from Sunny Mount. The registered manager confirmed that both service users had been assessed by Social Workers prior to introductory visits being made to the home. Evidence was seen in the daily records of service users currently living in the home that they had met the new service users and had been supported to express their views about the impact of new people moving in. The inspector had the opportunity to meet the family of one of the new service users that had come to look at the home on the date of this inspection. Positive comments were made about the premises and the family members said that their relative was looking forward to her move. The home does not have an admissions procedure or assessment tool to ensure that potential service users needs are assessed prior to them moving in which enables staff to determine that the home is suitable to meet their individual needs. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 8 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, 9 Individual care plans and risk assessments are in need of review and development to ensure that the reader is able to determine how to meet service users needs effectively. EVIDENCE: The care plans for both service users living in the home were examined. Both were noted to be in need of development and review. Aims had been identified for service users with regard to their social, personal, health and independent living care needs, however there was no evidence to determine that the needs had been met or that the recorded aims were identified as a result of individual assessment of each persons needs. Some information was noted to be unclear and would not instruct staff about the action to be taken to support service users. For example, plans referred to individuals needing “prompts” with personal care, but did not identify what this meant. One plan described a service user as sometimes “fabricating stories”. The inspector discussed this record with the registered manager who agreed that this was a value judgement and did not serve a purpose within the individual’s plan. The inspector was concerned that this record could influence staff to 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 9 disregard issues raised by the service user and may affect his confidence to disclose information to the staff team. The care plans seen had not been reviewed since March 2004. Risk assessments were observed to be in a checklist format that identified hazards associated with activities such as independent travel, bathing and moving and handling. However, the controls in place to manage known risks had not been completed in some cases. Risk assessments were also noted to be in need of review as the most recent review date on file was entered as November 2004. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 10 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): None of these standards were assessed at this inspection. EVIDENCE: No service users were present at this inspection therefore the inspector did not consider it appropriate to assess key standards without the input of the service user group. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 11 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 In the main service users receive support to manage their health care needs. Poor staffing levels prevent service users from staying at home when they are unwell, which is unacceptable practice. Medicine management within the home is not robust and is in need of development to protect service users and ensure they receive their prescribed medication. EVIDENCE: Service users records showed that they are registered with a local GP, dentist and optician as required. Chiropody is provided within the home by a visiting practitioner. The home keeps records of service users appointments with health care professionals, which showed that in the main regular health checks take place. The records showed that one service user had not received a dental appointment in 2005, which was discussed as in need of action with the registered manager. Examination of a service user’s daily records identified that the person had been unwell for two days in December 2005, was unable to attend his work placement and had been taken to Sunny Mount. The registered manager advised that this was due to Longdon Road being without staff from 9.30am until 4pm during weekdays. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 12 This is not acceptable and the home must ensure that there are arrangements in place for sufficient staff to be provided to enable service users to recover within their own home when they are unwell. Medication was noted to be securely stored within the home. It was reported that no service users currently self-administers their medication. Staff training records sampled showed that some staff have not received accredited training in the safe handling of medicines. The medication administration records (MAR) for the last 4 weeks were observed and showed the following anomalies: 1. 100 paracetamol tablets had not been entered onto the MAR as being received into the home. 2. The MAR for administration of paracetamol showed that 6 tablets from the 100 received had been administered, however the balance of tablets counted identified that 8 tablets were missing from the supply. 3. Written protocols for the application of prescribed PRN (as required) creams and shampoos had not been completed. 4. The MAR for one service user showed entries of an “O” code, with no record of what this meant. Feedback was given to the registered manager of the importance of maintaining accurate records of medication administration and immediate requirements made to investigate item 2 above. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 13 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): 23 The systems for managing service users finances are not robust and place service users at risk of financial abuse. EVIDENCE: The financial records maintained by the home that describe service users income and expenditure were sampled. In one record an entry of £100 withdrawal from the service user’s account had been made, however there were no receipts to evidence how the money had been spent. Within the same person’s file a bank statement showed a withdrawal of £200 made from a cash machine in November 2005. This had not been entered onto the person’s financial record and there were no receipts in place to evidence how the money had been spent. Receipts for expenditure on pub meals were missing from both service users records and in some cases the receipts available did not match the amounts specified within the financial records maintained. The inspector discussed the issue of service users paying for food that should be provided by the home with the registered manager and it was agreed that a review of this practice would take place. A number of invoices made to service users from Sunny Mount showed that individuals are not purchasing their own toiletries, instead items are bought in bulk for which the service user pays an amount after each invoice is received. This practice is considered by the inspector to limit service users opportunities to spend their money on items of their choice and does not evidence value for money. One invoice showed a chiropody fee of £7.00, which the registered manager explained covered the cost of two chiropody sessions. The service user’s health care records for the period the invoice related to had only one entry for 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 14 chiropody at £3.50 per session, which led the inspector to believe that the service user had been overcharged for this service or that the records which evidence such expenditure were inaccurate. Immediate requirements were made that these matters be addressed for the protection of service users living in the home. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 15 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 In the main the home is maintained to a standard that creates a comfortable environment for service users to live in. EVIDENCE: 127 Longdon Road is situated close to local amenities in Knowle village and is within walking distance of public transport routes. The home does not differ from other properties in the area and overall is well maintained both inside and out. Since the last inspection, handrails have been fitted to the ramp at the front of the property. The wallpaper in the lounge was noted to be torn in places, which affects the overall presentation of the room and the panelling in the bay window in one bedroom was seen to be damaged. Otherwise the home was clean, warm and comfortable throughout. The home’s records for the testing of the fire alarm system showed that a test had not been conducted within the last ten days. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 16 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, 34 The home does not provide sufficient staffing levels to enable the needs of all service users to be met. The procedure for the recruitment and selection of new staff is generally good and protects service users living in the home. EVIDENCE: Examination of the home’s rota showed that there are no staff present within the premises between the hours of 9.30am and 4pm during weekdays. The registered manager explained that this is due to service users being out at planned day centre and work placement activities during these times and went on to say that there is an on call telephone number that can be used in the event that service users need to return to the home unexpectedly. However this report has identified that in the event of service users being unwell there are no arrangements for staffing the home to enable them to remain there. The rota showed that staff work alone over each shift, including at weekends, which has an impact on service users being able to go out to take part in activities of their choice, other than in a group. There is a need to conduct a review of staffing levels, to ensure that sufficient numbers of competent staff are available to meet service users needs. This is of particular importance as the home is due to admit two new service users in the near future. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 17 Staff recruitment records were sampled which showed that, in the main appropriate checks had been made prior to the staff members’ appointment to work within the home. In one case the references received for a member of staff had been made by a colleague and a second reference was undated and did not provide evidence of the person’s suitability to work within the home based on the person specification and job description. The inspector was unable to discuss service users involvement in the home’s recruitment and selection process, as there was no one available to do so. This will be addressed at the next inspection. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 18 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 The absence of a registered manager has an impact on the day-to-day operation of the home for the benefit of service users. EVIDENCE: The home has no registered manager. The current managerial arrangements are that a senior member of staff employed at Sunny Mount has been seconded as a Team Leader to take responsibility for leading shifts under the guidance of Sunny Mount’s registered manager. The inspector was unable to examine this person’s records of recruitment and training to determine her experience and competence to fulfil this role. The CSCI have not been formally advised of these arrangements and it is a requirement of this inspection that an application for registration of a manager is made to the CSCI. 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 19 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 1 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 1 X 2 X X X X X X 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement The registered manager must develop a written procedure to assess the needs of potential service users prior to them moving to the home to ensure that the home can meet their assessed needs. The registered manager must review individual care plans in accordance with information gained from the reassessment of support needs. Care plans should incorporate the setting of targets with measurable outcomes. Requirement made at last inspection and not met at this inspection. The registered manager must review risk assessments in the light of assessed need and revised care-planning targets. The record of review should 01/03/06 show who took part in discussions and indicate how decisions were reached. Requirement made at last inspection and not met at this 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 21 Timescale for action 1 YA2 14(1-2) 01/03/06 2 YA6 15(1-2) 01/03/06 3 YA9 13(4)(a-c) inspection. The service user that has not seen a dentist in 2005 must be offered a dental appointment. The registered manager must review staffing levels within the home to ensure that service users needs are met at all times. The practice of sending service users to another home when they are unwell must cease. The registered manager must investigate the reasons for two paracetamol tablets being missing from the supply held in the home on the date of inspection. The registered manager must ensure that the Medication Administration Record accurately reflects medication actually given, at all times. Written and agreed protocols for the administration of PRN medicines must be developed and implemented. Codes entered onto the Medication Administration Record must cross reference with a description of the meaning of the code. All staff must receive accredited training in the safe handling of medicines where this is part of their role. The registered manager must establish a system to ensure that staff who administer medicines are competent to DS0000004533.V278189.R01.S.doc 4 YA19 13(1)(b) 01/03/06 5 YA33YA19 18(1)a 12(1)a,b 01/03/06 6 YA20 13(2) 12/01/06 7 YA20 13(2) 12/01/06 8 YA20 13(2) 01/03/06 9 YA20 13(2) 01/03/06 10 YA20 18(1)a,c,i 13(2) 01/03/06 127 Longdon Road Version 5.1 Page 22 do so. The registered manager must conduct an investigation into the £100 and £200 withdrawals from a service user’s account and advise the CSCI of the outcome. 11 YA23 13(6) 30/01/06 16(2)i 12 YA23 17(2) Sch4(3) The registered manager must ensure that records relating to service users’ personal finances are maintained 01/03/06 accurately, and that receipts are obtained, numbered, and filed appropriately. The registered manager must conduct a review of the practice of service users paying for food from their personal allowances. The registered manager must ensure that the service user who paid for two sessions of chiropody between November and January received both sessions and in the event he did not, the cost of one session must be reimbursed. Service users must be offered the opportunity to purchase their own toiletries from their personal allowances. The registered manager must ensure that the lounge wallpaper and the damaged panelling in one bedroom are placed on the maintenance programme for refurbishment. The fire alarm must be tested on a weekly basis and records maintained of each test. The registered manager must ensure that written references are received for each employee that demonstrate their competence to work within the home. DS0000004533.V278189.R01.S.doc 13 YA23 16(2)(i) 01/03/06 14 YA23 17(2) Sch4(8) 01/03/06 15 YA23 13(6) 12(2) 01/03/06 16 YA24 23(2)(d) 01/03/06 17 YA24 23(4)(c)(v) 7 13/01/06 18 YA34 9 19 Sch2(5) 01/03/06 127 Longdon Road Version 5.1 Page 23 8 19 YA37 9 12(1)(a-b) 20 YA37 8(1-2) The CSCI must be advised of the arrangements to manage the home in the absence of a registered manager. The registered provider must ensure that application for the registration of a manager is made to the CSCI. 01/03/06 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Where relatives or professionals are unable to attend review meetings, it is recommended that their views are ascertained by phone call or letter and recorded on file with the care plan. Recommendation made at previous inspection and not assessed at this inspection. 1 YA6 127 Longdon Road DS0000004533.V278189.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 © 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 127 Longdon Road DS0000004533.V278189.R01.S.doc Version 5.1 Page 25 - 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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