Inspection on 16/02/06 for 429 Warwick Road

This inspection was carried out on 16th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

429 Warwick Road 13/09/07

429 Warwick Road 05/09/06

429 Warwick Road 10/08/05

429 Warwick Road 11/02/05

429 Warwick Road 28/04/04

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Polesworth Group Friary Road

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Polesworth Group 70 Long Street

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Warwick Road, 429 Solihull Birmingham West Midlands B91 1BD Lead Inspector Kerry Coulter Unannounced Inspection 16th February 2006 11:00 Warwick Road, 429 DS0000004512.V283979.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 Warwick Road, 429 DS0000004512.V283979.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. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Warwick Road, 429 Address Solihull Birmingham West Midlands B91 1BD 0121 704 4563 0121 704 4563 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) Milbury Mrs Sue Kiely Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: 429 Warwick Road is registered to provide accommodation and care for a maximum of 7 adults with learning difficulties. The home is situated on a main road with its own small car park at the front of building. The home is a large attractive modern building in keeping with the design of other houses in the neighbourhood. Bedrooms are situated on both the ground floor level and the upper floor of the home. Whilst the dimensions of the hallways and the staircase to the first floor make the house unsuitable for wheelchair users, the bedrooms on the ground floor levels provide a suitable living situation for some service users with minor / moderate mobility related needs. The home provides a service to male and female residents, primarily in the middle age range. During the week residents are encouraged to make use of Day Service provision although residents often spend sometime at home. The home is situated within reasonable distance of shops and local amenities and the service has its own vehicle to support residents to access the community. Warwick Road, 429 DS0000004512.V283979.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 over one morning. Service users were out at the time of the visit. The Manager and the Assistant Manager were available. A partial tour of the premises took place. Care, staff and health and safety records were looked at. This was the second of the statutory inspections for this home for 2005/2006 and not all of the National Minimum Standards were assessed. To get a full picture of the home it is advised to read this report in conjunction with the report from August 2005. What the service does well: What has improved since the last inspection? Clear efforts have been made by the Manager to meet requirements made at the time of the last inspection. Good work has been done to develop care management practice: statements of need continue to be updated, and care plan information is of good quality. Plans are now cross-referenced to risk assessments. Development work is underway to ensure each service user has a person centred plan. Health Action plans have been developed. Discussion with the Manager indicates that it is further hoped to develop the plans to include areas such as nutrition. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 6 The systems for the safe storage, handling and administration of medication were well managed. One service user has commenced a music session which the Manager said she was enjoying. The dining room ceiling and radiator in the shower room have been repainted. Dining room chairs now match making the room look more pleasant. 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. Warwick Road, 429 DS0000004512.V283979.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 Warwick Road, 429 DS0000004512.V283979.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): 5 Service users have a contract so that they know the terms and conditions of their stay at the home. EVIDENCE: Key standard 2 has not been assessed. Previous inspections have identified that this standard has been met, the home has had no admissions since then. As previously required arrangements have now been made for the service user or their representative to sign their copy of the statement of terms and conditions with the home. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 9 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, 10 Service user needs are reflected in their individual care plan so that staff know how to support each individual. Service users are supported to take risks within a risk assessment framework. EVIDENCE: Care plans were found to meet the required standard at the last inspection, therefore only one plan was briefly sampled. It was observed to have been reviewed in the last six months. Since the last inspection further additions have been made to the plan with regards to the communication needs of the individual. This has been done in conjunction with the Speech and Language Therapist. It was positive to note that as well as recording the details of challenging behaviour incidents staff are also now recording things that have gone well. When this information is collated it is hoped this will ensure a more consistent approach in meeting needs. Development work is underway to ensure each service user has a person centred plan. This will provide service users with an easier to understand plan and one that involves them or people who know them well in its completion. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 10 Service user records included individual risk assessments. All the activities that service users participate in have been assessed, these had all been recently assessed by the Manager. Since the last inspection work has been done to ensure service user risk assessments directly cross-reference to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. Service users individual records are stored securely. Accident records that are compliant with the Data Protection Act are in use. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 11 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): 12 Adequate arrangements are in place so that service users experience a meaningful lifestyle. EVIDENCE: All service users attend day service provision provided by Solihull Borough Council, including Parkview day centre. Since the last inspection one service user has commenced a music session which the Manager said she was enjoying. Encouragement is provided for service users to take part in many aspects of daily living, such as cleaning and tidying and shopping for personal items. Records sampled show that service users participate in a variety of activities to include visits to pubs, cinema, meals out and walks. Key standards 13,15,16 and 17 were found to be met at the last inspection. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 12 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): 18, 19, 20 Personal support is delivered in an appropriate manner, but thought must be given about individual preferences regarding gender care issues. Service users health needs are met. The arrangements for the management of the medication are generally satisfactory to ensure that service users receive the medication they need. EVIDENCE: As observed at the last inspection, the service users and staff appear to enjoy a good rapport. Support is given in a warm and friendly manner and people are treated with respect and consideration. Information on the type of support needed for personal care is included in the care plan. The service users are mixed gender but all the staff at the home are female. Discussion with the Manager indicates that work needs to be done with service users to seek their views on the gender of the staff who support them. This then needs to be reflected in the care plan. A sample inspection of service users’ health records indicates that service users are receiving routine access to general health services, such as well person’s checks, dentist, eye tests, flu vaccinations and chiropodist. Evidence of the regular weight monitoring of service users was observed. Service users are referred, where necessary to health professionals for advice, for example the Continence Adviser. Since the last inspection Health Action plans have Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 13 been developed. Discussion with the Manager indicates that it is further hoped to develop the plans to include areas such as nutrition. At present the plans are in quite a basic format and not in a style that the service users would understand. Consideration should be given to including photographs or pictures to the present format to make them more accessible. The systems for the safe storage, handling and administration of medication were well managed. The home utilises a monitored dose system for medication. Records that medication had been received, administered and where appropriate returned had been made. The home retains copies of prescriptions and audits are undertaken for non blistered medication. As previously required a protocol on the use of ‘as required’ Gaviscon medication has been completed to detail how staff know when the service user is in discomfort. The training matrix shows that staff have received medication training. The Manager has also completed a medication competence assessment for a new member of staff. It is recommended that this assessment is also completed for the other staff on at least an annual basis. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 14 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 Financial procedures impact on the homes ability to show that service users are being protected from the risk of abuse and that their welfare is being promoted. EVIDENCE: The key standard 22 was met at the last inspection. The training matrix for the home indicates that the majority of staff have received adult protection training. Sample checking of the personal file of the most recently appointed member of staff revealed that CRB and POVA checks had been completed satisfactorily. The financial records for one service user were sampled. Receipts or vouchers were available for all expenditure. Where receipts were not available and vouchers had been used there were not always two staff signatures. It is recommended that to increase the safeguards in place that two staff sign the vouchers. The Manager said that this had previously been the practice and she would ensure this was done. Records showed that sometimes service users pay for staff that accompany them on activities, such as to the cinema. The home has only a very small activities budget and the Manager said that this was why service users contributed, otherwise activities might be reduced. The service users financial policy did not guide staff regarding this practice. This practice is not acceptable. Staff need clear guidelines to follow to ensure the financial protection of service users. Warwick Road, 429 DS0000004512.V283979.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, 26, 30 The standard of the environment within this home is generally satisfactory and presents as a homely and comfortable environment for the people who live there. EVIDENCE: Overall 429 Warwick Rd is an attractive and well maintained home, providing accommodation on a large domestic, scale in a comfortable modern environment. The rear of the home has been extended to provide an attractive dining area overlooking the garden. This provides a comfortable area that benefits from good natural sunlight, in which residents can dine or relax. As required at the last inspection the dining room ceiling and radiator in the shower room have been repainted. Dining room chairs now match making the room look more pleasant. Some communal rooms are starting to look a little ‘tired’ and the Manager said that a decorator has recently visited to quote for redecoration. Two bedrooms were sampled. These were observed to be personalised and there is plenty of evidence of personal effects and possessions. A good standard of hygiene is maintained in the Home, and the house is kept generally clean and tidy. Warwick Road, 429 DS0000004512.V283979.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): 32, 33, 34, 36 Service users are supported by staff who know them well and are appropriately qualified. General recruitment policy and practice supports and protects service users. Arrangements for supporting and developing staff are adequate. EVIDENCE: It is a strength of this home that many of the staff have worked there for some time, service users are therefore supported by staff who know them well. Discussion with the Manager and the training matrix shows that more than 50 of the staff have achieved an NVQ or equivalent in care. Several staff have also completed the Learning Disability Award Framework (LDAF). Rotas indicated, that typically two care workers staff the home during the day, and at night there is one sleep in member of staff on call. Numbers of staff on duty during the day increase to three when additional staff are needed to meet service user needs. This includes three staff on a Thursday evening when extra support is needed for service users to attend a local club. Discussion with the Manager indicates that the home has a staff vacancy of sixteen hours. Once this position is recruited to the Manager hopes that there will be more shifts where three staff are on duty. The recruitment records for one new member of staff were sampled. All the documents required were available including a Criminal Record Bureau check Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 17 to show that the necessary checks had been completed to safeguard service users. An examination of the home’s records confirmed that staff meetings are routinely taking place on a regular basis. Sampled records also showed that staff receive supervision a minimum of six times a year. This meets the required standard. However, for one staff there was a considerable gap in the frequency of their supervision. The Assistant Manager said she was sure that a supervision had been completed but was unable to evidence this. The Manager should ensure that there is not too long a period of time between each supervision and that records are kept in the home. Warwick Road, 429 DS0000004512.V283979.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, 39, 41, 42 Service user benefit from living in a home that is generally well run. Quality assurance systems are in place but improvement is needed to ensure audit reports are available. General practice promotes the health safety and welfare of people living and working in the house. EVIDENCE: The Registered Manager demonstrated good knowledge of the needs of the service users. She has many years experience in care and has successfully completed both an NVQ 4 and the Registered Care Managers Award. The Manager is making clear efforts to develop the service for the benefit of the people living in the house. Regular monthly visits required under Regulation 26 (Care Homes Regulations 2001) have been completed as necessary, and copies of reports submitted to the CSCI. Unfortunately the Manager has not been provided with reports of the last few visits. The home must have their own copies to enable the Manager and staff to effectively follow up any action points. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 19 Discussion with the Manager indicates that annual quality audits are completed. This includes questionnaires that are sent out to relatives. These were observed to have been completed in August but the Manager said she had not received a copy of the quality audit report as yet. For the audit to have its full value the home needs to receive it in a timely fashion. A report received over five months after the audit may not reflect the current situation in the home. Records were kept up to date and were generally satisfactory. Some daily entries for service users regarding activities undertaken lacked detail. Some entries just recorded that the service user went a walk or out shopping. It would be beneficial to include more detail such as if the activity was enjoyed and more detail about what actually happened. This information will be particularly helpful in guiding future planning. Safety records were examined and showed that the fire alarm and emergency lighting systems have been serviced and checked regularly as required. Fire drills have been carried out twice in the last six months. Staff were up to date with fire training. In addition, several staff were due to go to a fire forum at the end of February to hear about the new changes in fire safety legislation. Portable appliance testing has been carried out on electrical equipment, and the hard wiring certificate is in date, as is the Landlord’s Gas Safety Certificate. The record of testing of water temperatures was also seen, and completed as required. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 20 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 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 2 X 3 3 X Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA18 Regulation 12(1) Requirement Timescale for action 31/03/06 2. YA23 12(1) 13(4) 3. YA39 26 4. YA39 24(1-3) Work is needed to ensure the preferences of service users in regard to the gender of the staff who support are sought and acted on. The use of service users monies 31/03/06 to pay for staff accompanying them on activities must be reviewed. A clear policy must be developed on the use of service users monies. The home must be provided with an adequate budget to enable activities to take place. The provider must ensure the 31/03/06 Manager is provided with copies of regulation 26 reports in a timely fashion. Produce report following the 30/04/06 implementation of Quality Assurance and Monitoring System, ensuring that views of service users are represented appropriately. Make available to interested parties, and forward a copy to CSCI. Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 22 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 YA19 Good Practice Recommendations Health action plans. Areas covered should be increased. Consideration should be given to including photographs or pictures to the present format to make them more accessible. The medication competence assessment should be completed for all staff on at least an annual basis. To increase the financial safeguards in place for service users two staff should sign the vouchers used in the absence of receipts. Increase the frequency of formal staff supervisions, ensuring there is not a significant gap between each supervision. Service user records. It would be beneficial to include more detail regarding activities, such as if the activity was enjoyed and more detail about what actually happened. This information will be particularly helpful in guiding future planning. 2. 3. 4. 5. YA20 YA23 YA36 YA41 Warwick Road, 429 DS0000004512.V283979.R01.S.doc Version 5.1 Page 23 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. 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