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Inspection on 26/09/06 for 18 Aqueduct Road

Also see our care home review for 18 Aqueduct Road for more information

This inspection was carried out on 26th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 8 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

What has improved since the last inspection?

New furniture has been purchased for the lounge and dining area, which is both robust and attractive in design. Kitchen and lounge areas have been repainted and there is new flooring in the lounge. The kitchen suite has been partially replaced; completion of this upgrade is required. A new fridge/freezer has been purchased for the kitchen to improve storage of food. A second resident was admitted in April 2006 the move has been positively managed and provides opportunity for better interaction and a more homely environment within the home. It is positive to see that photographs of family and others are now in residents` rooms. This was a requirement of the last inspection. Robinia has recently taken a policy decision not to employ agency staffing. This should improve the continuity of care staffing for the service users. The situation will require ongoing monitoring by management to confirm adequate staff are recruited and trained to meet the service users` needs.

What the care home could do better:

The clarity of the Staffing rota at Aqueduct road needs to be improved so that it is more user friendly to anyone requiring access to the information. The addition of a "key" itemising the coded initials on the rota would improve it, as would clarity on how the total hours worked by staff, support the stated staffing ratios required for the individual service users. The options of bathing or showering need to be kept under proactive and regular review to ensure ongoing choice for the service users. The carpet on the stairs is worn and whilst it does not currently constitute a hazard it is in need of replacement. This needs to be included in a general maintenance programme which was requested by CSCI following a previous inspection, but was not made available to the visiting inspector. The programme to enhance and maintain the quality of the home environment needs to include the decoration of the property and the completion of projects such as the partially completed decking in the garden and kitchen upgrade.Daily activity records for Service users are now more comprehensive but there is still improvement required in this area, specifically in the identification and recording of meaningful activities undertaken by residents within the home setting. On the day of the visit the Registered Manager was in Derby, providing management cover to another Robinia home. She had been working there for three weeks and was due to return on 3.10.06 (precisely 28 days) The Deputy manager was attending a Regional Manager`s meeting approximately one hour away and (as the inspector was informed by staff) was not contactable by telephone. The Team leader was not due on duty until the afternoon. This left a senior support worker, with no direct access to a manager as the senior member of staff in the home until the afternoon. Concern was expressed regarding the lack of access to a more senior manager for this extended period and this issue needs addressing when constructing future staff rotas and an "on-call" arrangement to ensure adequate management cover at all times. A full evaluation of the use of the Sensory room in relation to the assessed needs of the two current service users would inform better use of this area thus increasing access to this useful facility for service users. The replacement of the washing machine in the laundry identified as a requirement in the last inspection, is now in hand with the delivery of a new machine pending, which will enable more hygienic and effective sluicing and washing of service users` clothing and bedding at the home.

CARE HOME ADULTS 18-65 18 Aqueduct Road 18 Aqueduct Road Shirley Solihull West Midlands B90 1BT Lead Inspector John Oliver Unannounced Inspection 26th September 2006 09:00 18 Aqueduct Road DS0000043650.V312931.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 18 Aqueduct Road DS0000043650.V312931.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. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 18 Aqueduct Road Address 18 Aqueduct Road Shirley Solihull West Midlands B90 1BT 0121 474 3197 0121 430 5132 18aqueductrd@robina.co.uk 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) The Robinia Group PLC Ms Christine Higgins Care Home 2 Category(ies) of Learning disability (2) registration, with number of places 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: The service at Aqueduct Road consists of a domestic three-bedroom house located in a residential area of Shirley Solihull. It is registered to accommodate two service users who have a learning disability and a diagnosis of autism. The property is within walking distance of a local park and other community facilities in the locality. Solihull Town Centre is accessible by bus as is Birmingham City Centre. Shirley Railway Station is a ten-minute walk from the Home. The premises consist of two single bedrooms one of which has an en-suite bathroom. There is a bathroom on the first floor with a toilet and a toilet is available on the ground floor that is shared on a communal basis. The home has a lounge, dining room, kitchen and sensory room. Upstairs is an office/staff sleep in room. Within the house but accessed separately is the managers office. There is a rear garden that is in need of some maintenance where a wooden decking structure is partially constructed. The garden is well screened by shrubbery and trees providing privacy for service users. The home does not provide off road parking and there is limited parking along the road. Current fees for services provided range from £2660 - £3300 per. week. There is no adapted access to the property and service users require good mobility to access the home’s bedrooms which are all situated on the first floor. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector had access to a service history of recent events which have occurred at the home and to information provided by the deputy manager of the home prior to the date of the inspection. The fieldwork visit itself was unannounced and took place between 9 a.m. and 6.45pm. The inspector was able to meet and observe opportunities and support offered to the Service Users throughout the day although due to limited communication abilities, neither was able to verbally feedback regarding their experiences of the service they received. The inspector was also able to interview a range of staff working in the home including the Deputy Manager (p.m.); Support workers; senior support workers, Team leader and a night care support worker. Current service user’s care plans and records were reviewed including relevant risk assessments and daily activity schedules, along with a range of the home’s policy and procedure documents and Health and Safety records. Staff supervision, training and recruitment records were also inspected. Care practices were observed and a full tour of the premises and external grounds was undertaken. Interaction between management and staff and between staff and service users was observed throughout the day. What the service does well: The building’s design and location means that it is well integrated in the local community with its function as a Care home not being evident or stigmatizing. It provides comfortable, clean and well furnished accommodation for those who use the service. Staff were observed to provide friendly and professional support to the service users and were responsive to needs as detailed in service user records and those expressed by the individual service users through non-verbal means. Picture images were on the walls in the house to assist communication with service-users, who use these and other non-verbal interactions to communicate their immediate needs. There is also a card version of these pictures available for use when supporting users in the community. These aids enable service users to maintain a level of control, choice and independence. A range of menus are available at the home including meal choices which are sensitive to the specific cultural needs of the residents. Service users are supported to use a range of local community facilities including the local college, cinema, laundrette and parks. Care plans and daily activity records are varied and provided in picture form to support communication needs. Files inspected show evidence of a monthly review of activities involving service users and their Key-workers. Robinia Care provides 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 6 each Service user with £500 each year towards a holiday. Both residents are due to go on holiday supported by staff later this year. Care records demonstrate regular access to health support services ensuring regular health care check ups are being carried out by a range of suitably qualified professionals. Regular management audits are now undertaken and documented in respect of the administration of medicines in the home. This ensures that service users receive the appropriate; prescribed medications they require and enables any variances to be identified and promptly addressed. What has improved since the last inspection? What they could do better: The clarity of the Staffing rota at Aqueduct road needs to be improved so that it is more user friendly to anyone requiring access to the information. The addition of a “key” itemising the coded initials on the rota would improve it, as would clarity on how the total hours worked by staff, support the stated staffing ratios required for the individual service users. The options of bathing or showering need to be kept under proactive and regular review to ensure ongoing choice for the service users. The carpet on the stairs is worn and whilst it does not currently constitute a hazard it is in need of replacement. This needs to be included in a general maintenance programme which was requested by CSCI following a previous inspection, but was not made available to the visiting inspector. The programme to enhance and maintain the quality of the home environment needs to include the decoration of the property and the completion of projects such as the partially completed decking in the garden and kitchen upgrade. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 7 Daily activity records for Service users are now more comprehensive but there is still improvement required in this area, specifically in the identification and recording of meaningful activities undertaken by residents within the home setting. On the day of the visit the Registered Manager was in Derby, providing management cover to another Robinia home. She had been working there for three weeks and was due to return on 3.10.06 (precisely 28 days) The Deputy manager was attending a Regional Manager’s meeting approximately one hour away and (as the inspector was informed by staff) was not contactable by telephone. The Team leader was not due on duty until the afternoon. This left a senior support worker, with no direct access to a manager as the senior member of staff in the home until the afternoon. Concern was expressed regarding the lack of access to a more senior manager for this extended period and this issue needs addressing when constructing future staff rotas and an “on-call” arrangement to ensure adequate management cover at all times. A full evaluation of the use of the Sensory room in relation to the assessed needs of the two current service users would inform better use of this area thus increasing access to this useful facility for service users. The replacement of the washing machine in the laundry identified as a requirement in the last inspection, is now in hand with the delivery of a new machine pending, which will enable more hygienic and effective sluicing and washing of service users’ clothing and bedding at the home. 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. 18 Aqueduct Road DS0000043650.V312931.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 18 Aqueduct Road DS0000043650.V312931.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4, The quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. New service users have the opportunity to visit the home prior to a move and have access to relevant information to inform their choice about where they want to live. The needs of the service users are being met by the maintenance of detailed care records. Service users needs are assessed prior to admission to assess the home’s capacity to best meet the needs of individuals admitted to the home. EVIDENCE: A new service user has been admitted to the home since the last inspection. There is evidence on the service user file that a clear planning, assessment and pre-admission process was undertaken. A social worker from a specialist Learning disabilities Team undertook a full assessment of needs in conjunction with Robinia Home Staff thus providing a clear and independent assessment of ongoing requirements from the home. The service user spent time at the home prior to admission and had opportunity to meet staff and the other resident, view his bedroom and communal areas of the property thus affording opportunity for him to indicate his approval of the home as a future place to live. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 10 A Statement of Purpose of the Home was observed on the staff notice board. A copy of a service user guide was seen for each of the individual service users. These had been produced combining the use of symbols and photographs of the staff members who are working with each individual. The files also contained individual statements regarding terms and conditions (a contract) again using pictures to indicate what the service users were paying for. Separate contracts were on the files, which were provided by the placement authorities. 18 Aqueduct Road DS0000043650.V312931.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, The quality of this outcome area was good. The judgement has been made using available evidence including a visit to the service. Staff provide service users with the appropriate assistance and communication support they need to make decisions about their own lives. Service users have a range of risk assessments relevant to the varied situations in which staff are working with them which identify how risks will be managed. Detailed care and daily activity plans exist which are flexible and reflect the need of individual service users. EVIDENCE: The service users have very limited verbal skills to be able to comment on life in the home but there was detailed information on service user files as to how individual needs were to be addressed and evidence on daily activity records that action was being implemented to address the presenting needs of both service users. These inputs were reviewed on a monthly basis with key workers and residents. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 12 Staff rotas indicated that 1:1 and 2:1 staff support was being provided whilst in the Home as required in the care plan and contract. The home operates a “key worker” system and on being interviewed the staff demonstrated good knowledge of each individual’s requirements regarding their needs and the management of associated communication and behavioural issues. Both service users were observed to be relaxed in the presence of staff and related well to the staff members. Risk assessments regarding resident interrelations were in place and appropriate reporting on individual files and to CSCI of recent incidents relating to both residents was observed. Care plans covering personal, social care and health needs were in place recording likes and dislikes and preferences regarding residents’ daily routines. Staff were observed to be aware and responsive to the presenting needs of both residents. These plans are reviewed regularly within the home but it is recommended that involvement is sought from external placement agencies and family carers to participate in reviews. A key worker is allocated to each service user and in interview with one of the key workers he demonstrated a broad knowledge of the needs and preferences of the person who he worked closely with. Both service users also have access to an advocate from an independent agency providing inputs to reviews and supporting service users to ensure that their views about the service are heard. Inspection of individual care records showed that there were risk assessments and risk management strategies relating to interaction between service users; activity within the home, activities in the community and transporting and escorting into community settings. The plans focussed on positive behaviours and on service users’ abilities. These risk assessments assist in minimizing risks to service users in a variety of different settings whilst enabling them access to a range of activities and experiences. Staff were observed encouraging service users to make choices on a day-today basis through the use of photographs and symbol boards which were available on the walls in the home and on portable boards for use when away from the home. These covered areas such as mealtimes, activities and immediate physical needs which improved communication, understanding and responsiveness between service users and staff members. 18 Aqueduct Road DS0000043650.V312931.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. The quality of this outcome area was good. The judgement has been based on available evidence and a visit to the home. Good practice in the provision of daily activities has been extended to the new service user and opportunities for access to education/occupation and social inclusion in the community have been maintained and are evident on care plans to meet individual needs. Appropriate staffing is available to support service users access to local community resources. Service users are offered ongoing access to Health Care professionals. Choices are available for service users providing them with a nutritious and varied diet. Service users have choice in their activities and are not subject to any unnecessary restrictions EVIDENCE: 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 14 A second service user has taken residence at the home since the last inspection. This has inevitably changed the dynamics of relationships within a two bedded home. The home and staff have focussed on the greater opportunities for social interaction between the service users and the development of the relationship between the two, organising both joint and separate activities. These activities provide a platform to enhance the positive relationships for the service users within the home. The interaction between the service users was observed to be generally positive, . Whilst there the inspector observed an incident, which resulted in one service user grabbing the other. The staff, trained in suitable minimal intervention techniques appropriately managed the situation whilst maintaining the dignity of both service users. The inspector also noted subsequent appropriate recording and notification of the incident on risk management forms which will enable the home manager to assess and review incidents and produce proactive strategies to minimize risks of further incidents. The relationship between the service users would appear to be mutually beneficial but does require close supervision and support from staff to ensure independence is maintained whilst managing any potential risk. During the course of the inspection the inspector observed both service users go out of the home supported by an appropriate staffing ratio. One service user visited the Laundrette and cinema and the other went to a local park (although he subsequently amended his choice, deciding not to walk, preferring to just ride in the Minibus, which is transport attached to the home to encourage community access). This demonstrated a flexible and responsive approach by staff towards this service user’s needs. These daily community activities are recorded on individual care files. It was positive to see service user’s take the initiative to indicate to staff that they wanted to go out by their use of the picture boards in the home. The detail of the activities undertaken within the home need more precise recording to identify the specific activities undertaken by service users when at home. General references to “activities” do not assist with the planning and provision of choice or variety of options. Staff informed me that a new minibus with more seating is currently ordered for the home. This will expand the possibilities for joint outings, enabling both service users and the required numbers of support staff to be safely accommodated on the transport. It was good to see that one of the service user’s has started at a local college course which he is able to attend with support from staff from the home. This both expands his interests, improves access to services and better integrates him into local community facilities. The range and flexibility of the daily activities and routines promote greater independence and choice for service users. There is freedom of movement and access to all areas in the home and grounds is unrestricted for the service 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 15 users, subject to heath and safety requirements and to an appropriate staffing supervision ratio being maintained. The menu provided is varied and nutritious and an examination of the pantry and storage areas for food confirmed that health and hygiene standards were being adhered to and the supplies matched the provision of food to produce the meals detailed on the menu. The home provides culturally appropriate food including a halal diet if required. In such a small domestically orientated home variation from the menu is relatively easy to achieve and staff informed me that choice over alternatives at mealtimes is always respected. There was however no formal evidence available to the inspector to confirm when a service user could or had exercised a choice at mealtimes and appropriate recording of meals taken would confirm that each service user had this choice and was maintaining a healthy and varied diet. 18 Aqueduct Road DS0000043650.V312931.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. The quality in this outcome area was good. This judgement has been made using available evidence and a visit to the home. The service users’ health care needs are appropriately managed to promote and maintain good health. The management audit of medication is ongoing and effective in promoting and maintaining the good health of both service users. Service users preferences about how they receive support with personal care are respected. The level of fees indicate that service users have specific, complex needs. The home demonstrates that it has the ability to support the service users with these personal and healthcare needs whilst encouraging their independence and ensuring timely and effective healthcare from other agencies. EVIDENCE: Policies and procedures are in place relating to the receipt, administration, and disposal of medication within the home. The inspector viewed the records kept and the records for the administration to individual service users and witnessed medication being dispensed. Examination of Medication Administration Records found no gaps in the recording process indicating that 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 17 medicines had been appropriately administered by staff for the period inspected. Prescribed medications were printed onto the MAR sheets and photocopies of prescriptions were attached which correlated with medicines stored on in the home. A rolling programme of accredited training for staff who handle medication is organised by Boots Chemist, the most recent period of training being undertaken in August 2006. All staff currently involved in the administration of medicines in the home have had access to this training. The management audit of medication now takes place on shift changes and is able to quickly identify any issues regarding the giving and recording of drugs. There have been two such errors in handling of medication recorded in the period since the last inspection. Both incidents were quickly identified via the management audit, corrected and notified to the Commission for Social Care and Inspection as required. There was evidence on service user files, of them accessing a range of appointments with health staff including General Practitioner, Dietician, Speech Therapist, Dentist, Optician and Chiropodist. It is recommended that these appointments are completed on a schedule for each service user and maintained as a separate record on service users’ files. These records should be coordinated with Health Action Plans for the residents concerned. Staff from the care home supported all appointments attended by the service users. This is in line with health and safety requirements and assists the staff from the home to have an accurate understanding of the outcomes of these appointments. A Community dietician had developed a healthy eating programme for one service user due to health concerns. This programme had commenced some months ago and a monthly recording of weight loss had been maintained. It was recommended this be kept under review with the community dietician, for advice on the individuals future health needs. Daily recording indicated that both service users had choice regarding when they wanted to go to bed and rise. Records also show when service users needed support with personal care, shaving and showering. Records showed that service users were supported in a gender sensitive way to maintain their personal care. 18 Aqueduct Road DS0000043650.V312931.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. The home is able to demonstrate that it has a complaints procedure accessible to service users in a suitable format and that efforts are made to aid their understanding and use of the process. There are procedures and policies within the home relating to Adult Protection which conform to the D.O.H. guidelines contained in the paper “No Secrets”. Staff in the home undertake appropriate recording of financial issues relating to service user finances. EVIDENCE: Neither CSCI nor the Service Provider has received any complaints since the previous Inspection took place. A complaints procedure in pictorial format was on display in the entrance hall and the CSCI contact information was also displayed, both in the hallway and in the Staff room. Service users had access to both of these copies which were designed specifically to assist their understanding. Staff informed the inspector that staff members have sat with the service users to explain what to do if they have a concern or complaint. A copy of the Birmingham City Council multi agency adult protection guidelines was available in the staff room and a member of support staff who was selected for interview on it’s content demonstrated a good understanding of the processes and when to use them. Staff training records sampled on this 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 19 inspection indicated that staff had received training in adult protection procedures and practice. The inspector was informed that this element of training was an ongoing programme for all newly appointed staff. Service users financial records were examined and there were appropriate individual written records of personal allowance expenditures, monies spent on items, receipts and a final balance which were signed off by two staff members. This recording system safeguards appropriate use and expenditure of service users’ monies. An advocacy service has been engaged to assist and enable the views of the residents to be represented in review situations. Some clarity needs to be sought as to the frequency of contact provided with the advocate to enable better understanding and communication to develop between the advocate and the service users. 18 Aqueduct Road DS0000043650.V312931.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29, 30. The quality in this outcome area is good. The judgement has been made using available evidence and a visit to the home. The home is accessible, safe and clean and well maintained and meets Service users’ needs in a comfortable and homely environment. EVIDENCE: The home is situated in a residential area and it’s design and positioning means that it fits unobtrusively into the locality. It has a secured gate facility at the frontage of the home to restrict access from the road and a rear garden area (mostly grassed) which is also fenced securely in which residents and staff can safely enjoy social and recreational activities. One of the residents was enjoying playing football with his key worker in the garden on the morning of the inspection. A wooden decking structure has been partially erected in the garden but requires completion if service users are to gain any benefit from this facility. The lawn at the back of the property also requires maintenance to make it more attractive and encourage use of the area. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 21 The shed in the garden was left unlocked and it is recommended on the grounds of safety and security that that a secure lock is put on this garden shed which is situated in the bottom corner of the garden. The home provides comfortable, clean and well furnished accommodation. The furnishing in communal areas is robust and functional, meeting both the practical needs and the behavioural challenges of the Service users. There is new flooring and furniture in the lounge and dining areas and decoration is homely in both communal and personal bedroom space for the two service users who now display pictures of family members in their respective bedrooms, personalising this space for each one of them. There has been some recent redecoration (painting) in communal areas and generally the home is bright, cheerful and airy and free from any offensive odours. The Sensory room appears to be used for storage with a number of full bin bags observed in there on the inspection visit. This would appear to be a wasted facility and the inspector would recommend that an audit is undertaken against the assessed needs of the two service users to consider whether the Sensory room needs to be “resurrected” or used in another way which can more directly benefit service users. The banister at the turn of the stairway is loose and requires securing to the wall to ensure the safety of both staff and service users when using the stairs. The carpet on the stairs is worn and whilst it is not currently presenting as a hazard it is in need of replacement. Kitchen unit doors have been partially renewed. However this now leaves a mix of old and new. It is recommended that the refurbishment of the cupboards in the kitchen is completed. The temperature of the newly delivered fridge requires monitoring to ensure appropriate temperatures are being maintained and food storage in this area adheres to appropriate food and hygiene regulations. The inspector was informed that a replacement washing machine, with sluice facility, as recommended in previous inspection reports has been ordered and that delivery was imminent. This will improve the hygiene standards and processes in the home when washing service user clothing and bedding. Inspection of communal sinks and basins in the home revealed the absence of appropriate facilities for washing and drying of hands and this requires addressing immediately to ensure an appropriate standards of hygiene is maintained in these communal areas. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 22 Whilst the decoration and furnishing is currently of a good standard the home has no planned maintenance or renewal programme for the fabric and decoration of the premises and it is recommended that development of this would enable good standards in the home to be maintained in a planned manner for the benefit of the service users. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 23 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): 32,34,35 The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The Service offers and provides relevant training to all staff to support and enhance their professional development and to ensure that they are able to meet the service users’ needs. The staffing levels provided enable the service users needs to be met and there is continuity of care which does not cause disruption to the service users’ daily routines. Robust recruitment practices ensure that service users are protected and supported by qualified and experienced staff. Interaction between staff and service users is positive and sensitive to needs, encouraging a relaxed and supportive environment. EVIDENCE: The senior Support Worker on duty and the key worker for one of the service users were interviewed during this inspection. Both members of staff demonstrated a good understanding of the two service users’ needs and both had a detailed knowledge and a respect for the service users’ routines as outlined in their care notes. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 24 Examination of recruitment records revealed generally well structured and comprehensive records with evidence of proof of identity, CRB checks, photos on file, two references, job application forms interview notes, contracts and copies of qualifications. The exception to this related to three recently recruited Polish staff who had been recruited through an employment initiative by Robinia Care. There were no POVA checks available on these staff members which is a serious concern as they had already commenced work at the home. An Immediate Requirement was issued for The Home Manager to take action in respect of this shortcoming. Two staff members have left the home since the last inspection. The Deputy manager informed me that the recruitment process to replace these posts had commenced. Rotas indicated that agency staffing had been used on a regular basis in the eight weeks prior to the inspection date but a Robinia policy decision had been taken this week to cease use of Agency staffing. This will have an impact on permanent staff giving them access to overtime and the service users will have greater consistency and continuity of staff at the home. Further inspection of staff records revealed that most staff have completed a written induction and received training in food hygiene, manual handling and Health and safety. Training regarding medication had been available in August 2006, as had a fire training course. There is an ongoing training and induction programme in place for staff which means that staff have access to the necessary skills to provide suitable, safe and sensitive services to service users. Fifty percent of staffing at the home have been trained in the “Team Teach” methods of physical restraint and management and dates are booked for newly recruited workers to undertake the same training on 4th and 5th of December 2006. A number of the staff working at the home have undertaken a makaton training course, which was available to staff in September ’06 and a communication follow up course is available in November. Future Training courses are arranged for staff in October ’06 in Coaching and Mentoring, Autism, Food hygiene and a repeat of the Induction training and Boots Medicines training is also scheduled. Files indicated a generally high value and commitment given to staff induction, ongoing training and supervision. It was of concern that only two members of current staff had received training as first aid providers. This is an inadequate number to ensure that an appropriately qualified member of staff is available on all shifts and an immediate requirement notice was issued to address this issue. The inspector was informed by the Deputy manager that accredited First Aid courses were scheduled for October ’06. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 25 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): 37,39,42, The quality in this outcome area is good. The judgement has been made using available evidence and a visit to the home. The services provided in the home are supported by a qualified manager and deputy manager who are also responsible for the management of two other small residential homes in the Solihull area. Effective communication and contact with this home is essential in ensuring that service users and staff benefit from sound leadership and management of the service. A management representative in the Robinia organisation provides regular quality monitoring of the service and produces monthly reporting of this process. The management of the home promotes an open, positive and inclusive atmosphere. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 26 EVIDENCE: The service is managed by a registered manager who also has responsibility for two other small services in the Solihull area. At the time of the inspection visit additional support was being provided by a deputy manager and Team leader. I was informed that the registered manager was managing a service for Robinia Care in Derby. She had been there for three weeks and was due back on 3rd October (28 days absence). The deputy manager was not available or contactable by phone on the morning of the inspection and the team leader did not come on duty until the afternoon shift. The senior support worker on duty welcomed me and was receptive and helpful to any comments made. The Deputy manager was also very supportive and receptive to recommendations and comments made regarding the Service and facilitated access to staff files, which were appropriately secured in cabinets during the morning of my inspection. Concern was expressed at the lack of access to a senior manager for the home staff during the morning of the inspection and the issue of an on-call rota to ensure access to a senior manager at all time, needs addressing in future staff rota arrangements. Reports of the monthly visits from a representative in the Organisation were available for inspection on the premises and copies of the two most recent reports were provided for the inspector to take away. The completion of these monthly reports form part of the Robinia organisation’s quality assurance system. The forms themselves are comprehensive and easy for staff to use in the monitoring of specific service issues. There is space on the form to record service user views and (more relevant to this home) for observation regarding service users at the home. It is important that all copies of the forms are signed by the manager visiting to evidence the visits and observations made. Staff and Service user records were up to date and locked in a secure facility thus maintaining confidentiality and requirements of the Data Protection Act 1998. Many of the lever arch files would benefit from splitting to enable ease of access to working documents for the current year. Written evidence was made available confirming recent Fire drills, regular fire alarm testing and fire training for staff and the date of the Fire officers last visit during which the checking of fire equipment was undertaken and certified as functioning effectively. There was evidence of a monthly recording of water temperatures of the outlets accessible by service users. Suitable procedures were viewed in relation to control of hazardous substances, control and administration of medicines and infection control. Staff members interviewed stated that they felt able to approach and raise any concerns regarding the service with members of the management team, even if this directly concerned the manager who they approached. The general 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 27 atmosphere within the home is relaxed but a strong commitment to the wellbeing and care of the service users was evident in the discussions I had with all members of staff on duty throughout the day. 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 3 X X 3 X 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 29 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 YA24 YA24 Regulation 13 (4) (C) 23 (2) Requirement The loose handrail at the turn of the stairway requires securing It is recommended that a planned maintenance and renewal programme be instigated with regards to the fabric, furniture and decoration of the home. All staff require full recruitment checks prior to commencing employment in the home. Monitoring of the effectiveness and the temperatures within the fridge section of the newly purchased fridge /freezer is necessary following some high readings on the day of inspection. Hygienic facilities for hand washing and drying need to be available in all communal areas. A member of staff with accredited first aid training must be available on all shifts. The management must provide evidence of a training schedule to enable this target to be achieved. It is recommended that the oncall arrangements for contacting DS0000043650.V312931.R01.S.doc Timescale for action 01/12/06 01/11/06 3 4 YA34 YA30 19 Sch (2) 16 (2) (j) 01/11/06 10/11/06 5 6 YA30 YA34 YA35 16 (2) (J) 13 (4) (c) 28/09/06 01/12/06 7 YA36 13 (4) (C) 10/11/06 18 Aqueduct Road Version 5.2 Page 30 senior managers working off-site be reviewed as a matter of urgency; access to senior management when off site must be clear and unambiguous for staff on duty at the home. 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 YA3 YA29 YA15 YA17 YA19 YA24 YA24 YA24 YA24 YA24 Good Practice Recommendations A review of the effective use of the Sensory room with a view to evaluating its function in meeting the assessed needs of the current residents is recommended. It is recommended that more specific detail is included in the record of activities undertaken within the home setting to demonstrate variation and choice. It is recommended that records of food eaten by service users at meal times are maintained, including any variances from the planned menus. It is recommended that a separate and specific schedule of outstanding health care appointments be included on service users’ files. It is recommended that the refurbishment of the kitchen units is completed. It is recommended that the worn carpet on the stairway be replaced. It is recommended that a secure lock be obtained for the shed in the garden to restrict access. It is recommended that the partially completed decking structure erected in the garden be completed to enable service users to benefit from this facility. It is recommended that contact with the advocacy service used in reviews, is extended to promote better levels of understanding and communication between advocates and service users. It is recommend that the filing system is reviewed to enable better access to information. It is recommended that a key to abbreviations used on the staffing rota be included on the rota itself. Improvement in the layout of the rota would also make it more accessible for those requiring access. DS0000043650.V312931.R01.S.doc Version 5.2 Page 31 10 11 YA41 YA41 18 Aqueduct Road 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 18 Aqueduct Road DS0000043650.V312931.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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