Inspection on 13/07/06 for 18 Clive Street

This inspection was carried out on 13th July 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 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

18 Clive Street 03/07/07

18 Clive Street 16/02/06

18 Clive Street 21/07/05

18 Clive Street 28/01/05

18 Clive Street 26/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 18 Clive Street West Bromwich West Midlands B71 1LH Lead Inspector Jayne Fisher Unannounced Inspection 13th July 2006 09:00 18 Clive Street DS0000004861.V303883.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 Clive Street DS0000004861.V303883.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 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 18 Clive Street Address West Bromwich West Midlands B71 1LH 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) 0121 553 7251 Calanmill Caring Services Millicent Bedworth Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15 February 2006 Brief Description of the Service: 18 Clive Street provides a homely and caring environment for three adults with learning disabilities. It is situated in a residential area of West Bromwich within walking distance of many local amenities. The Home provides a unique service as it was set up in order to provide care specifically to meet the existing client group. The Registered Provider states that it is unlikely that any new service users will be admitted should any future vacancies arise. The environment which is rented from the Local Authority is well maintained and communal areas consist of lounge, dining room, kitchen and garden. There are toilet facilities on the ground and first floor. Service users bedrooms and bathroom is located on the first floor. Service users are encouraged by staff to participate in daily household tasks. They are also encouraged to maintain and develop a range of social interests outside the home. Arrangements are made by the home for service users to enjoy regular holidays throughout the year. Some service users attend various college and day placements during the week, depending on their individual needs and interests. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels were provided in June 2006 which are £445.00 per week. There are additional charges for chiropody, hairdressing and magazines. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 09:00 a.m. and finished at 4.45 p.m. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the manager/proprietor and a support worker. Feedback was received from three relatives/visitors via comment cards. All three residents were at home during various stages of the inspection. Formal interviews were not appropriate therefore the inspector relied upon brief chats, observations of body language, eye contact, gestures, responses and other observations of interaction between staff and residents. All residents’ care plans were examined and care was case tracked by reading and assessing care documents, observing interactions and by talking to staff and chatting to residents. One meal time was observed. A tour of the premises was also undertaken. Staff personnel files were accessed and a sample of maintenance and service records were examined. Other documentation was reviewed including a pre-inspection questionnaire completed by the manager/proprietor. What the service does well: Residents looked relaxed and happy in their surroundings. Staff encourage residents to participate in household chores and to undertake other independent living tasks such as choosing and purchasing their own clothes. Residents have unrestricted access to all parts of the home and can choose when they wish to be in the privacy of their own bedroom. All residents enjoy an active social life and participate in a range of leisure pursuits within the local community. There are regular holidays to a caravan owned by one of the residents. There is no fixed menu, instead residents go food shopping and choose ingredients and meals they would like to eat over the forth coming week. The manager carefully monitors residents’ health care so that any problems are quickly identified and active treatment is sought. Residents’ are encouraged to maintain important links with their family and friends. There was positive feedback received from all three relatives/visitors regarding the care provided by staff. There is a comprehensive complaints system so that both residents and visitors know who they can approach if they are unhappy. The home is decorated and furnished to a good standard and provides a homely atmosphere for residents. There is a small stable and dedicated staff 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 6 group of one manager and two support workers. staff hold an NVQ qualification. Both members of support What has improved since the last inspection? What they could do better: The manager/proprietor acknowledges that there has been little progress towards meeting outstanding requirements made during previous inspection visits. Mrs. Bedworth has been wishing to retire for the last couple of years and has been actively trying to find a new manager. A new manager is now in the process of being recruited and is awaiting the return of satisfactory preemployment checks. A number of improvements are needed in order to rectify poor practice however Mrs. Bedworth is committed to developing the service for residents’ benefit. For example care plans and risk assessments do not adequately describe the level of support received by residents. One resident is currently having eating difficulties and whilst the manager is trying to encourage eating, specialist advice is urgently required in order to provide staff with more knowledge and guidelines about how to support the resident, and to carry out an assessment of nutritional needs which has not been undertaken. An assessment is also required by a competent person such as an Occupational Therapist due to changes in mobility and the possibility that aids and adaptations may be required. Arrangements for medication need improvement, particularly with regard to one aspect of administration in order to provide a safer system for residents. An immediate requirement was issued to address one practice issue which had recently been adopted. Arrangements for the protection of vulnerable adults also require urgent improvement particularly with regard to awareness and training for both the manager/proprietor and staff team. Health and safety practice also needs improvement as some maintenance and service inspections are now slightly overdue. Fire safety and food hygiene practice also requires slight improvements in order to provide greater safety for residents. An immediate requirement to address water temperature checks 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 7 and cooked food temperatures checks was made. The manager was able to demonstrate that she is continuing to try and access outstanding mandatory for staff. 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 Clive Street DS0000004861.V303883.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 Clive Street DS0000004861.V303883.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 and 5 The overall outcome for this group of standards is judged to be adequate. Residents are provided with information regarding the services available, however further details are necessary in order them to be able to make informed choices. EVIDENCE: As previously seen there is a detailed statement of purpose however further details regarding staff mandatory training must also be included in this document as well as accurate details regarding the Responsible Individual. There is also a service user guide in a pictorial format for service users as required by the National Minimum Standards (NMS). This is a clear and effective document which gives a basic outline of the services provided at 18 Clive Street. The NMS require a number of elements to be included in this document which would be difficult to be reproduced in a basic pictorial guide. The statement of purpose may be used as a service user guide for other users such as relatives, however in order for this to comply with the NMS 1.2, further details must be added including a copy of the terms and conditions of residency including fees charged, additional charges and service users’ views of the home. There are no vacancies at Clive Street. It is unlikely to that any new service users would be admitted should a vacancy occur. There is an outstanding requirement to ensure that existing residents receive a periodic reassessment 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 10 of their needs in order to ensure that care plans are up to date and reflect any changes. This has not been undertaken. On examination each service user has a contract/terms and conditions of occupancy. These were established in 2002 and at that time failed to include all of the elements required by the National Minimum Standards 5.2. For example the specific room number to be occupied, the exact fee levels charged and what these include in more detail (for example holiday). These contracts remain unchanged and have not been amended as required. 18 Clive Street DS0000004861.V303883.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 and 9 The overall outcome for this group of standards is judged to be poor. Care plans and risk assessments require expansion, updating and review as they do not cover all aspects of personal and social, and health care; this has the potential to place service users at risk. The lack of a person centred planning process means that service users are not offered enough opportunities to make their wishes and aspirations known regarding their care and lives. EVIDENCE: The manager admits that no further progress has been made with regard to improving care planning and risk assessments. All three care plans were examined. As previously stated these are basic in content and do not adequately describe the level of support that service users require. For example there are no details regarding oral hygiene. One care plan stated that a resident required ‘assistance’ with bathing but does not give explicit guidelines as to what this entails. Another person’s care plan with regard to personal hygiene stated ‘regular baths, change of clothing – supervision of everything’. There are no care plans in place with regard to resident’s 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 12 specialist needs for example with regard to autism and how this effects the service user’s daily life. Care plans are not updated as and when service users’ needs change. For example, one resident is now receiving a pureed diet and staff are assisting with feeding. There was no nutritional care plan in place regard this aspect of support. Some residents are overweight and require a weight reducing diet but this is not reflected in their care plans. There are no details of residents’ likes and dislikes. One resident’s health is deteriorating but there is no care plan with regard to mobility, pressure area care or behavioural problems. Care plans contain do not contain communication packages. There are no care plans in place with regard as to how residents are supported to manage their finances. As with care plans, risk assessments are inadequate. The manager admits there has been no further progress made towards reviewing these. On examination risk assessments are a description of need; they do not describe the risk or control measures in place to minimize risk identified. For example, one ‘risk assessment’ contained a number of risks including crossing the road, the use of electrical equipment, bathing and use of the cooker. It was not clear what control measures are in place for each risk (as they will be different for each one). Separate risk assessments must be carried out for every potential risk identified. Information must include who is at risk (this could be either service users and/or staff), the level of risk (high, medium or low), the control mechanisms in place and any extra precautions necessary. All risk assessments need to identify an actual date of review. There were no risk assessments in place for mobility, moving and handling, use of a wheelchair or tissue viability. 18 Clive Street DS0000004861.V303883.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 and 17 The overall outcome for this group of standards is judged to be adequate. Service users are given opportunities to maintain and develop social skills and enjoy a range of stimulating activities within the local community. Service users are fully supported by staff to maintain important links with family and friends. Residents’ daily routines are operated on the principles of choice and are flexible. Service users are offered a healthy diet however more advice and assistance is required with regard to providing specialist diets. EVIDENCE: Two service users attend external day care provision. During interviews one resident explained about his college course and stated that he liked going. He also chatted about his favourite leisure activity. A third resident has now ceased going to day centre and the manager has accommodated this by ensuring there are sufficient staff for her to stay at home during the day. Staff were overhead asking the resident what she would like to do during the day for 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 14 example what television programmes she would like to watch. There are no activity plans, instead care plan proformas contain a ‘daily planner’. The manager has recorded residents’ preferred activities but as with care plans these require updating in order to ensure they accurately reflect residents’ needs and wants. For example, one daily planner referred to the resident going to a day centre when this ceased earlier this year. The daily planner isn’t fully completed with a written statement on some days ‘much the same as Monday’ for the daily routine. Daily reports were examined which demonstrated that residents had recently enjoyed shopping trips, visiting a car boot sale, celebrated their birthday and brought their own clothes. There was also evidence that residents had helped with household chores. During interviews residents spoke about their recent holiday and how they had enjoyed going to the caravan. The manager had taken photographs which showed residents enjoying themselves whilst on holiday. Staff support residents to maintain links with families and friends. On the day of the visit a relative telephoned the home and spoke with her family member. All relatives/visitors who completed comment cards stated that they were made welcome by staff when visiting the home and are kept informed of important matters. Daily routines are flexible. One resident stated that he liked to get up early. Daily records contained evidence of some bedtimes. All relatives/visitors who completed comment cards stated that they could see their family member in the privacy of their own bedroom if they wish. All bedrooms and bathrooms are fitted with locks for privacy, although as previously requested the holding of bedroom and front door keys needs to be discussed with residents. As observed during the visit, residents are given the opportunity of opening their own correspondence. There is no set menu plan. Instead residents choose on a daily basis what they would like to eat and accompany the manager on shopping trips to choose the food they would like. This is a good initiative. Two residents are overweight and the manager stated that at a recent review meeting it was recommended that a referral to a dietician is made. This has not yet been undertaken. As already stated in this report detailed nutritional care plans must be established. Examination of daily food records confirmed that a healthy diet is provided with lots of meals including salad, baked potatoes and fresh fruit. Weight reducing ready meals are also purchased. These are not always the most healthy of products often containing a high percentage of salt. Advice was also given with regard to considering low fat alternatives to meat products such as sausages. It is also required that separate records are maintained of individual service users’ food choices. One resident recently suffered from high cholesterol levels which have now stabilized. There was no specific care plan in place with regard to how this is managed and will continue to be monitored. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 15 Nutritional screening and assessment forms are contained within care plans, however these have still not been completed. A serious concern was identified at this visit with regard to one service user who has had dramatic weight loss and has been undergoing tests at hospital. (A stomach ulcer has previously been diagnosed but there is no reference to this in the care plan or how this affects her diet). There have been on-going problems with eating and the manager states that at a recent review meeting she was advised to purchase a blender in order to provide a softer diet. The community learning disability team are making a referral to speech and language therapists. The manager is now providing a mainly pureed diet but during interviews was unsure as to how to provide a suitably nutritious pureed diet or to what consistency. For example there are no pureed vegetables or carbohydrates and food is blended with food supplements such as Ensure. There is a lack of understanding with regard to ensuring that pureed foods are presentable and appealing, for example ensuring food is served separately, ideally using a scoop, piping bag or mould. There is no care plan with regard to nutrition and how the resident is supported or assisted to eat. The manager was observed assisting the resident to eat inappropriately and in a manner which does not promote independence or dignity. A referral is urgently required to a dietician. 18 Clive Street DS0000004861.V303883.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 and 20 The overall outcome for this group of standards is judged to be adequate. The health care needs of service users are generally well met but further improvements are needed in the care planning systems in order to ensure any potential risks are quickly identified, and that there is access to all health care appointments. The systems for control and administration of medication require improvement in order to offer greater protection to residents. EVIDENCE: As observed residents are able to express their feelings and opinions about how they wish to be supported. As already stated however care plans contain minimal information regarding how support is given to meet personal care needs. Fortunately, there is a small staff team of three (including the manager) who are fully aware of residents’ preferred routines. During interviews a staff member gave good examples of how service users who need assistance are supported to make choices for example with regard to choosing what clothes to wear. One resident is able to choose and purchase his own clothing and recently brought some items as a birthday present for himself, 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 17 One resident has deteriorating mobility. The manager stated that she had purchased a wheelchair from a friend whilst on holiday for the resident to negotiate long distances. As explained, this may not be appropriate equipment for the resident and in addition must be assessed as to it’s suitability by a qualified person such as an Occupational Therapist (O.T.). During interviews a staff member also stated that some support is now needed for the resident to get in and out of the bath (no details were contained within a care plan or risk assessment). Therefore it would also be beneficial for an assessment to be carried out by the O.T. with regard to any aids that may assist with bathing or any other activity to promote independence. Generally there are good systems to promote residents’ health care needs. Examination of documentation and interviews with the manager confirms that any potential complications are quickly identified and receive prompt attention and treatment. For example, the manager reacted quickly to one recent incident after only a relatively short period of illness which resulted in the resident being admitted to hospital. All residents have within the last twelve months received hospital treatments as a result of the manager’s interventions. Residents are supported to access routine health appointments and checks for example there are regular visits to the dentist and two residents have regular audiology checks. There are a couple of exceptions where improvements are needed. For example, two residents still have not received ophthalmology checks and one resident does not receive the support of a chiropodist as the manager takes responsibility for trimming nails. As discussed this must receive appropriate attention. More consistent checking and recording of residents’ weights is required. All relatives/visitors who completed comment cards stated that they were happy with the overall care provided. Examination of medication practice and interviews with the manager reveals that improvements are required with regard to the safe handling of medication. There are still a number of outstanding requirements from previous inspections which have not received the appropriate action. The manager has been trying to access training for staff and could evidence that trainers had been contacted. The local pharmacist undertook some training in the past but this was a couple of years ago according to the manager. In the interim a competency monitoring and assessment system must be introduced by the manager. A serious concern was identified at this visit with regard to the covert administration of medication which had commenced last week on behalf of one resident who was refusing medication. An Immediate Requirement was issued to address this issue. Examination of medication administration record (MAR) sheets confirms that medication is administered with no gaps in records and short courses of antibiotics have also been administered appropriately. Any additional items discussed during inspection of these standards are contained within the Requirements of this report. 18 Clive Street DS0000004861.V303883.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 and 23 The overall outcome for this group of standards is judged to be adequate. There is a comprehensive complaints system which ensures that users’ views are listened to and acted upon. Policies, procedures and practice requires improvement in order to offer residents greater protection from abuse. EVIDENCE: There is a comprehensive complaints system which is openly displayed in the dining room and a copy of which is contained within the statement of purpose. All relatives/visitors who completed comment cards stated that they were aware of the complaints procedure. No complaints have been received about this service since the last inspection visit. There has been an outstanding requirement to undertake and provide training in vulnerable adult abuse awareness since 2003. Whilst it is acknowledged that the manager has been trying to secure training with the Local Authority, other trainers must be sourced if there is repeated failure to gain access to this course. One member of staff has undertaken training with another employer. A recent vulnerable adult abuse allegation demonstrated lack of awareness by management with regard to adult protection issues. An adult protection investigation was carried out which proved inconclusive. During this inspection the manager again demonstrated that she was not fully aware of the principles of protecting service users from abuse. For example, by taking one resident to visit her own house upon request. As explained there are ethical and safety issues regarding this practice. There was also lack of awareness with regard to the Care Homes Regulations 2001, Regulation 19 in respect of the appointment of new staff and the new guidelines relating to the Protection of 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 19 Vulnerable Adult (POVA) Scheme. A staff member who was interviewed was unable to give examples of varying types of abuse although did understand what procedure to follow in the event of an incident. There are still some outstanding requirements with regard to obtaining up to date policies such as the Local Authority Vulnerable Adult abuse procedures. Other relevant documents such as the Department of Health’s POVA guidelines and No Secrets have been obtained. The manager acknowledges that there has been no progress towards improving procedures with regard to residents’ finances. The majority of residents take responsibility for managing their own finances and have money recognition skills. However, the manager still offers some support by assisting residents with withdrawal from cash point machines and holds details of their personal identification number (PIN), on their behalf. As previously requested individual care plans must be established which confirm what type of support residents need including procedures to protect residents from financial abuse. One resident does not have money recognition skills and requires extra help. There are no records maintained of this resident’s expenditure or receipts obtained from purchases made. It is required that in order to protect both the resident and the manager that a recording system is devised. This remains outstanding. 18 Clive Street DS0000004861.V303883.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 and 30 The overall outcome for this group of standards is judged to be good. The standard of the environment within this home is good providing service users with an attractive and homely place to live. All parts of the premises are clean and hygienic although suggestions have been made to further enhance infection control practice. EVIDENCE: A tour of the premises was undertaken. Residents either gave permission or showed the inspector their own bedrooms. All bedrooms are individually decorated and furnished, reflecting residents’ personal tastes and characters. They contained a range of personal possessions, photographs and ornaments. All bedrooms have been fitted with suitable locks to provide residents with privacy if they wish. All communal areas are comfortably furnished and brightly lit. There were no offensive odours and all areas were clean and hygienic. The kitchen was due to be refurbished by the landlord in June 2006 but unfortunately had to be postponed. It was pleasing to see that liquid soap in now available in this area. The washing machine is located in the kitchen area and is domestic in 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 21 style which meets the needs of the service user group. As discussed a supply of personal protective clothing must be kept in this area. There a large garden to the rear which is neat and tidy with a patio area and tables and chairs for residents to comfortably sit outside should they wish. There some remaining requirements which still need attention and a small number of new items identified at this visit as contained within the Requirements section of this report. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 The overall outcome for this group of standards is judged to be adequate. Residents are supported by a small, stable, qualified staff team. Staff training and development must be given more priority in order that residents’ needs are fully met. EVIDENCE: At present there are two support staff employed both of whom are qualified to NVQ II. The manager has recently enrolled one of the staff members on an NVQ III course. It is recommended that some specialist training is also undertaken for example autism and dementia awareness. There is a number of mandatory training which is outstanding (see further comment in standard 42). During interviews the manager and staff member both demonstrated a good knowledge of the needs of the resident group. On examination of the duty rota this still requires improved recording with regard to accuracy. The manager works long shifts with only one day off per week. There is little flexibility in the duty rota with only two support staff currently employed. This situation is likely to improve with the future appointment of a new manager. Staffing levels must be kept under review given the deteriorating health of one of the residents. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 23 As already stated in this report, the manager needs to ensure that she is familiar with the requirements in relation to the Care Homes Regulations 2001 and pre-employment checks as well as POVA guidelines, for example with regard to the new member of staff currently in the process of being appointed. A full evaluation of the recruitment and selection procedures will be undertaken at the next visit when the potential new manager has been appointed and commenced employment. Although there is only a small staff group the manager still needs to ensure that a training needs assessment is carried out and individual training and development plans are in place for staff. Any other items discussed during inspection of these standards are contained within the Requirements section of this report. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The overall outcome for this group of standards is judged to be adequate. Service users benefit from a caring and conscientious manager who recognises that there are shortfalls in her knowledge and skills. There is no formal quality assurance system in place to ensure that service users and other stakeholders are consulted and their views underpin the development of the home. Improvements are needed in practices to ensure that the health, safety and welfare of service users is not compromised. EVIDENCE: Mrs. Bedworth is both registered proprietor and manager. She set up the home in 1996 specifically to provide care for the three residents who are currently accommodated. Mrs. Bedworth has a certificate in social services which she undertook in 1986 but has not undertaken any vocational training such as an NVQ, and has not undertaken any periodic training to keep herself up to date with changes in practice. Mrs. Bedworth works full time at the home and also provides all emergency out of hours support. The findings of 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 25 this inspection confirm that Mrs. Bedworth continues to remain dedicated to providing a loving and caring environment for residents. Mrs. Bedworth has recognised that she does not have the expertise or skills to continue to manage the service and has finally been successful in recruiting a new manager who will start once the required pre-employment checks have been carried out. There is no quality assurance or monitoring systems in place and neither is there an annual development plan for the home. Statutory training remains outstanding. Staff have undertaken some training (mainly with other employers), but this now requires updating. For example, one member of staff has undertaken food hygiene training but this was in 2001, the other member of staff and the manager have not undertaken this training. The manager was able to evidence that she is trying to secure training for example with regard to first aid but that this has not been forthcoming. Other training providers must be sourced. Fire safety requires improvement. There are a number of outstanding items which have still not received attention. In addition the fire extinguisher in the kitchen has not received an annual inspection since February 2005. Fire safety training was carried out in February 2005 and therefore all staff need to undertake this once more (at least annually). Fire drills are carried out monthly but the names of staff who participate are not recorded. All staff must participate in a bi-annual fire safety drill. The home does not have any emergency lighting and therefore should consider alternative options such as battery charged torches. The manager states that interlinking of the smoke alarms as previously required will be undertaken when the kitchen is being refurbished. Annual portable appliance testing is overdue; it was last carried out in February 2005. There was an up to date fixed wiring check and Landlords gas safety certificate. There was no Legionella risk assessment available although there is annual bacteriology and chlorination of the water system. A previous requirement was made in February 2006 to reinstate water temperature checks however this has not been actioned. In addition there has been an outstanding requirement to carry out checks and records of cooked food temperatures for the last eighteen months which has not received action. An Immediate Requirement was issued to address these two concerns. Food hygiene practice needs slight improvement. For example, frozen foods need to be labelled with the date of freezing. High risk items were stored correctly but were not labelled with the date of opening. Dried foods such as cereals need to be stored in pest proof containers. There is regular testing of the fridge and freezer temperatures and the kitchen was exceptionally clean and hygiene. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 26 Any other items discussed during this inspection and requiring action are contained within the Requirements section of this report. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 X X 2 X 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 28 Yes 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. Standard YA1 Regulation 4 Requirement To review and expand the statement of purpose and service user guide, for example to include staff mandatory training. (To forward a copy to the Commission for Social Care Inspection). (Previous timescale of 1/9/04 is not met). Timescale for action 01/11/06 2. YA3 14(2) 3. YA5 17(2) To continue to ensure a system 01/11/06 of periodic reassessment is implemented for existing service users. using a recognised/formal assessment tool, which meets the requirements of standard 2.3 of the National Minimum Standards for Younger Adults. (Previous timescale of 1/9/04 is not met). To provide all service users with 01/11/06 up to date statement of conditions of residency to include all information contained within Standard 5.2 of the National Minimum Standards for Younger People. (Previous timescale of 1/9/04 is not met). To review and expand the care DS0000004861.V303883.R01.S.doc 4. YA6 15 01/11/06 Page 29 18 Clive Street Version 5.2 planning system by: 1) To ensure that all aspects of care are included. For example, health care and nutrition. (Previous timescale of 1/9/04 is not met). 2) To ensure guidelines are established with regard to the administration of any P.R.N. (as and when required) medication. (Previous timescale of 1/9/04 is not met). 3) To demonstrate that families, friends and advocates are involved in the drawing up and reviewing of care plans. (Previous timescale of 1/9/04 is not met). 4) To demonstrate that service users are involved in the drawing up of their care plans through a person centred planning process. (Previous timescale of 1/9/04 is not met). 5) To re-produce care plans in a format suitable for service users. (Previous timescale of 1/9/04 is not met). 6) To ensure that all care plans are reviewed with the service user (involving significant professionals) at the request of the service user or at least six monthly and updated to reflect changing needs. (Previous timescale of 1/6/06 is not met). 5. YA9 13(4)(c) The home must ensure that all 01/10/06 aspects of risk taking are included in the service users risk assessment. These must be DS0000004861.V303883.R01.S.doc Version 5.2 Page 30 18 Clive Street reviewed on a regular basis. (Previous timescale of 8/9/03 is not met). To expand risk assessments to ensure that the level of risk is clearly identified (high, medium or low). (Previous timescale of 1/10/05 is not met). 6. YA16 17(1)(a) To discuss with service users the option of holding a key to the front door and to record outcomes in individual care plans. If keys are with held for any reason a risk assessment must be undertaken. (Previous timescale of 1/9/04 is not met). To obtain and introduce a nutritional screening and assessment tool. (Previous timescale of 1/7/05 is not met). To make an urgent referral and seek advice from a dietician in order to ascertain if a fully pureed diet is necessary for ‘A’. To take advice as to how to present a pureed diet (if necessary) and to ensure that this contains the required nutrients and is fortified with the correct products. IMMEDIATE REQUIREMENT – REFERRAL TO BE MADE WITHIN THREE DAYS OF THE INSPECTION – BY 16 JULY 2006. To establish a written care plan regarding nutrition and diet including any assistance required with eating and incorporating advice from dietician for ‘A’. To forward to the Commission for Social Care Inspection by 1 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 31 01/11/06 7. YA17 12(1)(a) 16(2)(i) 01/10/06 August 2006. IMMEDIATE REQUIREMENT. To introduce separate record sheets for the recording of individual service users’ daily food choices. Service users personal 01/09/06 preferences must be recorded in their care plans. For example bath times, personal care assistance provided by opposite gender staff. (Previous timescale of 18/2/04 is partly met). To obtain an assessment from a suitably qualified person (such as an Occupational Therapist) with regard to the wheelchair obtained for ‘A’ and to ascertain if any further equipments or aids are necessary. Outcomes to be forwarded in the care plan. 9. YA19 12(1)(a) To introduce a formalised procedure for the monitoring/screening of service users health with regard to potential complications such as testicular, breast and cervical cancer. (Previous timescale of 1/9/04 is not met). To ensure that all service users receive regular ophthalmic checks. (Previous timescale of 1/9/04 is partly met). To ensure that all service users receive chiropody treatment. To ensure that all service users receive more consistent monthly weight checks (or more regular if required) with records maintained. 01/09/06 8. YA18 12 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 32 10. YA20 13(2) To improve the control and administration of medication practice by: 1) Accredited training for staff in the safe handling of medication must include the elements identified in Standard 20.10 and be appropriately recorded on their individual training records. (Previous timescale of 4/11/03 is not met). 2) To review and expand the medication policy to include all subjects: disposal, drug errors, storage, key holding etc. (Previous timescale of 1/5/05 is not met). 3) To establish a household remedy policy for the use of over the counter medicines which must be ratified by the G.P. To ensure that the administration of any household remedy is fully recorded on a medication administration record (MAR) sheet. (Previous timescale of 1/5/05 is not met). 4) To ensure that care plans contain an up to date medication profile. (Previous timescale of 1/5/05 is not met). 5) To ensure that where there are any changes or discontinuation to medication either the G.P. signs the MAR sheet, or if this is not possible then two staff signatures are obtained with reference to the copy of the new prescription. (Previous timescale of 1/5/05 is not met). 6) To ensure that records 01/09/06 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 33 relating to the receipt of medication are more detailed. For example to record the quantity and strength of medication received. (Previous timescale of 1/11/05 is not met). 7) To ensure that consent is obtained to medication from each service user and recorded in the care plan (or to acknowledge if this is not possible). (Previous timescale of 1/11/05 is not met). 8) To ensure that all drugs administered are fully recorded on the MAR sheet. (Previous timescale of 1/11/05 is not met). 9) To ensure that all creams/ointments are labelled with the date of opening. (Previous timescale of 1/6/06 is not met). 10) To discuss covert administration of medication for ‘A’ with the general practitioner and pharmacist and to seek their advice and approval. Outcomes to be forwarded in the care plan within two days of the inspection by 14/6/06. IMMEDIATE REQUIREMENT 11) To discuss covert administration of medication (if agreed by medical practitioners) within a multi-disciplinary team including the service user and to record outcome in the care plan by 23 July 2006. IMMEDIATE REQUIREMENT 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 34 12) To establish a written care plan regarding covert administration of medication and a policy and procedure. To forward to the Commission for Social Care Inspection by 23 July 2006. IMMEDIATE REQUIREMENT 13) A system to assess and support ongoing staff competency to administer medication must be devised and implemented with records kept. 11. YA23 13(6) All information about financial matters, kept by the home on the service users behalf, must be kept available with their individual records, for example details of appointees, how service users manage their own finances. (To devise individual care plans). (Previous timescale of 8/9/03 is not met). All staff must receive training in adult protection issues. (Previous timescale of 21/1/04 is partly met – see immediate requirement). To review and update the adult protection policy to include details of the Protection of Vulnerable Adult (POVA) procedures. (Previous timescale of 1/7/05 is partly met). To obtain an up to date copy of the Local Authority vulnerable adult abuse procedures. (Previous timescale of 01/06/06 is not met). 01/10/06 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 35 To ensure records are kept of financial transactions made on behalf of one service user who requires more support to manage their personal allowance. (Previous timescale of 1/06/06 is not met). To arrange for training in vulnerable adult abuse awareness for the manager and staff within two weeks of the inspection and to forward details of training booked to the Commission for Social Care Inspection by 1 August 2006. IMMEDIATE REQUIREMENT 12. YA24 23(2)(b) To provide a second hand rail on the stairs. (Previous timescale of 1/5/06 is not met). To pursue plans to replace worn mattress in ‘A’’s bedroom. (Previous timescale of 1/5/06 is not met). To replace worn settee and armchairs. To ensure that second wardrobe in the second bedroom is secured to the wall. To replace worn grouting around the bath and wash hand basin. 13. YA30 13(3) To ensure that there is a supply 01/09/06 of personal protective clothing available within the kitchen/laundry area. To ensure that the duty rota is 01/09/06 kept accurate and up to date and identifies the night time sleeping in shift. (Previous timescale DS0000004861.V303883.R01.S.doc Version 5.2 Page 36 01/10/06 14. YA33 17(2) 18 Clive Street of 1/5/06 is not met). 15. YA35 18(1)(c) To provide a staff training and development plan which includes mandatory and specialist training. (Previous timescale of 1/9/04 is not met). To establish individual staff training and development assessment profiles. (Previous timescale of 1/9/04 is not met). To provide staff with equal opportunities and disability equality training. (Previous timescale of 1/9/04 is not met). 16. YA36 18(2)(a) A planned programme of supervision and annual appraisal must be implemented. (Previous timescale of 4/11/03 is not met). Quality assurance and monitoring systems must be developed by the home to measure its success in achieving its aims, objectives and statement of purpose. (Previous timescale of 21/1/04 is not met). The home must obtain and keep available all information on staff as detailed in Schedule 2 of the Care Home Regulations 2001. (For example proofs of identification). (Previous timescale of 1/9/04 is partly met). To ensure that all records containing sensitive information are held securely as in 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 37 01/11/06 01/11/06 17. YA39 24 01/11/06 18. YA41 17(2)37 01/11/06 compliance with the Data Protection Act 1998). (Previous timescale of 1/9/05 is not met). 19. YA42 18(1)(c) To provide up to date training for 01/11/06 all staff in: 1) infection control. (Previous timescale of 1/9/04 is not met). 2) health and safety. (Previous timescale of 1/9/04 is partly met). 3 first aid awareness. (Previous timescale of 1/9/04 is partly met). 4) food hygiene. (Previous timescale of 1/9/04 is partly met). 5) moving and handling. (Previous timescale of 1/9/04 is partly met). 6) To provide staff with annual training in fire safety awareness. 20. YA42 23(4)(a) To undertake a fire safety risk assessment as in compliance with the Fire Safety (Work Place) Regulations 1999. (Previous timescale of 1/7/04 is not met). To carry out individual risk assessment on all products used which are hazardous to health as in compliance with the Control of Substances Hazardous to Health 1988. (Previous timescale of 01/10/06 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 38 1/9/04 is not met). To ensure that there is regular testing and recording of all cooked food, fridge and freezer temperatures as in compliance with the Food Safety (Temperature Control) Regulations 1995. (Previous timescale of 1/5/05 is partly met – IMMEDIATE REQUIREMENT ISSUED TO BE UNDERTAKEN BY 16/7/06). To seek advice from the West Midlands Fire Safety Officer with regard to the current fire safety practice and in particular the possible need for interlinking of the smoke alarm system. (Previous timescale of 1/6/06 is not met). To undertake weekly testing of the smoke alarms. (Previous timescale of 1/06/06 is not met). To reinstate regular (at least monthly) testing and of water temperatures from all outlets with appropriate records maintained. (Previous timescale of 1/6/06 is not met – IMMEDIATE REQUIREMENT ISSUED TO BE UNDERTAKEN BY 16/7/06). The Registered Manager is required to ensure the health, safety and welfare of service users and staff in relation to safe working practices, (food hygiene, infection control, fire safety etc), and associated routines in the home, in addition to deficiencies noted about the premises as detailed in the report. 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 39 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 YA12 Good Practice Recommendations To consider introducing separate activity planners as opposed to activity plans which are included in the ‘care plan form’ and which are inaccurate and do not contain sufficient information. To ensure that food and fluid intake charts recently introduced for ‘A’ include the amount of fluid taken in fluid ounces and size of food portions. To consider obtaining a Controlled Drugs Register. To consider fitting a more suitable lock to the communal bathroom such as a pass lock. To install a paper towel dispenser in the kitchen area. To seek advice as to the feasibility of installing a small wash hand basin in the kitchen area. 6. 7. YA32 YA37 To provide training for staff in autism awareness, dementia awareness and healthy eating and nutrition. To consider providing the manager with training in risk assessment and management. 2. 3. 4. 5. YA17 YA20 YA24 YA30 18 Clive Street DS0000004861.V303883.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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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