Inspection on 03/07/07 for 18 Clive Street

This inspection was carried out on 3rd July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

18 Clive Street 13/07/06

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 Key Unannounced Inspection 3rd July 2007 09:20 18 Clive Street DS0000004861.V338418.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.V338418.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.V338418.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.V338418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13th July 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 reasonably 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 on 3 July 2007 by the registered manager which are £547.00 - £709.00 per week. There are additional charges for chiropody, hairdressing and some outings. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 09.20 a.m. and 4.45 p.m. with the home being given no prior notice. We met and spoke with all three residents, the registered manager and two staff members. Questionnaires were received from three relatives and advocate. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: What has improved since the last inspection? Assessments have been undertaken so that residents’ needs can be identified and met. Advice has been sought and taken from the dietician with regard to one resident who has specialist nutritional requirements. There is improved record keeping with regard to residents’ health care appointments and their weight is checked and recorded on a more regular basis. All staff have now completed training in adult protection so that they are aware of how to safeguard residents. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 6 The kitchen has undergone a programme of refurbishment and a wash hand basin has been installed. The duty rota is more accurately completed. Training records are well organised and the two support staff have undertaken a range of mandatory training. Health and safety practice is improved with regular testing of smoke alarms, food temperatures and water temperatures. What they could do better: There have been a number of issues which we have identified at previous inspection visits which have still not received action. For example residents’ care plans have not been reviewed since they were introduced in 2005. This is especially important as the manager told us that their needs and conditions are changing. The level of support provided to residents is not reflected in the care planning system. Although there is a very small staff team who know residents’ needs, new or temporary staff would not gain an accurate picture of how to support residents from the current care plans. There is no formal system in place for allowing residents to participate in drawing up of their own care plans and identifying their wishes and aspirations. Risk management is poor with a only a small number of potential hazards assessed. The manager requires training in this area in order to offer support to residents in risk taking. There are no activity programmes in place. Daily reports do not give sufficient information about how residents spend their time when they are not at their day centres. Although residents have access to a range of health care specialists, there are no formal health action plans, and screening for some potential complications still needs to be provided. Some aspects of medication management have been improved upon, although further issues need to be addressed in order for residents’ to receive their medication safely and the manager requires training in this area. Slight improvements have been made in respect of one resident and how she is supported to manage her finances. However, all residents require some level of support and records need to be introduced to demonstrate how this is carried out. Some parts of the home could do with redecoration and worn furniture needs replacing. Staff require a range of specialist training in order to meet residents’ different needs. There are no male staff employed so that the male resident does not 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 7 have an option as to which gender staff support him. Recruitment and selection procedures need improvement as they could offer better safeguards to residents. There is no quality assurance system in place so that people are not consulted about how the home is run and the service developed. Improvements are needed with regard to fire safety. Mrs. Bedworth is the registered manager and owner of the home and has for a long time been looking for someone to take over her role as manager as she herself has recognised shortfalls in her training and knowledge. A new manager was appointed in August 2006 and following a period of probation as an ‘acting manager’, Mrs. Bedworth states that she will be supporting her application for formal registration within the next four weeks. 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. The summary of this inspection report can be made available in other formats on request. 18 Clive Street DS0000004861.V338418.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.V338418.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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: There has been an outstanding requirement for the manager/owner to expand the statement of purpose and service user guide since 2004. We were told that this has not yet been carried out. As previously seen the statement of purpose which has not been reviewed since it was established in 2003, does not contain all of the details required by the Care Homes legislation. For example there is little information about the relevant qualifications and experience of the staff group, the document still refers to the National Care Standards Commission which ceased to exist in April 2004. There are inaccurate 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. However it does not contain all of the information required by 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 10 the Care Homes Regulations and the manager was unaware of the changes which had been made to the legislation regarding information relating to fees. There are no vacancies at the home which has remained occupied by the existing residents since it opened in 1996. The manager has in the past told us that as the home was set up specifically for the existing residents it is unlikely that she would seek to admit anyone else should a vacancy occur. Since we last visited we saw progress has been made in ensuring that all residents have up to date assessments of their needs carried out. In 2004 we asked that residents’ contracts be updated and expanded. This has not been carried out. We looked in one resident’s case folder and found two different contracts with varying information. Neither documents contained specific details of fee levels, were dated or signed by the registered manager. There were details of additional charges, but these did not include payments towards the homes transport (see further comment in standard 23). 18 Clive Street DS0000004861.V338418.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments still 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 residents at risk. The lack of a person centred planning process means that residents are not offered enough opportunities to make their wishes and aspirations known about their lives and lifestyles. EVIDENCE: We made a requirement for the manager to review and expand care plans in 2004 and there has been limited progress made. The acting/deputy manager told us that she intends to review care plans but wanted to first carry out up to date assessments of need which she has now completed. We looked at all residents’ case files. The ‘care plans’ which were established in 2005 have not been reviewed and therefore do not contain up to date information. For example, one resident was diagnosed with an under active thyroid in 2006 but there is no reference to how she is supported to manage this health condition within the care plan proforma. The first part of the care 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 12 plan is a description of daily routines and contains details of one resident attending her day centre although she stopped going last year. The second part of the care plan covers a small range of needs but there is limited information, and this does not reflect the level of support that residents receive. For example one resident’s care plan relating to ‘hygiene’ states: ‘to make sure she has regular baths and make sure all clothes are changed’. 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 specialist needs for example with regard to autism and how this effects her daily life or that occasionally she may suffer from incontinent episodes. We issued an immediate requirement to introduce a care plan regarding the specialist nutritional needs of one resident when we visited last year (see further comment in standard 17). This was carried out. However, when we looked at the resident’s case file this did not contain the nutritional care plan which had been sent to us. The acting/deputy manager stated that she had reviewed and changed the care plan but could not locate a copy of the revised document. New staff or temporary staff would not be able to gain an up to date picture of how to provide support to residents from reading the current care plan documentation. There is no formal person centred planning process or evidence to demonstrate how residents and their families or advocates are involved in the drawing up of their care plans. Existing care plans have not been reproduced in formats suitable for residents. We were informed by the acting/deputy manager that social workers visited to carry out reviews of all three residents’ needs in August 2006. Copies of review meetings for two of the residents were not available so it was not possible to determine if any recommendations were made, or had received action. Copies should be obtained. Case files do not contain communication programmes or information as to how staff support residents to make decisions. We spoke to the manager about formulating communication passports and how speech and language therapists may be able to offer support she told us “yes I’ve heard of those, how do I get in touch with the speech and language therapists, shall I do it or will you?”. Risk assessments and understanding of risk management remains poor. For example, the only risk assessment found in one resident’s case file was relating to refusal of medication and covert administration. The resident is exposed to a range of hazards which have not been assessed. For instance, she requires the use of a wheelchair (mainly on holiday) for negotiating long distances and there is no risk assessment regarding the use of this equipment or the hazards involved and how these are minimized. The resident had two 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 13 falls in October 2006 and January 2007 but no falls risk assessment had been completed. We talked to the manager about risk taking and gave an example of night time checks. The manager told us that she is of the opinion that all residents should receive night time checks and she told us “what if they had a heart attack”. Training is needed in risk appreciation and management. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given opportunities to maintain and develop social skills and enjoy activities and outings within the local community, although these are limited to when the manager is on duty. Staff support residents in maintaining important links with their families. Residents are offered a balanced and healthy diet. EVIDENCE: As we stated at the last inspection, the activity/daily routine information contained within residents’ case files needs updating. There are no detailed activity programmes as we recommended. Although recent assessments undertaken by the acting/deputy manager includes residents’ dislikes with regard to their preferred hobbies and leisure interests, these have not been formulated into activity programmes. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 15 Information as to how residents spend their time when not at their day centres has to be extracted from daily reports and these lack sufficient detail which we discussed with the manager. For example, one resident’s daily activity record stated “X went to the hairdressers, she wanted to go out so we spent the evening at Walsall, ate well, slept well”. Another resident’s daily report said “X fine, had a good day came back home from the centre 3.20 p.m. ate and drank well, medication given – went to bed”. On our arrival two residents were at their day centres. The third resident does not attend a day centre (although the manager states that there are plans to re-introduce this activity which ceased last year due to illness). We saw that the resident spent her day watching television, knitting and chatting to staff. We chatted to one resident who told us that he liked going to his day centre. Another resident told us that she liked to go to the casino. Daily records which are completed demonstrate that the manager regularly takes residents shopping and they frequently visit a casino with the manager to socialise with people they know, and have drinks and snacks. According to records and staff, the residents only go out when accompanied by the manager who drives the home’s vehicle which we raised with the manager. Residents were overhead asking if they could go to the casino on the evening but the manager said no and that she would take them another time (she was not on duty that evening). All three relatives/advocate who completed comment cards said that they were kept up to date with important issues. They all said that they felt the care home gives the support or care to their family member which was expected, or agreed. One person said that they give care: “always over and above the call of duty”. We chatted to one resident who confirmed that she maintained contact with her sister. We saw that residents are given some choices with regard to their daily routines. For example on our arrival at 9.20 a.m. the one resident who was not at a day centre had decided to have a lie in and was being assisted with her personal hygiene by a member of staff. She was offered plenty of drinks during the day and had breakfast at a time of her own choosing. Bedroom doors and bathrooms have been fitted with locks to afford residents some privacy. We have asked the manager at previous inspections to discuss with residents as to whether they would like to have a key to the front door (or to record why this is not possible), this has not yet been undertaken. At our last inspection we asked for one resident to be referred to a dietician regarding her specialist nutritional needs and this has been undertaken. A care plan has been established (although this could not be located in the case file), and there are now detailed records of residents’ food intake. It is recommended that sizes of food portions are more consistently recorded for the resident who does have eating problems. It is also recommended that 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 16 moulds or piping bags are obtained for helping to make pureed meals more presentable and appetizing. 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 look slightly overweight and the manager confirmed that they are not on weight restrictive diets but follow a healthy eating regime. We looked at food records and saw that residents have a varied and balanced diet which includes traditional cooked meals such as roast dinners and vegetables and also spicy meals such as chicken curry. They are able to choose different meals and the manager strives to ensure that their individual preferences are met. For example, one resident likes smoked salmon and one recent meal included this product. We overheard one resident being asked what she would like to eat for her breakfast. Staff were patient and took her into the kitchen to help her choose. We saw members of staff discretely and appropriately encouraging and helping the resident to drink and eat through out the day. During interviews staff were familiar with the resident’s specialist nutritional needs and food supplements. As we suggested at previous inspections, nutritional screening still needs to be completed and appropriate tools introduced. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of service However further improvements are needed in order to ensure residents’ preferences as to included. Health care needs including screening users are generally well met. the care planning systems in how they are supported are needs further development. The systems for control and administration of medication require improvement in order to offer greater protection to residents. EVIDENCE: We saw staff providing residents with sensitive and flexible personal support. For example assisting with eating in a discreet manner which promoted the resident’s dignity. One resident no longer wants to eat at the dining room table and so staff adhere to her wishes and she now eats in the lounge. As we have previously stated, care plans lack sufficient information as to residents’ individual preferences about how they wish to receive personal support (particularly with regard to staff who provide same gender or opposite gender care). There is one male resident but the home does not employ any male staff. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 18 The manager told us that one resident occasionally uses a wheelchair (when she is on holiday) to negotiate long distances. The manager told us that this wheelchair had been donated to the home following someone’s death. As we have previously stated, residents must received assessments from qualified persons before using any type of moving and handling equipment. We looked at residents’ case files and found that on the whole improvements had been made with regard to the recording of health care appointments. There are details of residents’ attendance at chiropodists, dentists and opticians. The manager told us that she no longer takes responsibility for trimming any resident’s toe nails. We could find no evidence of an appointment for one resident to have her eyes checked. The manager told us that she was taken to the opticians but refused to be examined. We asked the manager to ensure that this is recorded. There was another instance where a resident had attended an out-patient appointment at hospital but this was not recorded in her health care notes. Residents’ weight checks and records are now more consistently maintained. As we have stated previously residents do no have access to health care screening for potential complications such as breast, cervical and testicular cancer. There are no health action plans or detailed care plans with regard to health care. We originally identified this as an issue in 2004 and it remains outstanding. Last year one of the residents was undergoing investigation for possible onset of dementia. The manager is unable to confirm to us whether a formal diagnosis has been made (although we noted from one hospital consultant’s letter that he makes reference to this condition). We recommend that the manager obtains confirmation from health care specialists as to whether this is a formal diagnosis in order to be able to plan for and meet the specialist needs of this resident. All three relatives/advocates who completed comment cards said that the care home usually or always meets the needs of their relative. One person said “if my daughter is ill I am always kept informed as to the problem and treatment”. We looked at medication systems and found that some improvements have taken place although there are still areas where further improvements are required. At our last inspection we were concerned about covert administration of medication. The manager sought appropriate advice, a care plan and risk assessment was established. The medication policy has also been reviewed and medication profiles have been established. Although both members of staff have received accredited training in the safe handling of medication, the manager has still not undertaken this training which we identified as a requirement in 2003. This inspection demonstrated 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 19 that she lacks sufficient knowledge and expertise in this area. For example, there were gaps found in the medication administration record (MAR) sheets, these had occurred when the manager had taken residents on holiday. We asked that a formal household remedy policy is established and ratified by the General Practitioner (G.P.). There is a proforma now in place but this has not been signed or completed by the G.P. Instead the G.P. has written a letter for one resident stating ‘Mrs. Bedworth is adequately capable of buying any over the counter preparation to give to the above named patient if necessary’. There was no such ‘agreement’ in place for another resident who also from time to time has household remedies administered. We discussed with the manager the necessity for ensuring that good practice is observed with regard to household remedies as recommended by the Royal Pharmaceutical society of Great Britain. We saw that the manager had purchased some Zinc and Castor oil ointment for two residents. They were not included on the household remedy list and the tubs had not been labelled with the date of opening. The cream had been applied but there was no record of this administration on the MAR sheets. Since our last visit we noted that one resident was prescribed ‘diet pills’ according to her records. The manager told us that she had requested this on her behalf (although they have now been stopped). There was no record to demonstrate that this had been discussed within a multi-disciplinary forum including the resident. Two residents are also receiving sleeping tablets (Zolpodem and Zolpiclone). One resident’s Zolpodem was stopped in February 2007 but restarted again at the manager’s request. The manager told us “she was having bad nights, coming down the stairs and screaming. It happened on two or three occasions”. We discussed the other resident’s sleeping patterns. The manager told us that she would request reviews of residents’ medication when they attended their next hospital appointments. Other items still requiring attention as identified at previous inspections include: ensuring that there are two staff signatures to confirm any handwritten instructions entered onto MAR sheets are correct. to ensure that resident’s consent to medication is obtained and recorded (or if this cannot be obtained to discuss within a multi-disciplinary team and make decisions in the best interest of the resident with records maintained). to ensure that there is a competency monitoring system introduced for staff to ensure that there are detailed guidelines for any ‘as and when required’ PRN medications. We also recommend that there is a regular audit and running balance maintained of any PRN medication. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 20 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a comprehensive complaints system which ensures that users’ views are listened to and acted upon. Policies and procedures have improved with regard to adult protection although systems need further improvement with regard to residents’ financial safeguards. 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. One person said “I cannot remember the last time I have needed to complain. I am often asked my opinions and I know they are noted and listened to”. No complaints have been received about this service since the last inspection visit. Since we last visited all staff have undertaken or are currently doing training in vulnerable adult abuse. The adult protection policy has been updated although there is no reference made to the Department of Health guidelines and the Protection of Vulnerable Adult (POVA) list. A copy of the new Local Authority safeguarding adults procedures have been requested. Some improvements have taken place with regard to ensuring that detailed records are maintained for financial transactions made on behalf on one resident. However, all residents require some support in accessing and managing their monies and there is an outstanding requirement which we made in 2003 for detailed records to be maintained about how this is carried 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 22 out. For example, all residents need assistance in withdrawing their monies from their bank accounts and the manager holds their personal identification numbers (PIN). One resident’s money is managed by the Court of Protection who pay money to the manager who then transfers this to the individual’s bank account. There is no record of how much is entered into this bank account or receipts for withdrawals apart from quarterly bank statements. The manager agreed to keep a record of these transactions. There was a form dated 2003 and signed by the resident agreeing for a contribution of 50 of her mobility allowance to be made towards the home’s transport. The manager told us that she has never received this payment, and was not sure whether or not the resident was in receipt of a mobility allowance. This needs to be explored further and appropriate records maintained. We also suggested that if the resident does not receive this benefit, that it may advisable for a referral to be made for assessment. We checked the expenditure sheet held on the one resident’s behalf. This balanced accurately with monies held on the premises. There is only one staff signature when completing financial transactions and we acknowledged it would be difficult for two staff to witness this when routinely there is only one member of staff on duty. We suggested that regular audits be undertaken to ensure that monies and records are balanced which the manager agreed to carry out. We noted that the resident routinely spends a round sum of £5.00 for ‘night outs and refreshments’. Receipts are not obtained and the manager records the sum on a piece of paper. She told us that this money is spent at the casino and invariably the sum spent amounts to more than £5.00 but the manager herself covers any shortfall (despite the resident having sufficient funds in her bank account). We recommend against this practice and exact sums and records are maintained. There were personal inventory sheets in residents’ case files but the last entry was dated 1999. The manager agreed that this was now inaccurate and needed to be updated. Slight improvements are needed to recruitment and selection procedures in order to make these more robust. See further comment in standard 34. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall Clive Street provides residents with a homely and attractive place to live although some areas could do with redecoration. The premises is clean and hygienic with only slight attention needed towards infection control practice. EVIDENCE: We toured the building and residents showed us their bedrooms. Some improvements have taken place since we last visited. The kitchen has undergone a programme of refurbishment by the landlords, wardrobes have been secured to bedroom walls and the worn grouting in the bathroom has been replaced. Smoke alarms have been interlinked. The manager told us of plans to redecorate residents’ bedrooms and there was evidence that they had discussed this during the two meetings which have been held this year. The manager told us that social workers had agreed to some residents purchasing their own new bedroom furniture and we advised 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 24 that their written approval be obtained prior to this taking place as this is normally included as part of the basic contract fees. All bedrooms are decorated and furnished to suit the individual tastes of residents. They contained a range of residents’ own personal possessions. As we requested, a second handrail has been fitted to the stairs; the manager has told us that no other aids and adaptations are required by residents who we saw are fully mobile. Some areas require slight attention. For example when we visited last year we asked for one resident’s mattress to be replaced as it was slightly lumpy and worn. This has not been carried out. The manager said “we’ve been too busy although we will order one, we have the book”. Some furniture is slightly worn and could do with replacing. We noted last year that the settee and armchairs in the lounge needing replacement although this is not yet completed. The lounge could do with redecoration and some of the radiator covers are slightly broken. The home is quite small with a communal lounge and a separate dining room which is also used as an office. There is no sleeping-in room for night staff and they therefore have to sleep on the settee in the lounge. There is one communal bathroom and toilet located on the first floor this contains an overhead shower. A pass lock still needs to be fitted as the current locking system is not appropriate. The bathroom could do with some redecoration. There is no separate laundry with the washing machine being installed in the kitchen area. It is advised that a risk assessment is carried out with regard to infection control measures. A small wash hand basin has now been installed in the kitchen. Although there was a supply of liquid soap, a paper towel dispenser still needs to be fitted. There were disposable gloves but no aprons available. The bathroom contained bars of soap rather than liquid soap. The home was seen to be clean and smelt fresh through out. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by a small qualified staff team who know their individual likes and dislikes. Recruitment and selection procedures need slight improvement in order to offer suitable safeguards to residents. Specialist training for staff needs further development in order to fully meet the needs of residents. EVIDENCE: Both members of staff hold an NVQ qualification. A range of specialist training was recommended at previous inspections although as yet this has not taken place. Since the last inspection one member of staff has left employment and another has been recruited. The employment of this member of staff on a full time basis has resulted in the manager being able to work slightly less hours (although she was still seen to be working six consecutive days on occasion). We looked at the duty rota which is now more accurately completed. There has been one staff meeting since 1 January 2007. As we have already stated there are no male staff employed and it is suggested that this given some consideration. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 26 We looked at recruitment records and found although the majority of preemployment checks had been carried out, there were some Care Homes Regulations which had not been complied with. There was no health check in place or statement by the person as to their physical and mental health. The manager had not authenticated the two written references received and these contained no confirmation of the dates that the applicant had been employed by former employers. We discussed this with the manager who asked us “has it altered have there been any changes to the Regulations?”. The application form does not contain any declaration statement with regard to previous criminal convictions and we discussed with the manager how this may be useful information to obtain as part of selection processes. There was no record of any induction programme for the new member of staff. Staff have not undertaken training in equality and diversity. We saw that training records were well organised and each member of staff had a training assessment and profile in place. There is no formal supervision of staff. This has been outstanding since 2003. The manager told us “I chat to them every day”. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a caring and devoted manager who recognises that there are shortfalls in her knowledge and skills. There is no formal quality assurance system in place to ensure that people 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 residents 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 no management qualification. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 28 Mrs. Bedworth has not undertaken any periodic training to keep herself up to date with changes in practice and legislation, and lacks understanding of the social model of disability and risk appreciation. Apart from complying with an immediate requirement made at the last inspection in relation to adult protection training, she has not completed any statutory or specialist training apart from a fire safety course in February 2005. The findings of this inspection confirm that Mrs. Bedworth continues to remain dedicated to providing a loving and caring environment for residents. However, there is also evidence detailed in other areas of this report whereby the home is failing to make the progress needed which has the potential to impact upon the quality of service people receive. Mrs. Bedworth has recognised that she does not have the expertise or skills to continue to manage the service and has appointed an acting manager in August 2006 whom she informed us was going to apply for registration as manager following a six month probationary period. This has not taken place and Mrs. Bedworth has given an undertaking that she will forward an application within the next four weeks. There is no annual development plan for the home and no quality assurance system in place. The manager told us she had asked the acting manager to set this up but she herself could not explain the principles of quality assurance. When interviewed the acting manager told us that she has yet to introduce a quality assurance system. Some improvements have taken place with regard to health and safety practice and immediate requirements made at the last inspection in respect of food hygiene and the testing of water temperatures have been met. Smoke alarms are also tested on a weekly basis. Progress has been made towards improving statutory training for staff employed (although this does not include the manager herself). There is one exception whereby staff have not received fire safety training since February 2005. In addition there has been an outstanding requirement since 2004 to complete a fire safety risk assessment. The manager was not aware of the changes to the fire safety regulations and the implications upon service providers. As discussed, we will be contacting the local Fire Safety Officer. Risk assessments still need to be carried out with regard to substances hazardous to health (COSHH). A risk assessment for Legionella could not be located. The accident book is accurately completed although we were not informed of an injury sustained by one of the residents in January 2007 and we discussed this with the manager. We have asked the manager to ensure that the wheelchair which is occasionally used by one of the residents whilst on holiday is serviced and that regular health and safety checks are introduced. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 29 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 30 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 3 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 2 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 2 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 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 1 X 1 X X 2 X 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 31 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. 2. Standard YA24 YA42 Regulation 23(2)(b) 23(4) Requirement To replace worn mattress in ‘A’’s bedroom. Timescale for action 01/10/07 01/10/07 To seek and take the advice of the local Fire Safety officer in order to ensure that there adequate precautions in place against the risk of fire and thereby ensuring the safety of residents – for example to carry out a fire safety risk assessment and ensure that staff have undertaken suitable training. 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 YA1 Good Practice Recommendations To review and expand the statement of purpose to ensure that it includes up to date and accurate details and contains all of the information required by the National Minimum Standards and Care Homes Regulations 4. DS0000004861.V338418.R01.S.doc Version 5.2 Page 32 18 Clive Street To review and expand the service user guide to ensure that it includes up to date and accurate details and contains all of the information required by the National Minimum Standards and Care Homes Regulations 5. 2. YA5 To provide all residents with 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. To develop a rigorous and robust care planning system and ensure that it incorporates all aspects of personal and social support and healthcare needs. Reviews of care plans should be undertaken at least every six months (or as and when their needs change). Residents, their relatives, advocates and other significant professionals should be involved in these reviews. Copies from review meetings carried out by social workers with individual residents should be obtained and held on their case files. A formal and recognised system of person centred planning should be introduced, such as life story books, essential life style planning etc. Care plans should be reproduced in formats suitable for residents. Communication programmes and details of how residents are supported to make decisions should be established (in consultation with speech and language therapists if possible). To review and expand risk assessments to ensure that there are written risk assessments established for all aspects of service users lives which pose a risk. To consider introducing separate activity programmes as opposed to a description of activity routines which are included in the ‘care plan form’ and which are inaccurate, and do not contain sufficient information. To consider how opportunities for social inclusion may be expanded so that residents are not limited to going out into the community only when the manager is on duty. 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 this must be documented within a risk assessment. To introduce and complete nutritional screening and DS0000004861.V338418.R01.S.doc Version 5.2 Page 33 3. YA6 4. YA7 5. 6. YA9 YA12 7. 8. YA13 YA16 9. YA17 18 Clive Street assessment tool. It is recommended that the size of food portions are more consistently recorded for residents with eating problems and specialist nutritional needs. To consider obtaining moulds or piping bags to assist with making pureed foods more visually appealing. Service users personal preferences must be obtained and recorded for how they receive support for example with regard to same or opposite gender personal care provided by staff. To obtain an assessment from a suitably qualified person (such as an Occupational Therapist) with regard to the wheelchair obtained for ‘A’. Outcomes to be forwarded in the care plan. 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 (and to develop health action plans). To seek clarification as to whether one resident has been confirmed as suffering from dementia. 12. YA20 To ensure that the registered manager undertakes suitable training in the safe handling of medication in order for her to be able to ensure that there are safe systems in place for residents to receive their medication. It is recommended that a household remedy policy is established which is ratified by the G.P. Any household remedies which are administered must be recorded on the MAR sheets. To improve record keeping with regard to MAR sheets – any gaps must be fully explored and handwritten instructions must be signed by two staff members to confirm they are correct. To obtain residents’ consent to medication (or to discuss within an multi-disciplinary team and record outcomes which have been made in the best interests of residents in their care plans). It is recommended that the date of opening of all medicine containers are recorded and any balances of medicines 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 34 10. YA18 11. YA19 carried over onto a new medicine chart (PRN) in order to check that residents have been given medication as prescribed by a medical practitioner. 13. YA23 Records of all financial transactions made on behalf of residents must be maintained together with details of how they are supported to manage their finances (to devise individual care plans). To ensure that more accurate records are maintained with regard to residents’ expenditure. Regular audits should be undertaken of residents’ finances and records which are held on the premises. To ensure that residents have up to date and accurate personal inventories. To replace worn settee and armchairs. To establish a written programme of maintenance and renewal together with timescales for completion. To ensure that there is a supply of protective clothing available in the kitchen/laundry area. To consider fitted a more suitable pass lock to the bathroom. To install a paper towel dispenser in the kitchen. To ensure that there is a supply of liquid soap available in the communal bathroom. To provide staff with a range of specialist training including: autism awareness, dementia awareness, healthy eating and nutrition. To consider the employment of male staff. To ensure that all pre-employment checks are carried out as in compliance with the Care Homes Regulations 2001, Regulation 19 and Schedule 2. This must include a written statement by the applicant as to their physical and mental health and authentication of written references including validation of employment dates. It is recommended that the application form contains a criminal conviction declaration. To ensure that a written record is maintained of induction completed by new staff. To ensure that staff complete training in equality of diversity. 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 35 14. YA24 15. YA30 16. 17. 18. YA32 YA33 YA34 19. YA35 20. 21. 22. YA36 YA37 YA39 To introduce a formal supervision and appraisal system for staff. To consider providing the manager with training in risk appreciation and management. Effective quality assurance and quality monitoring systems should be established and the views of residents, stakeholders, families and advocates should be sought and underpin the development of the service. There should be an annual development plan for the home based on a systematic cycle of planning-action-review. 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. To carry out a Legionella risk assessment. To ensure that the wheelchair used by one resident is serviced and inspected. There should also be regular health and safety checks undertaken. 23. YA42 18 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Halesowen Records Management Unit West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Clive Street DS0000004861.V338418.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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