Inspection on 25/06/08 for 2-4 St Ives Close

This inspection was carried out on 25th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2-4 St Ives Close 17/06/09

2-4 St Ives Close 03/11/08

2-4 St Ives Close 20/07/06

2-4 St Ives Close 04/10/05

2-4 St Ives Close 17/05/05

2-4 St Ives Close 25/01/05

2-4 St Ives Close 06/09/04

2-4 St Ives Close 08/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 2-4 St Ives Close Leyfields Tamworth Staffordshire B79 8HL Lead Inspector Jane Capron Key Unannounced Inspection 25 and 26th June 2008 10:00a th 2-4 St Ives Close DS0000005002.V366768.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 2-4 St Ives Close DS0000005002.V366768.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. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 2-4 St Ives Close Address Leyfields Tamworth Staffordshire B79 8HL 01827 68517 F/P 01827 68517 h6029@mencap.org.uk www.mencap.org.uk Royal Mencap Society 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) Manager post vacant Care Service 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (1), Physical disability (5) of places 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th November 2007 Brief Description of the Service: 2-4 St Ives Close is owned by a housing association and operated by MENCAP. The service is located on an estate in Tamworth and is within walking distance of the town centre. The service provides support to nine people that have a learning disability. Some people also have sensory and physical disabilities and some exhibit complex challenging behaviours. The service is divided into two separate living units, which are known as Unit 2 and Unit 4, with their own kitchen and communal areas. The two units share a laundry and the office. One unit accommodates five people, some of whom use wheelchairs, the other unit accommodates three male people who have some challenging behaviours and sensory needs. The service provides people with single bedroom accommodation; all bedrooms all have a washbasin. The service is suitable for people that use wheelchairs. There is an assisted bath, level access shower, hoists and a vertical lift. The service has a large rear garden that is accessible to all of the people. The service has its own transport that is suitable for people who use wheelchairs. The service is situated in a quiet residential area and is indistinguishable as a care service. The service user guide does not identify the level of fees paid and people would need to contact the service to discuss fees. People do need to pay for extra items such as holidays and transport but these are not clearly identified in the information provided. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We visited this service over two days. The service did not know we were visiting. We spoke to the manager and several staff. Most of the people living at the service cannot speak so we watched how people are supported and how staff help people to choose things they want to do and how people take part in running the service. We looked at how the service is helping people with their personal care needs, such as bathing and washing and making sure that their health is looked after. We looked at the way staff are checked before they start work at the service and what training they get to work with the people that live there. We also looked at how the service is making sure people are kept safe. Before we visited the service sent us a completed Annual Quality Assurance Assessment (AQAA) that tells us about the service, the things they do well and about the things they want to improve. We also received surveys from three relatives and two health care professionals to get their views of how well the service is doing. As some of this information was not very up to date we also spoke to a health professional just after the visit to get more up to date information. Since our last visit we have received information about two safeguarding incidents. The service responded to these and is working with other agencies to resolve the issues. The service has received one complaint that was upheld. What the service does well: People that visit the service said some good things about the service. A health care professional said ‘ I feel the home is a very stable and happy environment for the people who live there’ and ‘It’s a home’. A relative in a survey when we asked what the service did well replied ‘Everything’. They also said that ‘I am very satisfied with the care my [relative] receives’. We feel that staff who have worked there a long time know the people well. They knew how people say what they want and know the things they like to do. Other professionals and relatives tell us that they find the staff caring. A health professional said ‘We have found staff to be very receptive’ and ‘Staff try hard and care a lot’. Relatives tell us that they feel that staff have the right skills and knowledge to provide the care people need. People that live at the service have help from Speech and Language therapists, Occupational Therapist and physiotherapists as well as psychologists and psychiatrist. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 6 People can do things they like to do and they should do even more things as a staff member has been employed who will be making sure they are more things to do. The service is organising holidays for people. Everyone living at the service has a single bedroom and there are rooms where they can sit with other people. What has improved since the last inspection? What they could do better: There are some areas that we felt could be made better for the people that live there. Currently the service does not give people the right information about the service and does not tell people what they would need to pay and what extras they would have to pay for. The service needs to further develop care plans and risk assessments. This will give staff all the information they need to provide people with support and make sure they are safe. Although the way medication is given has improved staff do not always have the information to know when to give ‘as required’ medication. The service is looking after people’s money and has procedures in place to make sure it is safe. However many people cannot decide how to spend their money and the service needs to make sure that proper decisions are taken when spending large amounts of people’s money. Some people have bedrails and there are no assessment that looks at the risk and benefits of using these. The service also needs to make sure that the safety of the rails is regularly checked. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 7 Staff are going to be trained in ways of managing physical aggression. However until this is done some people may be at risk and there are no plans in place to make sure they are safe. 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. 2-4 St Ives Close DS0000005002.V366768.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 2-4 St Ives Close DS0000005002.V366768.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): 1,2,4. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although the service is providing people with information this is not fully accurate thereby not giving people all the information to make an informed decision about whether the service will meet their needs. The service’s admission procedure makes sure that an assessment is completed and makes sure that people have the chance to visit and get to know the staff and other people that live there. EVIDENCE: The service has a Statement of Purpose and service user guide but these are currently are not in an accessible format. The information also does not include all the up to date information. For example the document contains the details of the previous manager, the level of fees are not included and the need for people to pay towards transport is not specified. We were also told that people living at the service are paying towards the cost of decorating and furnishing their bedroom. The circumstances relating to this are not in the information that is provided to people. The service currently identifies that it has a no physical intervention policy although this in the process of being changed and this needs to be reflected in the information. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 10 We looked at the service’s admission procedure and this included the completion of an assessment and providing people with a programme of visits before moving to the service. The service’s Annual Quality Assurance Assessment states that ‘prospective service users needs are thoroughly assessed. Discussion takes place between all parties concerned including current service users and an advocate.’ The last admission took place in December 2007 and information we looked at and discussions with staff confirmed that a full assessment was completed. This included information from the local authority, family, health care staff and the previous place where the person was living. Assessment identified the person’s heath and personal care needs including dietary, moving and handling needs, their spiritual needs, family relationships and the person’s likes and dislikes. We also spoke to the person’s key worker and she told us that prior to the person being admitted she was identified as their key worker and as such made visits to meet them in their previous placement and was on duty when she visited and moved to the service. The key worker said: ‘[the person] made a lot of visits and came to stay over night’ and ‘ we were in touch with previous service, and I visited the other placement.’ 2-4 St Ives Close DS0000005002.V366768.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): 6,7,8,9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Plans are in the process of being updated and developed into a more person centred format and therefore currently do not always provide all the information for staff to know how to support people. The risk management system is identifying risks but some areas need further development to make sure that people are always fully supported. People are supported to make choices about their lives. EVIDENCE: We examined two people’s files in detail. We saw that people have a support plan in place although the service is in the process of updating these to make them more comprehensive and more user focussed. These could be more accessible to people. Evidence shows that plans are reviewed with the person or their advocate and significant other people such as family members and health and social care professionals. The services own monthly management check states ‘plans not up to date’ and ‘plans are currently not accessible’. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 12 One plan seen contains information about the person’s health care and personal care needs, communication needs, financial management and activities. Individual goals relating to independent living skills have been identified including taking their drink to the sink, placing a mat on the table and taking clothes to the laundry. These are in a pictorial format. This person needs particular support in respect of his behaviour as this can cause a risk to others. The service is working with other agencies to address this however the plan still needs some further development. The plan of the person most recently admitted contains information about their health and personal care needs, spiritual needs, dietary needs and information about financial management but still needs to be further developed to include more information for example about their communication needs and activities. However when we spoke to staff they could tell us about how they met these needs. Risk management systems are in place. Files we saw show that the risks are identified risks and plans in place to respond to them. These include issues relating to eating, transfers, accessing the community and personal care. We did notice in one person’s file we examined that risk assessments are not always dated and signed and there were some risks are not covered for example the use of wheelchairs. We also saw that a risk assessment relating to hoisting dated December 2007 stated it was to be reviewed in one month and there was no evidence to show this occurred. We did discuss this with the manager and she confirms that this is an area that needs to be addressed. We saw that the service is promoting people’s choices. The Speech and Language therapist is working with people and with staff to improve communication methods. The staff we spoke to are aware of how people express likes and dislikes. One person responded to pictures and the service has put together pictures of food to help them decide what they want to eat. We saw this person expressing pleasure when shown pictures of a pizza and a chocolate cake. Another person is able to make a choice from a limited of number of items. To help them choose what to wear staff get out clothes for them to choose from. We also observed one staff asking if someone wanted to read a book and then offering him or her a choice of two books. We also saw a staff member that was baking cakes show people the packets to help them choose which cake they wanted to make. People are involved in choosing their bedroom decoration and furnishings, holidays and trips out. The service is working with people to assist them to participate in aspects of running the service. For example people are assisted to do the weekly food shopping, do the shopping list and to plan menus. People have some involvement depending on their abilities in areas such as cleaning their bedrooms and doing their laundry. The service has recently started having individual meetings with people to try and gain their views about the service and about things they want to do. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 13 2-4 St Ives Close DS0000005002.V366768.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): 11,12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People that use the service are supported to make choices about their lifestyle and to maintain relationships with their family. The service provides people with varied meals based upon their dietary needs and their preferences. EVIDENCE: People that live at the service enjoy a varied lifestyle. The service is providing opportunity to people to maintain and develop their skills. For example a number of people communicate non-verbally and with the support of the Speech and Language therapist staff are developing methods to communicate more effectively with people. Also people are being supported to be present and take part in independent living activities such as shopping and domestic tasks. The service has arranged for some people to attend a sensory room. The service’s AQAA tells us that it intends to develop its own sensory room but the service could not place a date on this being completed. People that wish to are supported to go to church and the family of one person takes them to church every week. The service’s AQAA tells us that one person votes in elections. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 15 A health professional told us that they felt that there are issues relating to the provision of day care activities and that the service needs a staff member to concentrate on this area. The manager said that she also believes this has been an issue and but now due to increased staffing people are being more involved in the community and having more opportunity to take part in activities. . She felt this would be even more following the appointment of a staff member with responsibility to develop and promote day activities for people. This staff member is due to start during July 2008. Currently some people go to college and day services. One person attends college several days a week and another one day a week taking part in craft activities. None of the people living at the service are able to develop employment skills. People now access the community on a regular basis. People regularly go into Tamworth shopping for both food shopping and to buy personal items and clothes. One person’s care whose care we examined went out to a local hairdresser. During the two days we were at the service people went out several times and one person that needed two people to support them when they went out could now go out regularly People are taking part in some social and leisure activities in and out of the service. For example several people enjoy travelling by train and the records show they had been out on a number of trips. Records also show that people have been to Drayton Manor theme park, to the cinema, out for meals, shopping and to shows. Within the service staff support people to do for example baking, art and crafts and one person particularly likes playing with a ball. The Occupational Therapist is working with three people on developing sensory activities and the service has bought some sensory items for people. People also listen to music and watch videos and television. One person really enjoys listening to the music of Westlife. People also spend time in the garden. We would however recommend that the service looks at developing this part of people’s lives so that people are more occupied during the day. The service is organising holidays for the people living there. Some people are planning to go to Majorca; another to Austria and one person has booked a trip to London. People pay for their own holidays and also the accommodation and travel costs of the staff. The service has its own transport. People living at the service pay towards the cost of transport. The service’s AQAA suggests that ‘positive relationships with family and advocates is encouraged and supported.’ The surveys we received from relatives confirm that the service always keeps in touch and keeps them up to date with information. Records and talking to staff tells us that some people 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 16 have regular visitors and others less so. Mencap has a relatives’ charter whereby the services actively try and involve family members in people’s lives. The service’s AQAA tells us that one of its plans is to try and get greater involvement of families. Staff are aware of issues of sexuality and how to promote people’s rights. Mencap provides staff with practical information for staff on prmoting diversity. Routines within the service are relaxed. There are no set mealtimes. Breakfast is taken when people get up. In respect of one person’s care we examined they like to lie in bed and listen to music before gettting up and staff supported them to do this. We also saw that staff knocked on people’s bedrooms before entering. People can access all areas of the service being wheeechair accessible and having a lift to the firt floor. We looked at the meals people are provided with. The service’s AQAA states ‘ Meals are appropriate to service users needs and likes/ dislikes. A pictorial menu is used with service users to enable them to choose their weekly menu. Service users are encouraged to help to prepare meals. Dietician, speech therapists are involved in setting guidelines.’ Records showed us that the service works with the dietician to make sure that appropriate meals are provided. Records provide staff with information over what food people like and dislike. The service users pictures to support people to choose meals and combines their wishes with any dietary needs. For example a number of people need to have soft diet and the staff look to provide meals of people’s choice in a soft format. Examples of meals include meatballs, chicken curry, meat pies and lasagne. Puddings include various cakes, at time made by the people that live there, yoghurts and fruit. People also go out for meals. Some people also need support to eat their meals. We saw evidence of lipped bowls and special spoons and in one case the family had put together a pictorial guide to support their relative with feeding. We noticed that one person had bought their own spoons and when we pointed this out the service they immediately agreed to refund the money. The service is monitoring people’s weight and food intake. We saw records of what people eat and records of the regularly weighing of people. 2-4 St Ives Close DS0000005002.V366768.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): 18,19,20. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service is working with other professionals to meet people’s health care needs People are supported to have their personal care needs met in manner that respects their privacy and dignity. People are receiving medication as prescribed but the service should have protocols for ‘as required’ medication in order to reduce the likelihood of any errors occurring. EVIDENCE: People had health action plans in place covering their health care needs. These are in an accessible format and cover all areas of health care. There is evidence that the service is working with a range of health care professionals including physiotherapists, Occupational Therapists, Speech and Language therapist, dieticians, Community Nurses and specialists in psychology and psychiatry. A health professional we spoke to during and after the inspection feels that the service refers issues appropriately and usually acts upon the advice they give. One health professional we spoke to said she had found the staff to be ‘ very receptive’. She also told us that health care staff have been included in staff meetings and that they are working with the staff on ‘pain profiling’, a process of identifying when people that cannot express it verbally 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 18 are in pain. However another health care professional feels that staff need better training to be able to fully meet people’s changing needs. She said that she had provided some training in epilepsy and this had helped staff to be able meet one person’s needs. Records show us that people are receiving health care services including seeing the doctor, dentist and the optician. There are close working relationships with the District Nurse that visits daily to provide one person with treatment for diabetes. People are also receiving nail care from a chiropodist. Personal care needs are being met. One file we looked at showed that the person likes to have a shower every day and when we spoke to their key worker she confirmed that this is provided. We also observed during the day that when personal care is provided this is done discreetly and in private for example one person needed some assistance and was supported to have this completed in the bathroom. We also saw that people are well dressed in appropriate clothing and when during the day one person’s clothes became dirty he was supported to change them. We also noticed in one record that a piece of equipment had been selected as it provided a ‘more dignified process of dressing and undressing’. The manager told us that a new medication system is in place and she was dissatisfied with the previous arrangements. The service now has a monitored dosage system in the form of blister packs. Medication is stored securely. Systems are in place to record medication received and any returned to the pharmacy. A system to monitor and audit medication practices is in place and this is assessed monthly as part of the service’s quality checks. The service did tell us that there have been some medication errors but the service had addressed these and further advice and training provided to staff involved. Records and discussions with staff show that the service trains its staff in medication administration. We checked two people’s medication and saw that the Medication Administration Records (MAR) have been completed appropriately. Auditing of these people’s medication show that the amount tallied with that received and that recorded as administered. We saw evidence of medication protocols in place for some ‘as required’ medication for example rectal diazepam but no protocols in place for ‘as required’ Diazepam and Tremadol for one person. Protocols need to be in place so that all staff are aware of the circumstances when medication should be given. Currently the service is addressing the need for people’s consent for medication, as people within the service are unlikely to have capacity to consent. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 19 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): 22,23. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service has procedures in place to respond to concerns and people are supported by advocates to express their views about the service. Whilst staff have safeguarding training and are aware of safeguarding issues certain practices within the service need to be addressed to make sure people are fully safeguarded. EVIDENCE: The service has a complaints procedure and a copy of this is displayed in the hallway. Part of this information is quite accessible but this aspect could be developed more. MENCAP does have an easy read procedure but we did not see a copy of this in the service. The AQAA told us that they had received one complaint since we did our last inspection and this was upheld. No complaints have been received since the new manager joined the service in November 2007. The service maintains a record of any complaints. The service involves the use of advocates to support people to express their views and the service surveys relatives once a year to gain their comments. The relatives that answered our survey all said they know about how to complain and said that the service always responds to any issues appropriately. The service’s AQAA told us that they ‘have an adult protection policy and are clear about our responsibility to work within the Local Authority Vulnerable Adults procedure.’ The service has told us about two safeguarding incidents 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 20 that have occurred, one of which was referred to the police and another to the local`authority. One related to the loss of money which the service reimbursed and the other related to agression shown by one person to other people living at the service. The latter is still ongoing and shows us that the service is working closely with other agencies to address the issues. In response to the incident extra staffing is in place and staff are due to be trained in physical intervention and to receive training in managing challenging behaviour. Currently the service has diversion and distraction plans in place but due to the absence of training feels it cannot physically intervene to protect people. The manager told us that this strategy had been agreed by a muliti- agency group of staff and that she feels uncomfortable with the current arrangment. We informed the service that an interim strategy must be implemented to ensure the safety of people until this training is completed. The service is aware of people’s rights and recently received limited physical intervention training to support someone that needed to have a blood test. This person did not have capacity to make the decsion and therefore the decsion and plan was developed by a multidisplinary group of staff. Records show that staff are trained in safeguarding issues. We saw records and spoke to staff about safeguarding issues and are satsifed that people are aware of protection issues and knew how to refer issues. Health professionals we contacted feel that staff are caring and protective towards the people that live there. We saw that one person was using bedrails to prevent them falling out of bed. No risk–benefit analysis was present on file. Bedrails can be a form of restraint and an assessment that includes the views of professionals, the person or their representative and family should be completed. The physiotherapist we spoke to said she would assist the staff to complete this. The service has procedures in place to manage people’s money. A new system is in place with each person having their own bank account and going to the bank with staff to withdraw their own money. We made a check of two people’s finances and accurate records are being kept. We were however told that some people are buying their own soft furnishings and paying for their bedroom to be decorated. Also people are going on holidays that cost significant amounts of money including paying for staff travel and accommodation. It is unlikely that people living at the service have the mental capacity to make decisions about such expenditure. Although one staff member told us that they discussed going on holiday with a relative and social worker the service could not provide written evidence of any discussions with third parties over these expenditures. The service needs to ensure that when people cannot make such decisions that other people such as advocates, family members and social workers are included in the decision making process. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 21 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): 24,26,27,28,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service provides people with suitable communal and private accommodation that is domestic in style. Bedrooms are of a good standard and people can personalise their rooms. The service is kept clean but needs to make sure that its laundry facilities meets infection control standards. EVIDENCE: The service is located on a residential estate and is within walking distance of local shops. The service is set back from the road and has a small garden area at the front and a large rear garden. The front garden would benefit from some weeding. The rear garden is mainly set to lawn with bushes around the edges. Outside of the kitchen doors of each unit is an area with potted plants. Outside of one unit is a small area with sensory plants. There are areas where people can sit outside. The service’s AQQA states that the service is ‘well maintained’ and over the last year has made improvements including new flooring in the kitchens and 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 22 an upstairs toilet and new extractor fans in the bathrooms. The AQAA also states that the garden areas outside both kitchens have been landscaped with service user involvement. The service provides accommodation that is suitable for people that use wheelchairs. Corridors and doors are wide enough and people can access the first floor by lift. The service provides assisted bathing facilities and a level access shower. Each unit has a kitchen come diner and own lounge. These are both decorated in a domestic manner. The lounges provide a range of seating for people and give people somewhere to relax. All bedroom accommodation is upstairs. The bedrooms we saw are of a good standard with matching furniture and soft furnishings. We were told that people had paid to decorate their own bedrooms. The manager told us that the service pays for redecorating every five years but if people wish their bedroom done more often or to a higher standard they pay for this themselves. Bedrooms are well personalised containing a range of personal belongings including pictures, photographs and ornaments. The service provides people with bathing and toilet facilities both up and downstairs. The two units share a laundry. This contains two washing machines (one broken) and a drier. Currently the service does not have facilities to wash laundry up to a heat that would disinfectant them. The manager reported that a suitable washing machine is being provided from another unit that is due to close although it is unclear when this will be. The service appears to be clean and hygienic and cleaning schedules are in place. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The way the service recruits staff is protecting the people that live there. The service is now providing sufficient staff to meet people’s needs but the reduction in the use of agency staff may provide people with a more consistent service. People are supported by staff that are generally trained and qualified and who are supported to undertake their role. EVIDENCE: We received positive comments about the staff from relatives who feel that they had the right skills and knowledge. Health care professionals feel that staff are caring and supportive of the people that live there. They feel that staff have a strong value base. Comment made include ‘Staff try hard and care a lot’ and ‘Staff have very strong bonds with service-users and there is huge loyalty by established staff to users.’ We feel that staff know people well and know how they communicate their needs. Staff respect people’s privacy and promote their dignity. Staff receive training from health care staff and from MENCAP. Training has included epilepsy, autism and mental health as well as value-based training including promoting people’s right. Some health care staff did feel that staff would 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 24 benefit from training in postural care and in working with people with complex needs. The service’s AQAA also identifies the need for training in profound and multiple learning disabilities. Training in working with challenging behaviour and the use of physical intervention is scheduled. The manager said that she has put in place a full schedule of training as she feels that some staff have missed out on training opportunities. The service tells us that they have a high percentage of staff trained to at least NVQ level 2. The manager reports that she identified issues about the effectiveness of communication between staff. This was also something raised by one of the health care staff we spoke to. The manager said alterations have been made to communication systems to make sure that she is always kept informed of issues ensuring that she can monitor practices. The service provides six staff on duty throughout the day. This level has recently increased with the service receiving additional funding to provide individual support to one person. This increase is starting to show benefits to the people that live there. The person needing 1:1 support is now receiving it and the other staff have the opportunity to provide other people with the support they need. These staffing levels should be adequate to support people. Due to staff absences including long-term sickness the service has been relying significantly on staff that are not employed permanently at the service. The manager informs us that over the last month that 95 shifts have needed to be covered. The service uses relief staff from MENCAP’s own agency and these staff undertake the training that permanent MENCAP complete. The service also uses staff from an agency. The manager tells us that they try to use the same staff regularly so that they get to know the people living there and their needs. She also told us that all agency staff receive some induction training so that they have some knowledge about the service. The manager assures us that this usage will reduce due to the recruitment of new staff. Staff are supported to do their work. The service has staff meetings and staff receive individual supervision with the manager. The service is making sure that prospective staff have the necessary checks before they start work. The sample of personnel files we looked at all contained references and a satisfactory Criminal Records Bureau checks. They also contained a photograph of the person concerned, a health check and confirmation of identity. 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service is generally being well led in the interests of the people that live there and the manager is aware of areas including relating to people’s safety that need to be improved. The service has Health and Safety procedures in place and staff are trained in safe working practices however the service needs make sure that recommendations made by the fire authority are addressed to make sure that people are being kept as safe as possible. EVIDENCE: Since we visited last time a new a manager is in place. She began working at the service at the end of 2007 and to date is not registered with us although an application has been received. The manager has previous experience as a manager at another service. She advised us that she has lots of plans for the service to improve and develop. A health care professional states that the 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 26 ‘new manager is making a difference’ and has had a ‘positive impact’. A staff member told us that they feel the manager is ‘firm but fair’ and ‘gets things going’. We saw that when she identifies areas that affect the care of people she responds to them, for example errors in medication have been dealt with and issues of poor internal staff communication have been addressed through improving the communication systems. She is aware of areas that need to be developed, for example care planning, managing people’s behaviour and risk management systems. The service provided us with an AQAA that contains information about the service and their plans for the future. The service has internal and external ways of monitoring the service. MENCAP’s service manager completes monthly visits that look at the environment, health and safety issues, polices, finances, staff practices, activities and support plans. Areas for improvement are identified and the following month. In the service the manager also undertakes monthly audits and can a continuous improvement plan in place that identifies areas that are to be improved. The service also reports that yearly surveys are sent to relatives and health care staff. Health and Safety procedures are in place and the service’s AQAA shows us that they are completing safety checks on such items are electrical equipment, fire safety equipment and gas equipment. The training matrix shows that people are receiving training in Health and Safety issues and if staff fail to attend any training this is followed up by the manager. A visit was made by the fire authority during 2007 and this identified areas that needed to be addressed. These include a review of the fire risk assessment and the installation of some fire detection equipment. The manager was unaware of this visit and when some of the issues were discussed she checked and saw that they had not been addressed. She did report that she was expecting a fire specialist through MENCAP to visit the service and stated she would contact the fire authority to follow up on the issues. Following this inspection we contacted the fire authority. They told us that the manager has contacted them and they are due to visit the service to provide advice. 2-4 St Ives Close DS0000005002.V366768.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 SERVICE Standard No Score 1 2 2 3 3 X 4 4 5 X 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 3 25 X 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE SERVICE Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X X 2 X 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 28 No 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 Services Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 12(1)(b), Requirement Timescale for action 25/07/08 2. YA23 3. YA23 4. YA23 Where people present behaviour that challenges, management strategies should be in place. This will make sure that people are properly supported. 13(4)(c) & Where people may be at risk 6 suitable strategies must be in place to make sure they are protected. 12(1)(a), An assessment must be 13(4)(c) completed before bedrails are put in place and arrangements made to ensure they continue to be safe. This will make sure that the risk and benefits are considered and that bedrails are appropriately used and safely maintained. 13(6) When decisions are made to spend large amounts of people’s money third parties such as advocates, family members and social workers should be involved in the decision-making process. This will make sure that people are safeguarded. 25/07/08 25/07/08 01/08/08 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 29 5. YA42 23(4) The service must put in place the 01/08/08 recommendations of the fire authority. This will improve the safety for the people that live there. 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 Comprehensive information needs to be developed so that people are clear about what the service offers and what the fees are and what they will have to pay in addition to the fees. Comprehensive care plans should be in place in an accessible format. This will make sure staff have the information available to provide people with the care they need. Risk management strategies should be kept up to date. This will make sure people are protected whilst being supported to undertake their chosen lifestyle. To further develop the opportunities people have for social and leisure activities. This will provide them with a more varied lifestyle. Where medication is prescribed on an ‘as required’ basis protocols for their use should be in place. This will make sure the medication is prescribed on a consistent basis. In order that infection control standards are maintained laundry should be washed at a high enough temperature that will disinfect them. This will help to control the spread of infections. People living at the service should receive a more consistent service is there is less reliant on the use of agency staff. Training in such areas as challenging behaviour and working with people with profound and multiple learning disabilities. This will help them to provide support to the people at the service. 2 YA6 3. 4. 5. 6. YA9 YA14 YA20 YA30 7. 8. YA33 YA35 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 2-4 St Ives Close DS0000005002.V366768.R01.S.doc Version 5.2 Page 31 - 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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