Inspection on 13/09/07 for 21 Dimmingsdale Bank

This inspection was carried out on 13th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

21 Dimmingsdale Bank 21/08/08

21 Dimmingsdale Bank 19/07/06

21 Dimmingsdale Bank 19/01/06

21 Dimmingsdale Bank 01/09/05

21 Dimmingsdale Bank 11/03/05

21 Dimmingsdale Bank 12/10/04

21 Dimmingsdale Bank 26/03/04

21 Dimmingsdale Bank 07/08/03

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 08/07/2008.

CARE HOME ADULTS 18-65 Dimmingsdale Bank, 21 Woodgate Valley Birmingham West Midlands B32 1ST Lead Inspector Sarah Bennett Key Unannounced Inspection 13th September 2007 11:20 Dimmingsdale Bank, 21 DS0000016927.V344886.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 Dimmingsdale Bank, 21 DS0000016927.V344886.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. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dimmingsdale Bank, 21 Address Woodgate Valley Birmingham West Midlands B32 1ST 0121 422 7500 F/P 0121 422 7500 yvetteperville@trident-ha.org.uk erikal@trident-ha.org.uk Trident Housing Association 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) Miss Yvette Patricia Purville Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 19th July 2006 Brief Description of the Service: Dimmingsdale Bank is a purpose built home for seven people who have a learning and additional physical disability. It was first registered in 1995. It is situated in a residential area on the south side of the city known as Woodgate Valley. It is within easy reach of local shops, public transport and local amenities. The property comprises of three linked houses, set out with a pleasing frontage of small areas of shrubs and spacious off road parking. The facilities include a large open plan communal area, which is utilised as a combined lounge and dining room. There is a main kitchen, and five bedrooms, all with en suite facilities, which can be accessed directly from the combined lounge/dining area. The office, sleep-in accommodation, laundry and a further two bedrooms are located on the first floor accessed via a stair lift. To the rear of the property there is a cushioned or astro turf patio with flowerpots, surrounded by a raised lawn and shrubbery. Due to the gradient of the lawn service users are not able to access it. Wheelchair access into the house and out to the rear garden is evident. The ground floor facilities are fully accessible. However, the first floor accommodation can only be utilised by those who are able to use a stair lift. The statement of purpose stated that the minimum fee per week starts from £810, which includes accommodation, care and support, laundry and all meals within the home. The fees do not include TV licences, activities, specialist equipment required after initial assessment and moving in and personal services including hairdressing, aromatherapy and transport. A copy of the latest inspection report is available in the home for visitors who wish to read it. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over one day; the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home were spoken to. Due to their learning disability and communication needs it was not always possible to get their views on the home. The staff on duty and the manager was spoken to. What the service does well: Each person who lives there has a care plan so that staff know how to support them to meet their needs and achieve their goals. The people who live there are encouraged to do things on their own so they can be as independent as possible. One person living there said, “ I like my bedroom, I have my own TV so I can watch the programmes I like.” The people living there are asked what they want to do, which staff they want to support them and where they want to spend their time. This gives them some control over their day-to-day lives. People are supported to buy clothes that they like and that suit them. Each person had their own individual hairstyle and one person said they had been to the hairdressers the day before and were proud to show off their new hairstyle. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 6 Each person had been on holiday this year supported by staff and said that they had a good time. Staff have the training they need so they know how to support the people living there and to keep them safe from harm. Staff make sure that all equipment is regularly tested so that it works and is safe to use. What has improved since the last inspection? What they could do better: More staff must be recruited to work there so that all staff know the people living there well and how they need to support them to meet their individual needs. The right checks must be completed for all staff that work there to make sure they are ‘suitable’ to work with the people living there. Risk assessments should be in place for activities that each person takes part in to make sure that staff know how to support them to minimise any risks as much as possible. All the people living there should be supported appropriately with their personal care to ensure their well being. The temperature of the medication cabinet should be checked regularly to make sure that all the medication stored there is stored at the right temperature so it helps to meet people’s health needs. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 7 The lounge flooring should be replaced to make it comfortable and clean for the people living there. Action must be taken to make sure that water temperatures are not too hot which could mean that people get scalded. 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. Dimmingsdale Bank, 21 DS0000016927.V344886.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 Dimmingsdale Bank, 21 DS0000016927.V344886.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make a choice about whether or not they want to live there. Arrangements are in place to ensure that individual’s needs are assessed before they move in to ensure they can be met there. EVIDENCE: The statement of purpose of the home and service users guide to the home were reviewed and updated in August this year. It included the relevant and required information so that people deciding whether or not they want to live there would have the information they need. It was produced using pictures so making it easier to understand. The manager said they are also going to get it produced in audio format to help more people to understand it. The people living there have lived there for several years and there were no vacancies. Therefore, standard 2 relating to assessment could not be fully assessed. However, the statement of purpose included the admission and assessment process. This included meeting the person, visits to the home, consulting with others involved with the person and the social work Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 10 assessment. It stated that it is not considered to be a ‘home for life’ only until the person’s needs can be met. Dimmingsdale Bank, 21 DS0000016927.V344886.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 good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need in care plans and risk assessments so they know how to meet the individual needs of the people living there. The people who live there are supported to make decisions and choices about their day-to-day lives in the home so they have some control over their lives. EVIDENCE: The records of three of the people who live there were looked at. These included individual care plans that were person centred, detailed and regularly reviewed. The care plan detailed what assistance the person would need from staff and what the person could do for their self so maintaining and developing their independence. Care plans showed that the person had been involved in developing it and they and their relatives where appropriate were involved in their review. The manager and staff had identified that one person’s needs have increased and that they may need 1:1 staffing to meet their needs. The manager had Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 12 acted appropriately and contacted the person’s social worker to ask them to complete an assessment and if necessary increase the funding so their needs could still be met at the home. This had not yet been completed. Regular meetings are held with the people who live there and minutes of these were looked at. They showed that people discussed the activities they would like to do inside and outside the home, person centred plans, awareness of health needs and healthy lifestyles, how to make a complaint and who they would like to invite to parties organised at the home. Trident employ a Participation Officer who is involved with people developing their person centred plans and they also attend the monthly support group for the people who live in homes operated by Trident. Some of the people living at the home attend these meetings. At the beginning of each shift a plan is developed. The planning of the afternoon shift was observed. The people living there sat around the dining room table with the staff on duty to discuss what was going to happen. People chose which member of staff was going to support them with their personal care and where needed with eating their meal. One of the people living there was nominated to help prepare the evening meal and another person to lay the table. Each person was asked what they wanted for their meal, which was a choice of spaghetti and mince or jacket potato, cheese and ham. People also chose the activities they wanted to do during the evening, which included listening to music in their bedroom, watching a DVD together and cleaning their bedrooms. It was obvious that people were regularly involved in shift planning, as they knew how to get involved and what they would be discussing. Some people found it hard to concentrate on this for too long and it may have been helpful to them if there were less distractions as the television was on in the lounge and the radio was on in the dining room. The lounge and dining room is one open plan room. Records sampled included individual risk assessments. These stated how staff are to support the person to minimise the risks when moving from one place to another, using the minibus, road safety, using the stair lift, using bed rails, using their wheelchair, epilepsy, opening windows on the first floor, fire, personal care including cutting their toe nails, pressure areas, support during the night, finances and falling. All risk assessments were detailed, had been regularly reviewed and updated where the person’s needs had changed. One person had recently started going to a cooking class at college but there was not a risk assessment to ensure staff know how to support the person to ensure all the risks are minimised. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. People are offered a healthy diet and have a choice of what they eat. EVIDENCE: Five of the people living there go to day centres during the week. The other people attend college courses in art and cooking and staff support them in activities. Daily records sampled showed that people take part in a variety of activities inside and outside the home. These include going to the hairdressers, arts and crafts, planning the weekly menu, going to church, watching TV and DVD’s, going to restaurants and cafes for meals and drinks, shopping, listening to music, writing, reading magazines, going to parks, playing games and going to a disco where they meet up with friends. One person said that sometimes they go to the pub for a beer and another person added that they have a coca-cola Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 14 when they go to the pub. When staff and the people living there were planning the afternoon shift they each chose what activities they would like to do. After they had their evening meal staff were observed supporting people to do their chosen activities. All the people living there have been on holiday this year supported by staff. Two people went to the Isle of Wight, two people went to Torquay and the other three people went on an activity holiday in Devon. There were photos of this, which showed that one person living there who has mobility needs enjoyed spending their time horse riding, rock climbing, sailing and abseiling. Records showed and people said that they could keep in contact with their family and friends. This may be through telephone calls, visits to them or them visiting the home, inviting them to parties and going to a disco each week where they can meet their friends. The people living there are encouraged to take part in household tasks so maintaining and promoting their independence skills. Records showed that these included setting the table, cleaning their bedroom, helping to make meals and drinks, putting their laundry away and making their bed. Each Sunday the people living there discuss the menu for the week. An alternative is offered for each meal. Staff were observed asking people what they wanted to eat that evening for tea. Food records sampled showed that people are offered a varied diet that includes fruit and vegetables. They included a record of fruit and vegetables eaten using pictures to involve the people living there in recording how much they have eaten. For three people’s records sampled they showed that they had over three and sometimes seven portions of fruit and vegetables each day. The recommended amount is at least five portions a day. The amount of fruit and vegetables offered to help people have a healthy diet had improved since previous inspections. Staff meeting minutes sampled showed that staff had discussed how they can encourage people to eat a more healthy diet and food records showed that they had put these ideas into practice. Staff were observed supporting people appropriately to eat their meals. There were a choice of breakfast cereals in the kitchen and food records showed that people have a choice of these each day. Adequate food stocks were provided and one person who lives there went out with a member of staff to buy the food during the afternoon. One person living there was helping staff to cook the tea. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for ensuring that individual’s personal care needs are met are not always sufficient to ensure the well being of each person. Individual’s health needs are met and the management of the medication is generally sufficient to ensure people get the right medication at the right time to ensure their health and well being. EVIDENCE: Care plans sampled stated how staff are to support the individual with their personal care. They included the person being involved and doing as much as they can so as to maintain their independence. One persons care plan stated that during the week they set their alarm clock before going to bed for 7am but at the weekend they have a lie-in indicating that people have a choice of when they get up when they do not need to. Care plans stated that people are supported to choose their own clothes. The people living there were well dressed and this was appropriate to their age, gender and the activities they were doing. Each person had their individual hair style. One person said they had been to the hairdressers the Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 16 day before and were pleased with their new hairstyle. Photographs seen of the people living there showed that they had been well supported with their personal care. One person’s fingernails were very long and one of them had broken off. They said it was sore. The skin on their arms was very dry and was peeling. It was not evident that staff had supported this person appropriately to ensure their well being. At the end of their shift staff were observed saying goodbye to the people living there and telling them when they would next be on duty. This shows that staff respect the people living there and are aware that it is important for them to know who is supporting them each day. Staff were heard talking to people as they arrived home from their day centres and asking how their day was. On the afternoon shift there was one permanent staff, two agency staff and two members of staff who had recently started working at the home. One person was observed getting off the sofa and sitting on the floor. A member of staff told them a few times to sit up on the sofa where it would be more comfortable. This seemed to annoy the person who started banging their face with their hand. After about five minutes the permanent member of staff asked another staff to help to get the person from the floor to the sofa using their wheelchair and encouraging them to transfer. They also changed the TV channel. This helped the person to calm down and stop hurting their face. This showed that it is important for staff who know the people living there and what they need to be on duty at all times. However, it was not enough for one permanent member of staff to be on duty as they spent a lot of time directing other staff to ensure people got the support they needed. Records sampled included an individual health plan that stated what support they need to meet their health needs and what health services they use. Records showed that people had regular health checks and were supported where appropriate to attend appointments with health professionals. People had been weighed regularly. Weight records showed that where people had needed to gain or lose weight staff had supported them appropriately to do this. A record is kept of the health appointments that the person has attended and any advice that is given for staff to follow to ensure the person’s health needs are met. One person had a fall earlier in the day. Staff supported them to go to hospital for treatment. When they got back home staff offered the person a drink and supported them appropriately. Staff communicated what the staff at the hospital had said and recorded the follow up advice in the person’s care plan so the other staff could follow this. Medication was stored in a locked cabinet. Three people’s Medication Administration Records (MARS) were sampled. These included a photograph of the person at the front so that unfamiliar staff would know what medication to Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 17 give to what person. The MARS sampled were signed appropriately and crossreferenced with the person’s medication indicating that medication had been given as prescribed. One person had been prescribed antibiotics that day. The manager had printed the side effects of these and put them with the person’s MARS for staff to monitor. Some people are prescribed PRN (as required) medication. A protocol that had been signed by the GP was in place stating when, why and how much of this medication should be given to the person so that staff know how to give the medication when needed. One person is prescribed eye drops. The label on these stated do not store above 25C. There was no indication of what the temperature of the medication cabinet was. The manager said they would get a thermometer to check the temp of the cabinet, as it can get very warm in the room. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of the people who live there and their relatives are listened to and acted on so as to improve the service offered by the home. Arrangements are generally sufficient to ensure that the people living there are protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedure included the relevant and required information including how to contact the Commission so that people would know how to complain if they were unhappy. It was produced using ‘Widgit’ symbols making it easier to understand. Records of meetings held with the people living there showed that they discussed the complaints procedure so as to raise their awareness of it. The Commission had not received any complaints about the home in the last twelve months. A complaint had been received by the home from a relative concerning the day placement of their relative as they now only go to the day centre four days a week. When they are at home for the other day there are not enough staff on duty for them to be able to go out. Records showed that the manager responded to this appropriately involving the relative and the person living there in a meeting at the day centre. A senior manager from Trident is currently investigating the part of the complaint about there not being enough staff for the person to go out on their day off. Another complaint was received from a relative who said that when they rang to speak to their relative at the home the staff who answered the telephone did not know who Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 19 their relative was. This complaint was upheld, however the manager said that this member of staff is no longer working there, as they had not passed their probationary period satisfactorily. The adult protection and prevention of abuse policy is produced using ‘Widgit’ symbols making it easier to understand. Staff training records showed that staff had received training in the prevention of abuse so they know how to protect the people living there. Staff records sampled did not include evidence that a Criminal Records Bureau (CRB) check had been undertaken for all the staff employed there to ensure they are ‘suitable’ to work with the people living there. The manager said that this had been done but the information needed had not yet been sent to the home. Some people living at the home sometimes behave in a way that ‘challenges’. Guidelines are in place for the behaviour of these individual’s. These show staff what the possible triggers for the behaviour are and how staff can support the person to either prevent the behaviour from happening or manage it using distraction techniques. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current arrangements do not always ensure that people live in a homely, comfortable and clean environment. The planned redecoration would help to improve this. EVIDENCE: The AQAA stated that the home is to be redecorated within the next twelve months. This is necessary, as several areas of the home are looking worn. The manager said they have colour charts for people to choose the redecoration and it would be done in the next few weeks. They said that new curtains and bedding are also to be provided. In the garden there were several attractive pots and hanging baskets on the patio. The AQAA stated that the people living there had been involved in planting these. This is only part of the garden that is accessible to the people Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 21 living there as the grassed areas are raised up to the fence that surrounds the garden. One person said that sometimes they sit in the garden and enjoy this. The lounge carpet was stained in several areas. The manager said that staff had cleaned it the day before but this did not make much difference and it had also been professionally cleaned. This should be replaced to ensure the home is comfortable for the people living there. If appropriate, alternative flooring should be considered. Furniture had been replaced over the last year in the lounge and dining room and this was in good condition. At one meeting of the people who live there they said they needed a new TV as when they play a DVD on it the screen shows ‘pink’. The manager said they hope to be able to buy a new TV for the lounge but it is dependent on the budget available. Only the people who can use a stair lift are able to access the first floor. The office and the laundry room are on the first floor as are two people’s bedrooms. These are the only people who can get to the office and use the laundry, as they are the only people who are able to use the stair lift. The home was clean and free from offensive odours apart from around one person’s bedroom where it smelt of urine. The manager said that air fresheners have been put in the bedroom but they hope when the redecoration is completed this would help to eliminate the odour. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their development and support are variable, which could impact on the well being of the people who live there. Information is not available to show that the recruitment practices protect the people living there. EVIDENCE: The statement of the purpose stated that six members of staff have National Vocational Qualification (NVQ) level 2 or above in Care and two members of staff are currently working towards level 2. As there are eight support workers and a manager employed at the home this exceeds the standard that at least 50 of staff have achieved this qualification to ensure they have the skills and knowledge to meet the needs of the people living there. The manager said that due to staff vacancies the home is run on agency and bank staff. There were also two staff absent due to sickness at the time of the inspection. The manager said that one of these staff was due to return the following week. On the morning shift there was one permanent member of staff, one ‘casual’ staff and one agency staff. In the afternoon there were two agency staff, two staff who had started working there recently who were still Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 23 on their induction and one permanent staff. How this affects the people living there has already been discussed under the ‘Personal and Healthcare Support’ standards in this report. Agency staff said they had an induction when they first started working at the home. The manager said that a deputy manager was recruited in March but had left in July, which made it hard for the manager to supervise staff. Two staff had recently been recruited and had started working at the home. The manager said the organisation had advertised for staff again, as all the vacancies had not been filled and they were interviewing the following week. The manager said and rotas sampled showed that the minimum staffing levels are always met with the use of agency staff. The manager said and one person’s records showed that one person is behaving in a way that can ‘challenge’ on a daily basis especially when they are being supported by agency staff. The manager said the person wants to do things for their self but is not able to and staff do not always understand what the person says, which causes them to become frustrated and they won’t repeat what they have said. The manager has involved other professionals and the person is waiting to be reassessed by a social worker. However, it appears that some of the person’s frustration is caused by them being supported by staff who do not know them well. Staff meeting minutes showed there had been five staff meetings in the last year and one had been planned but cancelled due to a poor staff turnout. At meetings staff had discussed the AQAA and the National Minimum Standards, the shortage of staff, key workers, the needs of the people living there, personal care of the people living there when the manager reminded staff what was acceptable and not acceptable, the last inspection report where it was agreed what actions would be taken to ensure that requirements were met, Person Centred Planning and the Mental Capacity Act. Three records of the staff that work there were sampled. Two records were for the staff that had recently started working at the home. They showed that they were receiving an induction that included looking at policies and procedures, attending training courses and being an extra member of staff on shifts as they got to know the people living there and how they are to support them. Staff recruitment records did not include the required recruitment records. The manager said that the Human Resources section of Trident had agreed with the Commission that these records are kept at the Head Office apart from individual’s Criminal Record Bureau (CRB) check number. These were not available for the new members of staff. These must be available to ensure that the required checks have been undertaken to ensure that ‘suitable’ people are employed to work with the people living there. Training records sampled showed that staff had received training in fire safety, medication, first aid, adult protection and the prevention of abuse, moving and handling, food hygiene and health and safety. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 24 Both of the new members of staff were having formal supervision that day with the manager. Each member of staff had a supervision contract between them and the manager stating what each of their responsibilities are in the supervision process to ensure they receive the necessary support to meet the needs of the people living there. The other member of staff records showed that they had received regular, formal supervision. During these sessions objectives had been set for the person and areas for improvement had been identified where necessary. Dimmingsdale Bank, 21 DS0000016927.V344886.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, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home. The people living there can be confident that their views underpin the self-monitoring, review and development by the home. The health, safety and welfare of the people living there is generally promoted and protected so ensuring their well being. EVIDENCE: The manager has been registered with the Commission since the last key inspection. The manager is currently undertaking the Registered Managers Award to build on her skills and knowledge. She has several years of experience of working with people who have a learning disability in a senior Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 26 role. The findings of this inspection show that the manager is using the staffing resources available to ensure that the needs of the people living there are met. However, these resources have been limited so it is not always possible to ensure this happens. Trident has recently recruited a Regional Manager to manage the homes in the Birmingham area. They started a few days before the visit and visited in the afternoon to meet the manager and the people living there. The manager has not had regular supervision recently but hopes this will improve with the appointment of a Regional Manager. The manager said that she is going to suggest in management meetings that they use the AQAA in the monthly Regulation 26 visits as a focus to assess whether or not the home is meeting the National Minimum Standards (NMS). The manager said that using the AQAA was a good way to audit how she and the staff are meeting the NMS. Trident has a comprehensive quality assurance system, which assesses the care provided, the environment, the staff and the management & organisation. This was completed in November 2006. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained so it would work if there were a fire. The stair lift is regularly serviced to make sure it is safe to use. One person’s records indicated recently that on one day the stair lift was not working. Staff said it had been repaired as a matter of urgency as two people need to use it to get to their bedrooms. An engineer completed the annual test of the gas equipment in March 2007 and stated it was safe to use. The portable electrical appliances are tested annually to make sure they are safe to use. One person whose bedroom is upstairs uses the call bell to alert staff when they need support to use the stair lift. Staff check this weekly to ensure it is working so the person can always get support when needed. Staff test the water temperatures weekly to make sure they are not too hot or cold. The recommended safe temperature so that people are not at risk of being scalded is 43 degrees centigrade. The last record stated that two people’s showers; one person’s bath and one person’s sink were 45 degrees centigrade, which is a bit high. There was no record that any action had been taken to reduce this. The manager said she would inform the maintenance team to get these rectified. The home has a minibus that staff drive to help the people living there to go out in the community. The minibus had a valid certificate of insurance and had recently been serviced to ensure it is well maintained. Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 25 26 27 28 29 30 3 3 3 2 X 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 STAFFING Standard No Score 31 X 32 4 33 1 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000016927.V344886.R01.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Dimmingsdale Bank, 21 Score 2 3 2 X 3 X 3 X X 2 X Version 5.2 Page 28 Yes, one Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA33 Regulation 18 (1) (a, c) Timescale for action Staff must be recruited to ensure 30/11/07 that the people living there are supported by staff that know them. Outstanding from the last two inspections. Evidence that a Criminal Record 31/10/07 Bureau (CRB) check had been completed for all the staff employed there must be available in the home. This is to ensure that ‘suitable’ people are employed to work with the people living there. Requirement 2. YA34 7,9,19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA9 Good Practice Recommendations Risk assessments should be in place for activities that each person takes part in to ensure that staff know how to support them to minimise any risks as much as possible. All the people living there should be supported appropriately with their personal care to ensure their well DS0000016927.V344886.R01.S.doc Version 5.2 Page 29 YA18 Dimmingsdale Bank, 21 3. YA20 4. 5. YA24 YA28 being. The temperature of the medication cabinet should be checked regularly to make sure that all the medication stored there is stored at the right temperature so it is effective. The lounge flooring should be replaced to make it comfortable and clean for the people living there. The organisation should review the communal space for the people living there and the lack of a private area for people to meet relatives/ friends other than their bedrooms. Outstanding from previous inspections. Where water temperatures exceed 43 degrees centigrade staff should report these to the maintenance team to ensure that the people living there are not at risk of being scalded. 6. YA42 Dimmingsdale Bank, 21 DS0000016927.V344886.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Dimmingsdale Bank, 21 DS0000016927.V344886.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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