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Inspection on 21/08/08 for 21 Dimmingsdale Bank

Also see our care home review for 21 Dimmingsdale Bank for more information

This inspection was carried out on 21st August 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

One person said, " I`m happy living here." 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. People living there said that they choose how their bedrooms are decorated and have the things they want in their bedroom. 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. Each person goes on holiday every year supported by staff to the places they want to go and with the people they want to go with. All the people living there do different activities inside and outside the home so they have a meaningful quality of life Staff have the training they need so they know how to help the people living there.

What has improved since the last inspection?

Staff have had more training that they need so they know how to keep people safe. More staff have been recruited to work there so that all staff know the people living there well and how they need to help them to meet their individual needs. The right checks have been done on all staff that work there to make sure they are `suitable` to work with the people living there. Risk assessments are in place for activities that each person takes part in to make sure that staff know how to help people to be as safe as possible. The lounge flooring is being replaced so it is comfortable and clean for the people living there.

What the care home could do better:

The people living there must be helped to get the treatment they need when they have had an accident to ensure their safety and well being. People must have the medication they need to keep well. All hazardous substances must be put in a locked cupboard so that people cannot use them in the wrong way, which could mean they are poisoned.Action must be taken to make sure that water is not too hot which could mean that people get scalded. Food records should state how people are being helped to ensure they have a healthy diet so they can be well. Health records should clearly show that staff follow what health professionals say and people attend the health appointments they need to be well. Staff should write down when a safeguarding referral is made and what happened about it. This will help to improve the safety of the people living there. The communal space for the people living there should be reviewed so that if possible there can be a private area for people to meet their family and friends other than their bedrooms. More staff should have NVQ level 2 or above in care so that they know how to meet the needs of the people living there. Staff should date food when they put it in the freezer to make sure that people are not at risk of food poisoning.

CARE HOME ADULTS 18-65 Dimmingsdale Bank, 21 Woodgate Valley Birmingham West Midlands B32 1ST Lead Inspector Sarah Bennett Unannounced Inspection 21st August 2008 10:20 DS0000016927.V370506.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 DS0000016927.V370506.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. DS0000016927.V370506.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 www.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 DS0000016927.V370506.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 13th September 2007 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 the people living there 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 service users guide stated, “ Our fees are calculated upon the particular care and support required for an individual which is established through the assessment process. The minimum fee is £990 per week to a maximum of £1250 which includes accommodation, care, support, laundry, all meals and day provision from the service.” A copy of the latest inspection report is available in the home for visitors who wish to read it. DS0000016927.V370506.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. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. A member of our business services team visited with the inspector as part of their personal development plan. The focus of inspections we, the commission, undertake 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 provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home. The Annual Quality Assurance Assessment (AQAA) completed by the senior practitioner was submitted following the visit. This provides information about the home and how they think it meets the needs of the people living there. Three of the people living 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. A partial tour of the premises took place. A sample of care, staff and health and safety records were looked at. Due to the needs of several of the people living there it was not possible to ask for their views on the home so time was spent observing practices and interaction from staff. Where people were able to comment on the care they receive their views have been included in this report. The manager was not on duty but the senior practitioner and area manager were present. Staff on duty at the time were spoken with. What the service does well: One person said, “ I’m happy living here.” 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. DS0000016927.V370506.R01.S.doc Version 5.2 Page 6 People living there said that they choose how their bedrooms are decorated and have the things they want in their bedroom. 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. Each person goes on holiday every year supported by staff to the places they want to go and with the people they want to go with. All the people living there do different activities inside and outside the home so they have a meaningful quality of life Staff have the training they need so they know how to help the people living there. What has improved since the last inspection? What they could do better: The people living there must be helped to get the treatment they need when they have had an accident to ensure their safety and well being. People must have the medication they need to keep well. All hazardous substances must be put in a locked cupboard so that people cannot use them in the wrong way, which could mean they are poisoned. DS0000016927.V370506.R01.S.doc Version 5.2 Page 7 Action must be taken to make sure that water is not too hot which could mean that people get scalded. Food records should state how people are being helped to ensure they have a healthy diet so they can be well. Health records should clearly show that staff follow what health professionals say and people attend the health appointments they need to be well. Staff should write down when a safeguarding referral is made and what happened about it. This will help to improve the safety of the people living there. The communal space for the people living there should be reviewed so that if possible there can be a private area for people to meet their family and friends other than their bedrooms. More staff should have NVQ level 2 or above in care so that they know how to meet the needs of the people living there. Staff should date food when they put it in the freezer to make sure that people are not at risk of food poisoning. 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. DS0000016927.V370506.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 DS0000016927.V370506.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 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 so they can make a choice as to whether or not they want to live there and their needs can be met there. EVIDENCE: The service users guide had been updated since the last inspection. It included the relevant and required information so that prospective service users would be able to make a choice as to whether or not they want to live there. The area manager said that the organisation’s media team are working on an audio and DVD format of it so to make it easier to understand. The AQAA stated that the statement of purpose had been reviewed and updated to include the relevant information. The AQAA stated and staff said that there have been no admissions for several years. There are no vacancies. Therefore, the standard relating to assessment of people’s needs before they move in was not assessed. DS0000016927.V370506.R01.S.doc Version 5.2 Page 10 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, 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 so they can support the people living there to meet their needs and achieve their goals. The people who live there are involved in making choices and decisions about their lives. EVIDENCE: The records of three of the people living there were looked at. These included a detailed individual care plan that showed staff how to support the person to meet their needs and achieve their goals. The AQAA stated and records sampled showed that the people living there are involved in their care plans. They are also involved in the monthly and annual review of it to ensure it is updated to include their needs and goals as they change. The AQAA stated that staff plan to continue with work on person centred planning with the people living there. DS0000016927.V370506.R01.S.doc Version 5.2 Page 11 Care plans cross-referenced to risk assessments and other strategies and guidelines developed for the individual by staff or other professionals. This made it easier to track all the information needed about the person to support them to meet their needs and to be safe. The AQAA stated that each person has monthly meetings with their key worker and these are fed back into staff supervisions and actions are identified. Records sampled showed that these were now happening monthly and the AQAA stated that this was something they wanted to improve on. They also plan to ensure that the minutes of these meetings are in an accessible format to make them easier for people to understand. The AQAA stated and records showed that monthly meetings are held with all the people living there. Minutes of these are written and in picture format making them easier to understand. People talk about activities, holidays, the running of the home and how they want it decorated and furnished. The AQAA stated and records sampled showed that individual risk assessments are in place for all the identified areas of risk to the individual. These were detailed, reviewed monthly and showed that the person is involved in developing them. They showed staff how to support the person to take risks and be as independent as possible whilst ensuring that they were safe. The monthly visits by the provider include an audit of care plans and risk assessments to ensure they are effective in meeting individual’s needs. DS0000016927.V370506.R01.S.doc Version 5.2 Page 12 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. The people living there are offered opportunities to experience a meaningful lifestyle. People are offered a varied diet, which they choose but it does not always promote individual’s health and well being. EVIDENCE: The AQAA stated that five people attend day centres and two people have their day opportunities provided at home. One person has completed an academic course in ‘Paper Crafts’. One person travels independently in a taxi to a local college where they do computer and personal safety courses. One of the day centres was closed for a holiday so another three people were at home. The senior practitioner said this made it difficult to provide individual activities for people. Staff were observed involving people in activities within the home but this was restricted due to the numbers of staff on duty. Staff were observed DS0000016927.V370506.R01.S.doc Version 5.2 Page 13 playing games and cards with people and putting on music that people said they wanted to listen to. One person’s placing authority had withdrawn their funding for day opportunities as they no longer have the resources to continue funding this so had made a strategic decision that all individuals they place will receive the same funding packages. Although it was evident that their activities are not restricted it is difficult for the provider to provide a meaningful day service for a person where no extra funding is given. One person said they go to college during term time and do courses in cooking, flower arranging and art. Another person said they also do these courses and the two people go to a local college together. The AQAA stated that all staff have had training in the ‘Eden Principles.’ This is about involving people who live in long-term care homes to have more involvement with animals, plants and children. Studies have shown that this helps to reduce and eliminate the loneliness, helplessness and boredom that people can often experience. The AQAA stated that staff should now be more spontaneous with activities and they plan to move these principles forward to improve the lifestyles of the people living there. Staff said that the people living there who wanted to were to be involved more in gardening and had been involved in planting pots in the garden. One person said they go to a club on Thursday and Saturday evenings, which they enjoy. Some people were looking forward to going to a barbecue at their friend’s house that weekend. One person said that they buy a newspaper and magazine from the local shop every Sunday. Some people said they had been to the cinema recently and another person said they had been bowling. One person said that they now have a day off from the day centre during the week and they go out with staff bowling, swimming or ice skating. Records sampled showed that people had been bowling, out for a meal, to the cinema and to the theatre. Some people said that they had been on holiday. Staff said that two people went to Llandudno, two people went to Minehead and two people are going to Wales in September. One person has stated that they would like to go on holiday on their own and this is being arranged. One person asked staff if they would show us a picture they had taken while on holiday, which they were obviously proud of. The AQAA stated that some people have suggested that they go abroad on holiday and staff are working with individuals to plan these for the future. The AQAA stated there are no restrictions on visitors and the people living there can choose when and where they see their visitors. Records sampled showed and people said that they can keep in contact with their family and friends through visits and telephone calls. DS0000016927.V370506.R01.S.doc Version 5.2 Page 14 One person said, “ I sometimes go shopping to Asda with staff for food.” People were observed helping to make drinks and helping to prepare the evening meal with staff. People were asked what they wanted to drink and it was evident that a variety of drinks were always available as two people said they would like a cappuccino, which they had. The AQAA stated and people said that they are involved in planning the menu for each week on Sundays. There are two options for the main meal of each day. These were varied and included healthy options. A variety of breakfast cereals were available and people said they chose what they had for breakfast. Food records sampled were not all completed so it was not clear that people are receiving a diet that promotes their health and well being. One person’s records sampled stated that to be healthy they needed to lose weight. The dietician had recommended healthy options for the person to take to the day centre for their packed lunch. Their food records stated ‘packed lunch’ but not what this included. One person’s health records stated that to be well they needed to have a high calorie diet. Their records did not indicate that they had anything different to the other people living there. It would be useful for staff to state approximately how much food the person had eaten and whether they had any additional snacks so it is clear that they are being provided with the calories they need. The dietician has also prescribed supplement drinks for the person to help them top increase their weight. Their records did not indicate that these had been given to the person every day, as they should have been. DS0000016927.V370506.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. People’s personal care needs are met so improving their self esteem. The people living there are not always supported appropriately to meet their health needs, which could impact on their well being. EVIDENCE: Throughout the day staff were observed to interact well with the people living there in a way that respected them as an individual. The people living there were dressed appropriately to their age, the weather and the activities they were doing. They had individual styles of hair and dress reflecting their individual personalities and backgrounds. Two people have a bedroom upstairs and need assistance from staff to use the stair lift to come downstairs. One person pressed the call bell to ask staff to assist them. Staff answered it immediately and went straight away to support them so they were safe. DS0000016927.V370506.R01.S.doc Version 5.2 Page 16 Records sampled included an individual moving and handling assessment. This detailed how staff are to support the person to move around whilst minimising the risks to them and that of staff supporting them. One person’s records showed that this had been updated after they had an accident to include detailed guidelines for staff to prepare for moving the person so they are not left unattended which could result in further accidents. The AQAA stated and records sampled showed that each person has a health action plan. This is a personal plan about what support the person needs to stay healthy and what healthcare services they need to access. Records showed that people have annual health checks and also attend well woman and well man clinics. One person had an injury to their finger and staff said this had resulted in a fracture. It was not clear from the person’s records when or how they had sustained this injury. Their records showed that they are at risk of falls and action is taken to minimise these involving the relevant health professionals. Some records were not dated so it was not clear what staff were reporting on. One record indicated that the person had the injury but staff did not know how they had sustained this. However, according to their records it was not until two days later that they had been taken to hospital for treatment. Once the person was taken to hospital staff had acted on the advice of the health professionals to ensure the person was as comfortable as possible. Accident records did not include details about the accident and it was not reported appropriately to the relevant professionals to ensure that action was taken to safeguard the person. The area manager said that she had not been informed of this as required and would investigate how staff had responded to this. The AQAA stated that staff need to be more focussed when completing health and accident/incident records. Records sampled showed that people are referred to health professionals as needed. Some records did not clearly show that the advice of professionals had always been followed to ensure the person’s health and well being. Some records indicated that advice from the dietician had not been followed. Some records did not record that the person had been to follow up appointments as required by the health professional. The senior practitioner said and records sampled showed that one person’s health needs had increased. An application had been submitted to the person’s placing authority to increase the staffing for this person to 1:1 so their needs could be met. This application had not been successful but staff were continuing to assess the person’s needs to ensure they could be met at the home. Staff said and the AQAA stated that they receive training in giving medication and have to be assessed as competent by the manager before they can give it to the people living there. DS0000016927.V370506.R01.S.doc Version 5.2 Page 17 Two staff were observed giving medication to individuals. There were only two staff on duty at the time and the phone started ringing. They did not answer the phone as they said this may distract them and it is important not to be so that people receive the medication they need to be well. Some people are prescribed as required (PRN) medication. Protocols were in place stating when, why and how much of the medication should be given so it is not misused. These had been signed by the person’s GP to show their agreement to this. Boots supply the medication using the monitored dosage system. This is delivered to the home in pre-packed blister packs for each dose of medication for each person. This makes it easier for staff to know what to give to each person and when. The packs sampled cross-referenced with the Medication Administration Record (MAR) indicating that medication had been given to people as prescribed. Some medication cannot be stored in blister packs as this reduces its effectiveness. One person’s tablets that they needed to take once a week was stored in a box. Their MAR indicated that they were given this each Monday. However, for that week the MAR had not been signed and the tablet that should have been given was still in the box. This could have a detrimental effect to the health and well being of the person. The area manager and senior practitioner were made aware of this and said they would ensure that the person received this medication as prescribed. Some people were prescribed liquids. Staff had dated the bottle when they had started using it so it was clear to audit that the medication was being given and that it would not be used past its shelf life, which could make it ineffective. At the front of each person’s MAR there was a photograph of the person so that unfamiliar staff would know who to give the medication to. DS0000016927.V370506.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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on. Arrangements are not sufficient to ensure that the people living there are always safeguarded from abuse, which could impact on their well being. EVIDENCE: A complaints procedure is displayed in the home. This uses widget symbols as well as text to make it easier to understand. The AQAA stated that staff had recently had training on the complaints procedure so they know how to support people to make a complaint if they are unhappy and what to do if a complaint is made. The AQAA stated and the complaints log showed that there had been one complaint received by the home from a person living there in the last 12 months. This was upheld but appropriate action was taken to resolve the issues raised so to improve the service. The complainant was satisfied with this outcome. In May this year we visited to home to do a ‘thematic inspection’ that was focussed on how the home safeguards the people living there. We found that staff had some understanding of the term ‘safeguarding’ and of the need to protect people from abuse. The staff members we spoke to were able to describe what they would do in the event of actual or potential abuse taking place involve people using the service. The training records at the thematic DS0000016927.V370506.R01.S.doc Version 5.2 Page 19 inspection showed that the majority of staff last received training in safeguarding over two years ago. It was recommended that refresher training be arranged for staff. Staff meeting minutes sampled showed that staff had received updated training in safeguarding following our visit. The AQAA stated that safeguarding is discussed at staff meetings and the induction programme includes informing staff of safeguarding procedures. It also stated that they could do better by developing staff awareness of the multi-agency guidelines on safeguarding vulnerable adults. This will help staff to know how to respond appropriately if an allegation of abuse is suspected and to report it to the relevant people to safeguard the people living there. At the thematic inspection the people living there said that they felt safe and if they did not feel safe or were frightened they knew who to speak to. People we spoke to were comfortable about talking to their key worker about their safety. At the thematic inspection it was found that the organisations own policy and procedure on safeguarding needed reviewing. The procedure made no reference to how a member of staff would be referred to the POVA (Protection of Vulnerable People) list. The manager felt sure that this would be done by a more senior manager in the organisation but did not know the process. The registered manager was not aware of the safeguarding procedures within the other local authorities that were funding people living within the care home. The AQAA stated that the safeguarding procedure is being produced using widget symbols making it easier to understand. At the thematic inspection it was found that a safeguarding referral had recently been made to a neighbouring local authority. The referral was not made as promptly as necessary and no review of procedures was made as a result of any lessons learnt from the delay. The registered manager was not aware of the outcome of the referral. It is recommended that a log of all safeguarding referrals is made so that it is clear that issues have been reported appropriately and followed up to ensure the safety of the people living there. The finance records of three of the people living there were looked at. A record is kept of how much money each person has spent and what on. Receipts are kept of all purchases. The money in each person’s cash tin cross-referenced with the amount stated on their records indicating that their money is spent appropriately. Staff check each person’s money at each handover of shift to ensure it is not being misused. DS0000016927.V370506.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, 26, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that people live in a homely, comfortable, clean and safe environment that generally meets their individual needs. EVIDENCE: The flooring in the lounge, kitchen and hallway is worn and stained in places. The area manager told the people living there that samples would be arriving the following Tuesday for them to have an opportunity to choose the flooring for these rooms. They said it should be completed in the next two weeks. Communal rooms were well decorated and furnished and this had improved since the last inspection. At previous inspections it had been noted that some people are unable to access the laundry and office, as these are upstairs and due to their mobility difficulties some people cannot use the stair lift. The AQAA stated that photos DS0000016927.V370506.R01.S.doc Version 5.2 Page 21 are to be taken of these rooms and shown to people who want to know about these rooms. Although this is not ideal it is not possible to enable access to these rooms and shows that some effort is being made to ensure that people know about their home. As the downstairs is open plan there is no space where people can go to be quiet or meet visitors apart from their bedroom. This has been noted at previous inspections and recommendations made to improve this. The AQAA stated that they plan to have further discussions about what additional space people want and if a quiet room could be provided. The AQAA stated and it was observed that people’s bedrooms are personalised and each person has an en suite bedroom that is appropriate to their individual needs. One person has an adapted bathing facility in their en suite as they prefer to have a bath but need it to be adapted so they can get in and out of it safely. The AQAA stated and people said that they are involved in choosing the decoration of the home and their bedrooms. Bedrooms were well decorated and furnished and several had been redecorated since the last inspection. The home was clean and free from offensive odours. The odour of urine that was present at the last inspection in the lounge has been eliminated through redecoration and furnishings being replaced. This makes it a more pleasant space for people to spend time in. DS0000016927.V370506.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 support and development are variable, which could impact on how the needs of the people living there are met. The recruitment practices safeguard the people living there. EVIDENCE: The AQAA stated that 33 of staff have National Vocational Qualification (NVQ) level 2 or above in Care and that 33 of staff are working towards achieving it. The standard is 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. We have previously made requirements for staff to be recruited to ensure that people using the service are supported by staff who know them. Several recruitment drives have taken place. The most recent one has been successful in recruiting the necessary staff so that the home will be fully staffed. One member of staff was off sick on the morning shift but a ‘bank’ staff that knew the people living there well covered this. Rotas sampled showed and staff said DS0000016927.V370506.R01.S.doc Version 5.2 Page 23 that less bank and agency staff were being used so that there are more staff who know the people living there and what they need. More bank staff have been recruited who will be doing an induction and the Learning Disability Qualification (LDQ) so they know how to work with the people living there. The people living at the home and people living in other homes managed by the organisation have been involved in interviewing staff so they can have a say in who works with them. As stated earlier in this report funding for one person’s day care had been withdrawn and an application for additional funding for one person had been refused. This impacts on the service that can be provided. Staff are continuing to monitor and report in reviews how this impacts on individuals and whether or not their needs can be met there. Staff meeting minutes showed that these are held regularly. Staff receive training at these meetings to improve their skills and knowledge in working with the people living there. Staff records sampled showed and the AQAA stated that a robust recruitment process is in place. This ensures that staff have the necessary checks including a Criminal Records Bureau (CRB) check before they start working there so that ‘suitable’ people are employed. Staff told us at the thematic inspection about the employment checks in place to make sure that people are kept safe. The AQAA stated that in the last year staff had received training in medication, first aid, fire, safeguarding, mental capacity, data protection and the ‘Eden Principles’. Staff training records sampled showed that staff had received the necessary training to meet the needs of the people living there. Records showed that when staff first started working at the home they had an induction so they know how to work with each person living there to meet their needs. Staff records sampled showed that they receive regular supervision with their manager. The minutes of these were detailed and showed that the training and development needs of the member of staff were identified so they can obtain the skills they need to do their job. At each supervision session an action plan is developed so that staff know what they need to do to improve their performance and meet the needs of the people living there. DS0000016927.V370506.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that the home is run to benefit the people living there. Arrangements do not ensure that the health, safety and welfare of the people living there is always promoted and protected. EVIDENCE: The AQAA stated the registered manager has NVQ 4 and is working towards achieving the Registered Managers Award so she has the skills and knowledge to run the home for the benefit of the people living there. The AQAA stated and it had been discussed at previous inspections that the home would benefit by recruiting a deputy manager to offer additional support to the manager and staff. The area manager said this post had recently been recruited to. DS0000016927.V370506.R01.S.doc Version 5.2 Page 25 The AQAA stated that they plan to involve and consult with the people living there, their families, friends and advocates in developing the Quality Assurance framework for the service. There is a framework is in place and at the last inspection it was found that this includes looking at the quality of care, the environment and staffing. A representative of the provider visits the home every month to complete an audit as is required. A report of the visits is written. Reports sampled showed that these include asking the views of the people living there about the home so it can be improved in the way they want it. Records showed that a Corgi registered engineer had completed the annual test of the gas equipment in February this year and stated that it was safe to use. Records showed that hoists and the stair lift had been regularly serviced to make sure they were safe to move people around. Records showed that staff tested the temperatures of the fridge and freezers daily. These were within the recommended ranges so the risk of food poisoning was minimised. On the kitchen worktop there was a packet of meat that was being defrosted for tea. There was no date written on it as to when it had been frozen. The use by date stated 14th August but it was possible to freeze the meat. Food stored in the freezer was recently dated and there was no indication that food was stored there for very long periods so it was assumed that the date was 2008. Staff need to date food when they freeze it to ensure that people are not at risk of food poisoning. Fire records showed that staff test the fire equipment regularly to make sure it is working. Staff test the water temperatures regularly to make sure they are not too hot or cold, which could put people at risk of being scalded. Most temperatures were within the recommended range but the baths in two people’s en suite were higher than they should have been. There was no record of any action taken to reduce these. This was also found at the last key inspection. Staff must take action to ensure people are not at risk of being scalded. The area manager and senior practitioner were made aware of this. In the cupboard under the kitchen sink there was a bowl of dish wash tablets. Although these were wrapped individually so making them harder to open the cupboard was not locked, which could put people at risk of eating a hazardous substance. This was discussed with the area manager and senior practitioner who stated that they would ensure these were locked away. DS0000016927.V370506.R01.S.doc Version 5.2 Page 26 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 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 1 X DS0000016927.V370506.R01.S.doc Version 5.2 Page 27 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 12 (1) (a) Requirement Timescale for action 21/09/08 2. YA20 13 (2) 3. YA42 13 (4) 4. YA42 13(4) The people living there must be supported appropriately and treatment sought when they have had an accident to ensure their safety and well being. Medication must be given to 21/09/08 individuals as prescribed to ensure their health needs are met. All hazardous substances must 21/09/08 be stored in a locked cupboard so that people are not at risk of using them inappropriately. Where water temperatures 30/09/08 exceed 43 degrees centigrade staff must report these to the maintenance team to ensure that the people living there are not at risk of being scalded. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000016927.V370506.R01.S.doc Version 5.2 Page 28 1. 2. YA17 YA19 3. YA23 4. 5. YA23 YA28 6. 7. YA32 YA42 Food records should state how people are being supported to ensure their diet promotes their health and well being. Health records should clearly show that advice is followed from health professionals and people attend the health appointments they need. This will show that people’s health needs are being met. The registered manager should know how to make a referral to the POVA list to ensure that she knows her responsibilities regarding the protection of people using the service. A record should be maintained of all safeguarding referrals and of the outcome. This will ensure that improvements are made to the safeguarding of 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. At least 50 of staff should have achieved NVQ level 2 or above in Care so that staff have the skills and knowledge to meet the needs of the people living there. Staff should date food when they freeze it to ensure that people are not at risk of food poisoning. DS0000016927.V370506.R01.S.doc Version 5.2 Page 29 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. 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