Inspection on 16/12/05 for 23 Barncroft Street

This inspection was carried out on 16th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

23 Barncroft Street 27/05/09

23 Barncroft Street 19/06/07

23 Barncroft Street 06/07/06

23 Barncroft Street 05/08/05

23 Barncroft Street 09/02/05

23 Barncroft Street 14/10/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 23 Barncroft Street Hill Top West Bromwich West Midlands B70 0QJ Lead Inspector Deborah Sharman Announced Inspection 16th December 2005 09:00 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 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 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 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. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 23 Barncroft Street Address Hill Top West Bromwich West Midlands B70 0QJ 0121 556 8809 0121 556 8809 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) Milbury Care Services Limited Mrs Diane Falconer Care Home 4 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (2) of places 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user in the category LD may also be DE and will remain until such time that the current service users placement is terminated. 5th August 2005 Date of last inspection Brief Description of the Service: 23 Barncroft Street is an adapted bungalow property, which is owned and managed by the Milbury organisation. The home is situated in the Hilltop area of West Bromwich, which is easily accessible and is close to nearby public transport routes. Local shops and amenities are also available. The accommodation consists of four single occupancy bedrooms, kitchen, lounge/dining area, and bathroom and toilet facilities. The home offers a small enclosed rear garden/patio and off road parking to the front of the property. A range of services are on offer and include social and recreational pursuits, an open visiting policy, access to visiting healthcare professionals, a varied menu, and in house activities such as aromatherapy, sensory sessions, and games etc. Service users are offered 24-hour personal care and support, including two wakeful night staff per duty. All staff aim to enable service users to live an ordinary life in the community. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection meaning that the provider, Acting Manager, staff and service users received advanced notice and were able to prepare. This was the second statutory inspection of this inspection period at 23 Barncroft Street. The Inspection began at 9.00 and finished at 6.00pm. The Acting Manager who was appointed since the previous inspection in October 2005 supported the Inspection. The Area Manager was also present for much of the afternoon. The home is currently accommodating two service users as one service user passed away shortly before this inspection and the other being in hospital and not anticipating returning to Barncroft Street. The plan for this inspection was to assess those key standards, which were not assessed at the previous inspection. In the event additional standards relating to the admission of a new service user in October 2005 were also assessed. The plan was also to assess only those previous requirements relating to those standards chosen for assessment. In the event the new Acting Manager asked the Inspector to assess progress over and beyond this, as she was keen to demonstrate all progress made. This would also serve to provide the new Acting Manager with a benchmark or starting point. Service users currently accommodated are non-vocal and are unable to participate in the process of inspection. However case tracking was thorough to ensure that the inspection was service user focussed with effort concentrated on outcomes for service users. A staff member was also interviewed in detail to assess how the home has supported staff to gain sufficient knowledge to meet service users needs. The environment was briefly inspected to assess progress as this was thoroughly inspected at the last inspection. Documentation was assessed and care provided to one service user was case tracked from prior to admission. Staffing levels were not assessed but the Acting Manager updated the Inspector with respect to proposals for change. What the service does well: 23 Barncroft Street is a small domestic style bungalow discreetly located within the community. There is a happy welcoming atmosphere and staff have adapted to recent changes in the management structure. The new Acting Manager has made many improvements in the two months that she has been in post. A staff member spoken to said that he feels that the team works together and communicates well. Written night records provide detailed information. Two comment cards were received before this inspection from relatives. Both were satisfied overall with the level of care provided 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: There are a number of improvements still required that significantly affect outcomes for service users. Concern was particularly identified in relation to the management of service users health from the case tracking undertaken. A care plan to meet the significant needs of a service user admitted in October was not in place until the end of November and as a result there were a number of serious and significant omissions in care provided. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 7 The care plan whilst very detailed for the areas included do not address all areas of need assessed before admission. The new Acting Manager must ensure that assessed need is included in early plans of care and that this guidance is implemented in practice. Likewise risk assessments were not undertaken prior to admission to inform the care required. Systems to better manage nutritional risk are needed and to more accurately assess and respond to pressure sore risk. Particular concern was expressed to the Acting Manager (who took up post at about the same time as this service user was admitted) and Area Manager about shortfalls in practice in relation to pressure sores and pain control. The provision of routine health screening must also improve. 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. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 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 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Outcomes for service users in relation to the process of admission to the home require improvement. Service users cannot be assured that the home will fully meet or plan to meet their all their assessed needs. EVIDENCE: A Community Care Assessment undertaken by the placing Social Worker was in place for a service user recently admitted to the home. To the Acting Managers credit she reported refusing to accept the new service user without it. An assessment had been undertaken by the home, which was said to have been undertaken pre admission, but the lack of date, venue and who contributed to the assessment made this difficult to verify. Its content however, was consistent with much of that in the Community Care Assessment documentation. Neither a care plan nor risk assessments were in place for the new service user until two months after admission. The service user was dependent and unwell and this compromised the quality of care provided. This service user was admitted to the home from hospital with two pressure sores. Neither the Acting Manager nor staff have received training to raise their awareness about the management of pressure sores. District nurses were visiting regularly to monitor and clean the area and an air mattress was provided but systems were not otherwise in place to meet these needs. There is no documentation on the premises to show the grade the pressure sore was upon admission but discussion lead the Inspector to believe that the pressure sore had deteriorated during the service users stay at Barncroft Street. The 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 10 placing Social Workers assessment advised to monitor the service user for pain. There is consistent evidence in shift records of the service user being in pain and no action was taken to obtain pain control medication for two months and in spite of the service user having serious medical conditions. The home had not written to the new service user to confirm that the home could meet the service users needs. There is no evidence of the new service user having had the opportunity to visit the home before the decision was taken to admit. There is no recorded rational for there not to be a visit. Staff spoken to did not know whether the service user had had a trial visit and the acting manager had not been able to identify this either (the service user was admitted to the home one week prior to the new acting manager taking up post). Two out of four service user terms and conditions of residence contracts were available on the premises. Two were not. Telephone enquiries made by the Acting Manager during the inspection located the contracts at head office, which upon request were faxed to the home. All records must be held on the premises. Assessment of the contract showed that the contract is insufficient and does not address most aspects of the National Minimum Standard. Service users rights therefore are not protected. The fee was clearly set out but this was the only compliant aspect of the contract. It was of particular concern to read in the contract, we ‘may put up our fees from time to time but it will not exceed the assets available to you’. The contract between the provider and the service user requires urgent review. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Service users can be assured that most of their needs have now been included in plans of care but failure to ensure that this was done in a timely manner has compromised the care provided to a service user with significant needs. Staff demonstrated that they understand how service users communicate and make decisions. Risks have recently been assessed with control measures identified for a vast range of subjects but staff are not yet aware of these assessments and their role in relation to them. EVIDENCE: A care plan was not put in place for a new service user with specific needs until two months after admission. When it was put in place the care plan was positive, detailed, considered the dignity and ability of the service user and covered most if not all areas of assessed need. The care plan had anticipated in advance the outcome of a proposed discussion with the GP about the need for nutritional supplements. This was misleading and is not advised. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 12 Care planning throughout considered the rights and preferences of the service user although there was not a care plan with respect to decision-making. Staff spoken to however was able to explain how the service user made and indicated decisions to them. Some written shift records evidence some decisions made by the service user and respected by staff e.g. ‘requested to go to bed at 8.30pm’, ‘was given an alternative meal’ and meals refused were documented. Risk assessments have been improved since the last inspection in number and quality. They have been redone. Comprehensive risk assessments are now in place for both the premises and for individual service users. One hundred risk assessments have been newly undertaken since the last inspection and cover a vast range of topics that pose risk. The Inspector advised the Manager to develop and extend the risk assessment in place in relation to the use of bedrails, as both the need for and use of bedrails should be risk assessed. Staff must also read and sign each risk assessment to familiarise themselves with the requirements of each one to avoid the exercise being simply a paper one. A missing service user procedure is in place and the Inspector advised that a simplified version be made readily accessible to staff e.g. by the phone or on the wall by the door. Nutritional risk assessment templates must be improved to ensure outcomes that reflect accurate levels of risk, as must waterlow assessments. Water low assessments are in place to assess risk of pressure sores. However the service user who had a high-grade pressure sore was assessed as being at low risk, which is not accurate. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 16, 17 Activities including access to the community are beginning to be formally planned but are dependent on sufficient staffing levels at appropriate times. Service users are supported to access to the community. Some not all service users have been supported to have a holiday this year. Service users rights and responsibilities are generally respected. Systems for service users at nutritional risk must improve to identify the level of risk and to intervene appropriately to address the risk identified. EVIDENCE: Service users do not attend traditional day centres and work experience or employment would not be appropriate and is not an assessed need for any of the service users currently living at Barncroft Street. Barncroft Street is commissioned to provide fulfilling activity for service users. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 14 The new Acting Manager has implemented activity programmes for service users and has ensured that these are in pictorial format. It remains now for the manager to ensure that these guide staff practice and routine or that any deviations from the planned programme are accounted for. Activity records were inspected to assess outcomes for a service user. Of those dates assessed the plan for community activity on two days had been replaced by ‘relaxing in the lounge’. The Acting Manager acknowledged that staffing levels had inhibited activity when the home had been fully occupied with two of the service users being highly dependent. The proposal now is to review staffing levels to give a higher ratio to better facilitate activity and social inclusion. Staff spoken to listed a range of activities undertaken with service users in the community including the library, park and meals out. Staff spoken to demonstrate that support is needed to understand awareness of service users rights of access to public facilities under the Disability Discrimination Act. There was evidence that service users are being taken to a church without staff being fully aware of whether the denomination of that church meets service users religious heritage /beliefs. This requires review. Service users were taken out for the morning on the day of inspection. Of the three service users accommodated in the summer of 2005 two service users went together on holiday to Blackpool. The third service user the Inspector was told did not have a holiday. A staff member spoken to was not fully aware of why this was but felt it may be because the service user was ‘noisy’. The Acting Manager who was not in post at the time of the holiday was not aware either of why all service users had not been provided with a holiday to meet their preferences and needs. This requires investigation. Care plans do include some reference to family contact but agreements for contact with families have not been discussed, formalised or recorded. Evidence of contact with families is hard to evidence from the current monitoring system used which depends upon staff remembering to record it in the record of shift / daily notes. Service users daily routines are well detailed in their plans of care. Housekeeping responsibilities are also included as per the service users assessed needs. Whilst key holding and mail management are not included in the care plan staff spoken to demonstrated appropriate knowledge of how mail is and should be managed. The care plan assessed accounted for why the service user does not vote. The service users have a pet dog who since the last inspection has been inoculated to promote health and hygiene within the home. The rules on smoking, alcohol and drugs are not included in the service users contract. Nutritional management systems are inadequate. Nutritional assessment tools have been devised and provided by the provider but without a key to insert scores for variables assessed. Scores were therefore being incorrectly 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 15 apportioned and outcomes not properly concluded. Care plans do not state clinically safe weights for service users making the exercise of weight taking meaningless. One poorly and dependent ‘frail’ service user had lost 2 pound in a month. Action was not taken to address this and care plans do not address fortification of diet. The care plan referred to nutritional supplements being prescribed 4 times per day but supplements had not been prescribed. It was intended to discuss this with the GP. The care plan does not sufficiently guide staff as to what action to take in the event of service users at risk refusing meals and there were many examples of this service user refusing a meal and having only a yoghurt instead which was likely to lead to weight loss and complications re the pressure sore. A second service users weight records show that he has lost 9 pound in weight between October and November 2005 and a further 12 pound between November and December 2005. Discussion informed the Inspector that the service user needs to lose weight. There is however no recorded or planned rational for this significant amount of weight loss. The Community Care assessment and preadmission assessment for the frail service user case tracked both state that the service user needs to be fed and given drinks. Discussion with a staff member showed that this service user who was refusing meals and had lost weight was in practice largely feeding herself contrary to assessed need. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19. Service users receive personal support in the way they prefer and require. The performance of the home has been poor in relation to meeting nutritional need, pressure sore awareness and management, pain control, seeking medical intervention sufficiently quickly and some routine health screening EVIDENCE: Staff spoken to demonstrated sufficient knowledge as how they promote the service users privacy and dignity in practice. Levels of personal support required are very detailed in plans of care. Retiring and rising times are flexible and outcomes based on service user preference are evidenced at times although not consistently in shift records. Where required and in line with risk assessment and plans of care service users are hoisted to transfer safely. Occupational therapy is involved and is helping the home to assess appropriate seating for service users. The support of a dietician has been requested but is not available. The provider could consider funding this privately to ensure that the dietary needs of service users are appropriately assessed and met. A key worker system is in operation. Intervention is required to ensure that the health care needs of service users are recognised and that procedures are in place to address them. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 17 The home was too slow to respond to evidence of a service user being in significant pain with pain control medication not sought for two months. Staff consistently wrote in care records that the service user was ‘screaming’. The placing social worker had advised that signs of pain needed monitoring. The homes pre admission assessment informed that the service user was likely to wake night due to pain from pressure sore/s. Night records indicated this to be the case with no action taken as per day records. It is thought that a pressure sore on admission deteriorated although records have not been sufficiently maintained by the home to assess this. The Commission for Social care Inspection was not informed of the pressure sore/s under regulation 37. Some 4 or 5 days previous the acting manager had been concerned about the health of a service user. The acting manager said that she called the placing social worker who visited and said that the service user appeared to be ok. This visit and outcome is not recorded. A GP was not contacted. The service user passed away 5 days after the acting manager was first concerned. The Acting Manager must ensure there is no delay in obtaining advice from a medical practitioner in the event of concern about health. There is a health action plan in place for the service user which does not include plans for all health screening required e.g. dentist, optician, breast screening etc. Chiropody treatment is included in the plan of care and there was evidence that this had been provided. Staff spoken to was not aware of the range of health screening required with the exception of chiropody. Records showed that the service user had lost weight. Systems to measure nutritional risk and to respond to risk identified are not sufficiently in place. Records to monitor food intake are now in place but had not been in place to support the care of the service user who passed away. The keeping of records did not monitor fluid intake referred to in the social workers assessment. Although staff did not feel fluid intake to be of concern there was not a system in place to monitor or evidence the reasons for no concern and to ensure compliance with assessed need. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not assessed at this inspection although progress has been made and some previous requirements have been met. EVIDENCE: Staff have now received adult protection training but certificates had not been made available as required. Following many phone calls to attempt to evidence this during the inspection day a letter of confirmation was faxed through to the home. Although the Inspector noted that it confirmed the information verbally given by the manager over the phone. An independent central record of who attended would have been more acceptable evidence. A complaints procedure in widget format has been made available but the effectiveness of the widget formula for the service users accommodated was discussed and was of concern to all taking part in the inspection. The area manager offered to ensure that this is reviewed. A Whistle blowing procedure was available on the premises at this inspection but changes to adult protection procedures required have not been made. Evidence was supplied that indicated the issue has been passed on to the relevant department. One of two relatives who responded to the Commission for Social Care Inspections pre inspection questionnaire about the quality of service provided by the home said they were not aware of the homes complaints procedure but hadn’t had to make a complaint. The other respondent was aware of complaints and how to access inspection reports written about the home. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not assessed at this inspection. Infection control was not assessed at this inspection and neither was progress towards previous requirements in relation to infection control. The manager said that progress had been made and that cleaning schedules had been implemented but time did not allow for this to be looked at meaningfully. Cold storage of food temperatures were assessed however. They were generally but not totally compliant. Discussion with a staff member showed that support is required to help some staff understand what the safe temperature ranges are for the fridge and freezer and what their role is in the event of temperatures being found to be unsafe. The environment also was not fully assessed but a brief tour showed that some previous requirements have been met providing a safer and more pleasant home for service users. A new freezer has been purchased. The rear garden fence has been mended and garden debris removed. The bathroom door lock has been repaired providing greater privacy for service users. Windows were clean and are included in a regular cleaning programme now. A letter obtained 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 20 by the manager states that communal decorating and ramps would be provided. In the absence of the provision of target dates for this, the Commission for Social care Inspection has provided dates, which must be complied with. Staff have tried to make improvements themselves by decorating a service users bedroom. Their efforts are to be applauded but the outcome is not as it would be if a professional decorator was to be employed. Furthermore decorating is not the role and responsibilities of care staff. The manager was unsure what the home’s insurers position would be in the event of a carer sustaining an accident whilst decorating. A staff member said the premises need a ‘face lift’. The Inspector agrees with this judgement. Wallpaper is considerably peeling in communal areas. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, Staffing levels and structures are under review and have been adjusted to meet the reduction in service user numbers. Some staff are working without being fully and appropriately trained including high risk areas such as induction for new staff, moving and handling, fire training. This puts service users at risk. EVIDENCE: Staffing levels were not fully assessed but were discussed at the Acting Manager’s request. The home is currently under occupied accommodating 2 service users. Two staff are being provided. One service user requires 2 staff to support his personal care at limited times during the day. The new Manager is reviewing staffing hours currently. She has requested an increase in the budget to fund an additional 35 care hours and is awaiting a decision. She is reviewing the use of night care hours with a view to transferring night care hours to days. Her preferred model of staffing will mean that 4 staff will be provided from 8am until 10pm. This would mean the manager working as the 4th staff member for limited periods. The rota has improved with staff designations and hours included within it. The Acting Manager is aware of the need to start to include staff full names. She was further advised to ensure that the rota distinguishes between when she is providing care and when she is providing management hours. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 22 The staff training budget is centralised. Early following her appointment the new Acting Manager met with the training officer to audit gaps in training provision for staff. She has updated the team-training matrix and agreed a plan with the training officer to meet gaps identified. A night staff member appointed 6 months earlier has not received induction training to the required standard. Why not is unknown as the Inspector was informed that the Learning Disability Award Framework induction training is the system used by the provider to support new staff. This new staff member has also not been provided with moving and handling training which is unacceptable and leaving service users who are moved and handled during the night at risk. The Acting Manager assured the Inspector that she only works with a colleague who has the appropriate training but this remains insufficient and are risks that the manager will need to be mindful of whilst considering reducing the night staff ratio. This staff member was on target to have attended the minimum 5 training days per year although not all training attended was evidenced. She had also attended none core training. Medication training has been provided but it is not known if this training is accredited. Fire training has improved since the last inspection when an immediate requirement for improvement was issued. The Inspector expressed concern however that a staff member specifically identified as part of the immediate requirement to receive fire training had refused to do so (according to the acting manager – there was no note on the staff members personal file) and continued to work between August and December without sufficient fire training. This left the provider in breach of the immediate requirement without action having been identified as required by the provider, without action having been taken and without the provider informing the Commission for Social care Inspection of the immediate requirement breach. A service user was admitted to the home with pressure sores without staff or the Acting Manager subsequently appointed having received training in tissue viability awareness. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 This inspection has identified many improvements made by the new Acting Manager. It has also identified areas of omission and learning for the new Acting Manager to address to evidence that the home is well run. No evidence was offered to demonstrate any self-monitoring by the home. EVIDENCE: The home has been without a registered manager for sometime. The previous application received by the Commission for Social Care Inspection was withdrawn and a second Acting Manager appointed, Hayley Whitehouse who took up post in October 2005. Ms Whitehouse informed the Inspector at inspection that she intends to apply for registration and has obtained the necessary forms. Ms Whitehouse informed the Inspector that she has obtained NVQ 4 in Care and is working towards the Registered Managers Award although this was not verified. She said she has ten years relevant experience including 6 years with the current provider in three different units including both residential and day care. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 24 Ms Whitehouse presented as well prepared for the inspection with a clear sense of what she wanted the inspection to achieve. She demonstrated that she has made many improvements in the eight weeks that she has been in post. She demonstrated that she had gained learning from the outcomes of inspection where feedback showed concerns particularly in relation to the management of changes in the health of service users. Where service users did not have contracts of residence she set about achieving this during the course of the inspection clearly communicating to head office what she wanted and why and achieved her objective. Staff spoken to said that she is a good manager who tells them when something is not right. The provider has a quality assurance tool. The new acting manager said that she has completed the tool and sent it to the area manager without keeping a copy. Therefore there was no evidence available on the premises. She said that the views of third parties had been sought but again the evidence was not available. Two comment cards were completed by relatives and returned to the Commission for Social care Inspection in preparation for this announced inspection. Both were satisfied overall with the level of care provided. One was not aware of the complaints procedure and said they didn’t have access either to a copy of the inspection reports on the home. Standard 42 was only assessed in relation to progress made to meet previous requirements. Fire training had improved following immediate requirement but had not been fully met at the time. Not including staff now away from work on maternity leave all staff have had fire training. The provider must demonstrate that it takes action where staff refuse to attend mandatory training. Water systems have been chlorinated but there was not a bacteriological report available. There was some evidence that a five-year total electric test had been carried out in November 2005 but no certificate was available for this. Contrary to previous requirement not all water outlet temperatures comply with the safe range. One-bedroom temperature records consistently show as being between 44 – 46 degrees rather than 38 – 43 degrees. The acting manager said that she had sought advice and had been advised that staff are taking temperatures without letting the water run first. The Inspector advised that water temperatures must always comply as service users are likely to burn themselves when first turning the tap on and should not have to let water run before the temperature is safe. Staff have not received sufficient updates in Moving and Handling training. Training was booked for 12.12.05 but cancelled. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 1 2 1 1 Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 2 15 2 16 2 17 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 23 Barncroft Street Score 3 1 x x Standard No 37 38 39 40 41 42 43 Score 2 x 1 x x x x DS0000004840.V264890.R01.S.doc Version 5.0 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 15 Requirement Care plans informed by risk assessments and Preadmission assessments carried out before admission must be in place prior to admitting new service users Timescale for action 31/12/05 2 YA3 14(1)(d) New Requirement at December 2005. 31/12/05 The registered person shall not provide accomodation to a service user at the care home unless, so far as it shall have been practical to do so – the registered person has confirmed in writing to the service user that the home is able to meet the service users assessed needs. Copies of letters sent must be retained on the premises. New Requirement at December 2005. Potential new service users must be offered the opportunity to visit the home prior to deciding to move in. Trial visits must be recorded. 3 YA4 12 31/12/05 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 27 Any reasons for not providing trial visits must be accounted for. New Requirement at December 2005. The terms and conditions of residency contract between the provider and the service user must be reviewed to comply with all aspects of Standard 5 and 16.11 Contracts must be held for all service users on the premises. New Requiremet at December 2005. Risk assessments in place for 31/12/05 bedrails must be reviewed and developed to address reasons for use and safety risks during use with safe systems identified for all risks. All staff must read and sign all risk assessments to evidence famliarity and understanding.# New Requirement at December 2005. The Acting Manager is advised to review the day activities for service users and explore the option available in terms of external support / provision To ensure individual activity plans are produced with regards to day care, which are up to date and wholly reflect residents needs and wants. To ensure that activities are fully evaluated. The Acting Manager is required to investigate the reason for the none provision of a holiday to DS0000004840.V264890.R01.S.doc 4 YA5 5 31/03/06 5 YA9 13(4) 6 YA12 12, 16 31/01/06 7 YA14 12, 13 31/01/06 23 Barncroft Street Version 5.0 Page 28 one service user during summer 2005 and to state in writing to the Commission for Social care Inspection future holiday plans for this individual. New Requirement at December 2005. Arrangements for contact with 31/01/06 family must be reviewed for each service user, any agreements recorded in the care plan and contact clearly evidenced to facilitate easy monitoring of the plan’s effectiveness. New Requirements at August 2005 Nutritional risk assessments must be undertaken for each service user and any risks must be included in a plan of care which must be carried out, reviewed and evidenced. All service users must be regularly weighed and the results must inform the risk assessment and plan of care. Requirements made August 2005 To ensure that specialist services (e.g. dietician) are consulted with a view to risk assessing and implementing any dietary constraints or weight reducing measures. The provider must ensure that action is taken to ensure health provision is improved. A written action plan is required to demonstrate what steps will be taken to ensure that: Changes in service users health are recognised and acted upon 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 29 8 YA15 12, 15 9 YA17 Sch 3 (3)(m) 13(4) 13 31/01/06 10 YA19 12 31/01/06 11 YA19 13 31/01/06 without delay. That the need for pain control is identified without undue delay and referred for medical attention. Nutritional risk is properly assessed and action taken to meet any identified risk. Tissue viability awareness training is provided for the Acting Manager, senior staff and the care staff. All routine health screening will be provided to all service users. New requirement at December 2005. The Provider must confirm in writing to the Commission for Social care Inspection whether medication training provided is accredited. New Requirement at December 2005. The home’s adult protection policy must contain reference to the Protection of Vulnerable Adults list and its relevance The home’s Adult protection procedures must make it explicitly clear what is expected of staff and managers in the event of service users permission to report incidents / allegations of abuse being refused. New Requirement at August 2005 The manager must ensure that a maintenance programme is developed to include a plan with targets dates to address the following: DS0000004840.V264890.R01.S.doc 12 YA20 13(2) 31/01/06 13 YA23 13 31/03/06 14 YA24 23 30/04/06 23 Barncroft Street Version 5.0 Page 30 · Redecoration of communal rooms as a priority. · The provision of ramps to exit the premises in the event of fire as per fire risk assessment. New Requirement at August 2005 At December 2005 target dates not provided. Work must therefore be completed by end of April 2006. The manager must take steps to improve infection control practice. 15 YA30 13(3) 31/01/06 16 YA33 18 New Requirement at August 2005 and not assessed at December 2005. To ensure that vacant carers 31/01/06 posts are recruited to and all shortfalls in staffing provision are addressed. At December 2005 not met but progress made.(One new staff member to start 19.12.05 and one awaiting CRB clearance) The provider is required to 31/01/06 confirm in writing to the Commission for Social care Inspection its chosen model of staffing level provision demonstrating how this will meet the assessed needs and dependencies of services users. New Requirement at December 2005. 17 YA34 18 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 31 18 YA35 18 New staff must receive appropriate induction training (LDAFF) within 6 weeks of appointment. New Requirement at December 2005. 31/01/06 19 YA37 9 An application for registration as Manager must be forwarded to the Commission for Social care Inspection without delay. New Requirement at December 2005. The acting manager should consider ways in which service users and their relatives / representatives can be part of the quality assurance system, and ways of sharing the outcomes of the process with relevant persons and stakeholders in the home. Requirement first made February 2005 31/01/06 20 YA39 24 31/03/06 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 32 21 YA42 23(4)(d) Fire training for those staff that have not received fire training ( D.R.) must be booked by 12 August 2005 with the training date and staff names confirmed in writing to the Commission for Social Care Inspection by this same date at 4.30p.m. New Requirement (Immediate notice) at August 2005 – not fully met by December 2005. The provider must confirm in writing to the Commission for Social care Inspection proposed action in respect of the ommission which has lead to a breach in this immediate requirement.(D.R. not received training at December 2005) New Requirement at December 2005 A five-year total electric installation test must be provided to the Commission for Social Care Inspection by the date given. New Requirement at August 2005. Not certificated at December 2005. Water outlet temperatures must all comply with the recommended safe range. Action must be taken without delay when water temperatures do not comply with the safe range. Cold storage temperatures must be taken and recorded accurately twice per day and action must be taken when temperature does not comply 31/01/06 22 YA42 23 13(4) 31/01/06 23 YA42 13(4) 13(3) 23/12/05 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 33 with the safe and legal range. New Requirement at August 2005 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 YA18 YA32 Good Practice Recommendations In the interests of service users dignity, it is recommended that the stock of incontinence aids are stored discreetly in the bathroom rather than on display. That the home continues to work toward meeting Sector skills workforce targets of 50 of care staff having achieved an NVQ level 2 or above by 2005. 23 Barncroft Street DS0000004840.V264890.R01.S.doc Version 5.0 Page 34 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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