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Inspection on 11/02/08 for 24 Upland Road

Also see our care home review for 24 Upland Road for more information

This inspection was carried out on 11th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 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

Information about the home has been updated and is available in the hall for people to read. The service user guide has pictures to help people to understand the information more easily. Care plans are in place for everyone, containing good levels of information for staff to meet people`s needs well. New staff are encouraged to read care plans so that they can provide the correct care and support. People are encouraged to take part in the life of the home, including setting tables, returning crocks to the kitchen and making drinks. People are supported to shop for their own clothes and to visit the barbers and hairdressers. The staff are friendly and respect people`s privacy and dignity, e.g. by knocking on their doors before entering and closing doors when supporting people with personal care tasks. Systems are in place for recording and accounting for medication. Any old unused medication is returned to the chemist promptly so that it is not used by mistake. Complaints procedures are in place at the home. A copy of the complaints procedure is available in the service user guide in the hallway and the acting manager said that she would be sending relatives an updated copy of the service guide for them to refer to. Staff are being provided with access to Health and Safety related training courses and are supported to complete National Vocational Training courses so they are equipped for their work at home. Managers` carry out a number of audits and checks to make sure the home is running properly. A senior manager visits the home each month to ensure the home is running well and to check that any shortfalls are addressed by the acting manager.

What has improved since the last inspection?

Since the last inspection work has taken place to repair the wardrobe handled and vanity unit doors in one person`s bedroom, noted in the last report. A part of the rear garden has have been developed into a sensory area to make the garden more interesting for people at the home. Fire drills are being routinely carried out and staff have received fire safety training to keep people safe in the event of a fire at the home. Prevention of vulnerable adult abuse training ahs been provided to staff at the home so that they are better equipped to protect people from harm. The staff showed a good awareness of how they should report any concerns should this be necessary.

What the care home could do better:

There a number of staff without epilepsy and epistatus training and consequently they are not able to administer the necessary medication to a person at the home, in the event of a seizure. This could lead to unnecessary, avoidable admissions to hospital for the person concerned. Hence there is a need for training to be provided promptly. People are provided with some support to get out and about but there is scope for offering new activities to try and encourage people to get out more often and enjoy a more varied social life. There is a recommendation for staff to receive equality and diversity training. This training reinforces the need for staff to see people as individuals with their own specific needs and wishes.The acting manager said that she would introduce a shift check of all "as needed" medications to ensure that tablets that are just given out occasionally, such as paracetamol are accounted for everyday, so that any errors can be traced very quickly. The acting manager plans to leave the home shortly for another job and reports that recruitment to the manager`s post is already underway.

CARE HOME ADULTS 18-65 Upland Road, 24 Selly Park Birmingham West Midlands B29 7JR Lead Inspector Kevin Ward Key Unannounced Inspection 11th February 2008 08:30 Upland Road, 24 DS0000016883.V357132.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 Upland Road, 24 DS0000016883.V357132.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. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Upland Road, 24 Address Selly Park Birmingham West Midlands B29 7JR 0121 415 5389 0121 415 5389 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) londonroad@tiscali.co.uk Milbury Care Services Ltd vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Upland Road, 24 DS0000016883.V357132.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 6th November 2006 Brief Description of the Service: 24 Upland Road is registered to provide accommodation, care and support for up to six people with learning disabilities. The house is a substantial two-storey detached property and is located in an established residential neighbourhood in the Selly Park district of Birmingham. There are six single bedrooms, two of which are on the ground floor. Rooms have wash hand basins, but none have en-suite facilities. Downstairs is the large kitchen, separate dining room and lounge. There is an additional room at the rear of the house which is used as a quiet room, for activities and as an extra lounge. The house has a bathroom on both floors, each having bath, sink and toilet. The bath on the ground floor has assisted facility. There is an additional w.c. upstairs also. Staff accommodation and the office is also located on the first floor. The house is set in its own grounds, and has the benefit of a secure and private garden to the rear of the property. At the front of the house, in addition to the garden, is a large drive offering off-road parking. There is a good range of local amenities and community facilities close to the home, which is well served by public transport. The fees for the staying at the home, published in the Statements of Purpose is £1,253.17 per week. People pay a contribution to the fees based on a personal financial assessment. The people living at the home pay a contribution to the cost of the home’s vehicle and pay for personal items, such as clothing, toiletries and entertainments. The fees noted above were relevant at the time but people may wish to obtain more up to date information directly from the home. Upland Road, 24 DS0000016883.V357132.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 one star. This means that people who use the service experience adequate outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Questionnaires were completed and returned by the three people that live at the home, with support from staff. Two health professionals also completed questionnaires giving their views of the service. The inspection included meeting everyone living at the home and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how their needs are met in practice. Discussions took place with three staff on duty and the acting home manager, who is covering at the home following the recent departure of the manager. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Information about the home has been updated and is available in the hall for people to read. The service user guide has pictures to help people to understand the information more easily. Care plans are in place for everyone, containing good levels of information for staff to meet people’s needs well. New staff are encouraged to read care plans so that they can provide the correct care and support. People are encouraged to take part in the life of the home, including setting tables, returning crocks to the kitchen and making drinks. People are supported to shop for their own clothes and to visit the barbers and hairdressers. The staff are friendly and respect people’s privacy and dignity, e.g. by knocking on their doors before entering and closing doors when supporting people with personal care tasks. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 6 Systems are in place for recording and accounting for medication. Any old unused medication is returned to the chemist promptly so that it is not used by mistake. Complaints procedures are in place at the home. A copy of the complaints procedure is available in the service user guide in the hallway and the acting manager said that she would be sending relatives an updated copy of the service guide for them to refer to. Staff are being provided with access to Health and Safety related training courses and are supported to complete National Vocational Training courses so they are equipped for their work at home. Managers’ carry out a number of audits and checks to make sure the home is running properly. A senior manager visits the home each month to ensure the home is running well and to check that any shortfalls are addressed by the acting manager. What has improved since the last inspection? What they could do better: There a number of staff without epilepsy and epistatus training and consequently they are not able to administer the necessary medication to a person at the home, in the event of a seizure. This could lead to unnecessary, avoidable admissions to hospital for the person concerned. Hence there is a need for training to be provided promptly. People are provided with some support to get out and about but there is scope for offering new activities to try and encourage people to get out more often and enjoy a more varied social life. There is a recommendation for staff to receive equality and diversity training. This training reinforces the need for staff to see people as individuals with their own specific needs and wishes. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 7 The acting manager said that she would introduce a shift check of all “as needed” medications to ensure that tablets that are just given out occasionally, such as paracetamol are accounted for everyday, so that any errors can be traced very quickly. The acting manager plans to leave the home shortly for another job and reports that recruitment to the manager’s post is already underway. 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. Upland Road, 24 DS0000016883.V357132.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 Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with updated information and contracts about the home so that everyone is clear about the service people are entitled to from the home. EVIDENCE: The service user guide and the statement of purpose have been updated and reviewed to give clear information about the service provided at the home, including the fees for the service. Copies of these documents are ondisplay in the front porch for people at the home and visitors to look at. The manager also agreed to send copies to relatives so that they have a copy of their own. The service user guide has been illustrated with pictures to help to make it easier for some people to read and understand. No new people have moved into the home since the last inspection. The manager confirmed that anyone new would be provided with opportunities to visit and stay overnight so that their needs could be assessed and to check that they get on well with others living at the home. This practice was carried out with the last person admitted to the home, prior to the last inspection. Contracts have been issued to people this year with updated information regarding fees and charges. One person’s contract was seen to have been Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 10 signed. The manager explained that this is because the person concerned does not fully understand the contents of the contract; consequently she will be arranging for a relative to sign to show that proper consultation has taken place. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are planned for and reviewed and they are encouraged to make everyday decisions so that their needs can be met in the way they like. There is scope for improving the decision making process to include other professionals, where there may be concerns about a people’s capacity to make an informed decision e.g. refusing health care tests. EVIDENCE: Two people’s care plans were checked and information from another person’s file was sampled. Both care plans contain very detailed information to enable staff to meet people’s needs sensitively. In addition to information about people’s care needs the care plans also contain helpful information about their preferred routines and the order in which they like things done. This is particularly beneficial for people who cannot easily verbally explain what they want so that their wishes can be respected. On the morning of the site visit, a person at the home was seen to receive the support they requires in the Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 12 fashion that is detailed in their care plan. Staff confirmed that they have seen people’s care plans and entries in staff meeting records show that the acting manager has impressed upon staff the need to read and closely follow people’s care plan when carrying out personal care support. Communication passports are also in place for people at the home, which provide a helpful insight into the non-verbal gestures and behaviour that people use to express their needs and wishes. One person was kind enough to share the contents of their communication passport at lunchtime. People’s care plans explain how personal care tasks are to be carried out safely and good work has take place to cross reference many aspects of the care plans with risk assessments. The care files contain a good range of risk assessments, taking account of people’s personal needs and hazards associated with everyday living, e.g. epilepsy, stairs, car foot spa, money management and slips and falls. Care plans are being dated to show that the documentation has been reviewed and updated, as necessary. Personal plans involving the setting and review of personal goals are also being reviewed. Letters and meeting records indicate that people’s relatives are encouraged to attend and take part in these meetings where they are able to do so. Meetings are being routinely held with the people at the home (notes seen) to check that they are happy and to discuss everyday issues that affect them. A member of staff explained that he also meets with people to plan their personal menus. This was also confirmed by a person at the home. A box containing pictures of meals was seen that one person uses to help them to choose their favoured meals. A board was seen containing pictures of staff on duty for the day so the people at the home are made aware of the staff that will be supporting them. Two people have recently been supported attend well person checks but have declined to undergo the necessary examinations required. This has been recorded in their care plans but there remains a need for decisions about future checks to be recorded in a way that is in keeping with the requirements of the Mental Capacity Act. The acting manager agreed to refer the two people concerned to psychology services with a view to making a multi disciplinary decision about future health checks. This should enable relevant professionals and relatives to arrive at a decision as to whether proceeding with tests, on the basis people’s “best interests” is necessary at this stage. The acting manager agreed to ensure that the outcomes of the decision making are documented. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is scope for increasing the range of leisure activities and options for going out more so that people enjoy a better social life and involvement in the community. People are involved in menu planning so that they enjoy the food provided at the home. EVIDENCE: The staff and the acting manager were seen to be responsive to people’s needs and to encourage them to make choices and decisions, e.g. about when they bathed and what they ate for breakfast. Everyone is encouraged to take part in everyday living chores to foster independence and a sense of belonging. People were seen to take part in clearing tables, returning crocks to the kitchen, loading the dishwasher and other tasks. One person was observed to make a cup of tea for herself and a friend at the home and to help herself to a piece of fruit. People also confirmed that they take part in cleaning their bedrooms and Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 14 other parts of the home. Everyone looked very comfortable and relaxed in the home and at ease with the staff that support them. None of the current people at the home attend day services and rely on the support of staff at the home to go out places. Entries in people’s activity records indicate that they are not supported to go out very often. One person likes to stay at home a lot of the time and this is recorded in their care plan. The acting manager said that another person at the home is also not very keen to go out a lot either due mainly to choice. A person’s care plan states that a fondness for playing music, which they were seen to enjoy doing during the site visit. Entries in one person’s records show that they are supported to go out several times a week for personal shopping and go for a cup of tea or go to McDonald’s, where they choose to eat. This also involves catching the bus on occasions. The person concerned also confirmed that they also buy some small items of grocery shopping for the home on some occasions and like to go to the library. However in most cases, people’s records show that they stay at home a lot of days and do not venture out. The acting manager explained that two people have shown by the reactions, e.g. anxiety that they do not enjoy going on holiday. Occasional trips out are arranged for people, such as a recent trip to the Safari park. The acting manager said that plans are in place to help a person celebrate their Birthday at the home the following day, including an Indian buffet, in keeping with the person’s favourite food choices (recorded in care plan). One person likes to stay with a relative at the weekends and another person receives some contact from relatives. Letters and entries in people’s records show that the home encourages relatives to remain involved where possible. Comments by people at the home and the acting manager confirmed that people are supported to use the local barbers / hairdressers for their haircuts and receive support to shop for personal toiletries and clothing. A large choice of cereals were seen to be available for people to choose from at breakfast time and one person was seen to enjoy an unhurried and relaxed breakfast including toast and cereals of choice. Choice menus were seen for each person at the home. A person at the home confirmed that they had recently been asked about their favourite foods for the menu. The menus are planned so that where people’s preferences overlap, (e.g. chicken dinner) the same meal is cooked for all on the same day. However where this is not in keeping with people’s wishes separate meals are cooked. Evidence of this was seen on the menus. One person likes to eat mostly vegetarian and soft foods. This was recorded in the care plan and Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 15 reflected on the menu plan. The acting manager explained that where necessary the home has made use of the dietician service to support a healthy diet. This is also verified in a questionnaire returned by the dietician. A person at the home confirmed that they like the food cooked provided. Snack foods, such as crisps and biscuits were available for people to eat at the home, as well as fresh fruit. One person was seen to make several cups of tea and drinks were frequently provided for other people at the home. . Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at the home are provided with the support they need to meet their personal care needs. The rating for this group of Standards has been undermined by the slow provision of medication and epilepsy training for new staff and the potential implications this holds for avoidable admissions to hospital. EVIDENCE: Staff were seen to be mindful of people’s privacy and dignity. One person had a sign on her door asking that she be left alone. All personal care tasks were carried out in privacy being closed doors and a staff member was seen to vacate the bathroom to allow a person to complete some aspects of personal care in private. The acting manager explained that the home seeks to respect the gender care preferences of people. This is also recorded in their care plans. Where there is a need for staff of the opposite gender to provided personal care a record is kept as evidence of this fact. Everyone at the home was observed to well groomed and dressed in age appropriate, well-laundered clothing. This indicates that people are supported to take a pride in their appearance and maintain a good self-image. Comments Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 17 by the acting manager and a person at the home confirmed that people are encouraged to adopt age appropriate bedtimes. Entries in people’s records show that they are supported to gain access to advice from health professionals where necessary, such as consultants and nurse specialists to monitor their health needs. Similarly support is provided for people to attend routine health checks, such as dental checks, eye tests and well person checks. As previously noted two people have rejected some checks and the acting manager has agreed to seek a multi disciplinary involvement to reach a decision as to whether any further support needs to be given to encourage the people concerned to attend the checks. Questionnaires returned by two healthcare professionals indicate that the home acts on the advice provided and seeks support where necessary, e.g. dietician advice. A medication cupboard is in place for the safe storage of medication. The cabinet was well ordered and clean. Recent medication sheets were sampled. The records indicate that prescribed medication is being properly recorded into the home so that the number of tablets can be accounted for on the medication sheets. Protocols are in place explaining the reasons for that medication is given and how people like to take their medication. Three boxes containing “as necessary medications” were checked. Two medication boxes were found to balance accurately with the record sheet but in one case four paracetamol could not be accounted for. A recent audit completed by the acting manager showed that the tablets had correctly balanced at the start of the month. Since the site visit the acting manager said that she would be introducing a twice-daily medication audit to more closely account for all “as necessary” medications. A senior member of staff on duty confirmed that safe handling of medication training has previously been provided and a competency assessment is carried out for all staff giving out medication in addition to test based on the home’s own procedures. This was verified in discussions with the acting manager and staff training certificates. Currently only five staff, including two night staff have completed medication training though the manager said that more training is being planned. The acting manager said that this would take place shortly, as soon as the correct training is available on the organisation’s computerised system, the “L box”. Safe practice protocols, signed by a nurse, are on the file of a person with epilepsy, to support staff in the safe administration of midazolam medication. Currently only four staff including the acting manager have received Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 18 “epistatus” training, necessary to give this medication safely. The acting manager explained that the nurse cannot provide this training until staff have received medication and epilepsy training to underpin their knowledge. Medication training planned for 21st January 08 was cancelled, as there are plans for this training to be provided by home a computer package, which should be up and running very shortly. Two staff spoken to said that in the event of the person having a seizure they would dial 999, for an ambulance, as recorded in the epilepsy protocol. This occurred recently and the person was admitted to hospital. This may have been avoided had more staff already received the appropriate training. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable procedures are in place for dealing with complaints and staff are trained to recognise and report suspicions of abuse to ensure that the people living at the home are kept safe from harm. EVIDENCE: There have been no complaints made to us since the last inspection and the manager reports that no complaints have been made directly to the home during the same period of time. The complaints log was checked and verifies that previously complaints have been properly recorded and followed up, indicating that complaints are taken seriously by the home. An easy read version of the complaints procedure including pictures and symbols is available for people in the home and the service user guide contains a copy of the complaints procedure. The manager said that she intends to send out a copy of the service user guide to relatives again shortly to keep them updated. Staff confirmed that they are provided with vulnerable adult abuse training. This was verified in a sample examination of staff training certificates and training records. Staff also confirmed that they had seen the adult abuse and whistleblowing procedures informing them how to report any suspicions of abuse or other concerns about the running of the home, should they need to do so. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 20 “protection from abuse” also features as a topic within the home’s induction programme that staff complete when they start at the home. The acting manager confirmed there have been no allegations of abuse since the last inspection that would require further investigation. Lockable storage arrangements are in place for the safekeeping of people’s money. Two people’s expenditure records were checked. The records account for people’s personal money and receipts were seen to tally against the records. The manager also completes a financial return, as part of the financial procedures, accounting for people’s money at the home. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a clean and comfortable, well maintained home that meets their needs. EVIDENCE: 24 Upland Rd is a detached house that fits in well with others in the street. Overall it looks well maintained and is comfortably furnished. Many of the rooms were decorated last year, including the small lounge, hallways, stairs and two bedrooms. The acting manager said that she plans to redecorate the main lounge in the coming year. All except one person’s bedroom was seen because the person concerned was relaxing and wanted to be left alone. The bedrooms are well decorated and suitably furnished to meet people’s needs. People have been supported to personalise their bedrooms to be as they like them, e.g. with pictures music Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 22 playing equipment and lights. All bedrooms are for single use, all have locks on doors should people wish to use them. There are no en-suite facilities but there is a bathroom on each floor – an assisted Aqua bath on the ground floor and unassisted bath on the first floor with plans to convert it to an assisted facility. There are 3 toilet areas. There are no shower facilities. The facilities are adequate for the number of residents. Since the last inspection good work has taken place to develop a sensory garden for the home. There is a front garden has a bird table used to feed the birds. A person at the home was seen to enjoy taking bread out for the birds after lunch. A cleaning schedule is in place that staff sign to confirm that they have carried out cleaning tasks. As previously noted the people at the home are also encouraged to take part in light cleaning tasks, where they are willing to do so. Liquid soap and paper towels were available in the toilets and staff were observed to encourage people to wash their hands when necessary, to support safe hygiene in the home. Staff at the home were seen to make use of protective clothing to when carrying out care and domestic tasks and stocks of aprons and gloves were seen in various areas of the home discreetly stored to staff to use conveniently. The acting manager confirmed that no one at the home has continence needs that would require an assessment or supplies of continence equipment. The laundry room is situated well away from the kitchen and has modern machines that are suitable for washing continence laundry should this be required. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall staff are receiving training to equip them for their work and satisfactory recruitment procedures are in place to ensure that suitable staff are employed at the home. EVIDENCE: The recent rotas show that there are currently two staff on duty morning, evening and weekends. The home also provides a waking night worker and a member of staff sleeping in each night. The staffing arrangements are satisfactory to meet the needs of the people currently at the home. Four staff have left the home four new staff have joined the home since the last inspection. Staff confirmed that they are being provided with routine supervision and access to staff training in Health and Safety related subjects and adult abuse training. This was also verified in discussions with the acting manager relating to the training matrix. Further evidence was also provided by staff training certificates. On the day of the site visit three staff went on autism training after talking with the inspector. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 24 As previously noted only 5 staff have completed safe handling of medication training and four have been trained to give midazolam medication in the event that a person at the home has a severe seizure. The acting manager said that has been no equality and diversity training for staff at the home. This training reinforces the need to see people as individuals with their own specific needs and preferences. A training certificate was seen in a staff file for attendance at attitudes based training last year. There has been no behaviour management training at the home recently. The acting manager said that this is part of the training plan for the home and will be provided during the coming year. The acting manager confirmed that there are no current challenges presented by people at the home that would necessitate urgent training. The acting manager explained that the number of staff holding National Vocational Qualifications (NVQ’S) had reduced since the last inspection, due to staff changes but that new staff were being provided with these training opportunities. The acting manager reports that 6 of the 14 staff used at the home (including 4 bank staff ) staff have now achieved NVQ level 2 and one senior member of staff is completing NVQ level 3. Two more people have been registered to start training and two more are waiting for confirmation of places on a training course. Two staff recruitment records were checked. In both cases the checklists confirm that Criminal Record Bureau checks, POVA first checks (list of banned staff) and references are taken up prior to people starting work at the home. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall suitable arrangements are in place for ensuring a quality service and good systems are in place for maintaining a safe living environment for people. EVIDENCE: The manager left the home recently and an acting manager is covering the service. The acting manager has 22 years experience of working with people with leaning disabilities and is training for the Registered Managers Award. The acting manager also explained that she would be leaving the home in March 08 and that the organisation is already in the process of advertising for a new manager. A range of measures are in place for checking that the home runs properly and for developing the service. The people at the home have recently been Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 26 surveyed (questionnaires seen) and the acting manager said that surveys had also been sent out to relatives and professionals by staff at a central office. The results have been used to contribute to the home’s annual review / development plan, which was seen on display in the hallway for people to read. Weekly Health and Safety audits are being carried out, including checks of first aid boxes and COSSH cupboard, to ensure a safe environment. Weekly medication audits also take place to support safe medication procedures in the home. Daily checks are carried out of the home’s vehicle and twice daily money checks are carried out by staff to account for people’s money effectively. A previously noted staff meetings are taking place on a regular basis and meetings routinely take place involving people at the home to check that they are happy and make plans. Reports of monitoring visits by senior managers are kept in the home. These visits are taking place regularly each month demonstrating that senior managers are maintaining an overview of the work of the home. Health and Safety records were sampled including the fire safety log. The records show that fire alarms are being routinely tested each week and that regular fire drills are carried out each month. Emergency lighting tests are also being carried out each month. Maintenance reports were seen confirming that the fire equipment is checked by a qualified contractor. Fire audits are also being carried out regularly each month to support safe fire safety practices in the home. Maintenance certificates were seen providing evidence that gas and electrical equipment is being checked and maintained. A hot water temperature monitoring record is being kept up to date and indicates that hot water is being kept at a safe, comfortable temperature to avoid the possibility of people being scalded. Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13 (2) Requirement Prompt action must be taken to ensure that medication, epilepsy and epistatus training is provided to reduce the possibility of avoidable admissions to hospital for a person with epilepsy dependent on midizolam medication. Timescale for action 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations Where there is a concern about capacity to consent and to make informed choices, e.g. refusal to undergo health tests, multi disciplinary team involvement should be sought, to agree the most appropriate course of action and the decision should be fully recorded. Action should be taken to increase the range of leisure activities and opportunities to venture out so that people enjoy a more varied social life. Proceed with pans to recruit and register a manager as soon as possible to ensure the home is well managed when the acting manager leaves her post shortly. DS0000016883.V357132.R01.S.doc Version 5.2 Page 29 2 3 YA13 YA37 Upland Road, 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Upland Road, 24 DS0000016883.V357132.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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