Inspection on 30/06/05 for 24 Upland Road

This inspection was carried out on 30th June 2005.

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

Other inspections for this house

24 Upland Road 09/02/09

24 Upland Road 11/02/08

24 Upland Road 06/11/06

24 Upland Road 15/12/05

24 Upland Road 17/11/04

24 Upland Road 30/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Upland Road 24 Upland Road Selly Park Birmingham B29 7JR Lead Inspector Gerard Hammond Announced 30 June 2005 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 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 Stationary 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 E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Upland Road Address 24 Upland Road Selly Park Birmingham B29 7JR 0121 415 5389 0121 415 5389 Telephone number Fax number Email 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 Ltd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. Date of last inspection 17th November 2004 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, dining room and lounge. There is an additional room at the rear of the house which is used as a quiet room, for activies and as an extra lounge. The house has a bathroom on both floors, each having bath, sink and toilet. There is an additional w.c. upstairs also. Staff accomodation 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 by the home, which is well served by public transport. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Direct observation and sampling of records (including personal files, care plans and safety records) was undertaken for the purposes of compiling this report. The Inspector met all of the residents and formally interviewed the Manager. The Organisation’s Service Manager was in attendance for part of the day, and two other members of staff and a visiting therapist were also interviewed informally. What the service does well: What has improved since the last inspection? What they could do better: Good work already done on the development of care plans should now be built upon. This should involve setting some targets and then evaluating them at review, looking to see what has worked, and what needs to be changed. There is also a need to look at how important information relating to people’s care is managed. Personal files should be reviewed, so that only current information is in place, and this needs to be organised in such a way that it is readily accessible at all times. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 6 Senior Managers within the Organisation should take action to ensure that all members of staff have a clear understanding of their responsibilities to undertake training relevant to the work that they do, and allocate priority to achieving this. Resources should be allocated to ensure that the décor, fixtures and fittings in the Home are maintained to an appropriate standard. 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. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 8 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 standard(s) 2, 4 Prospective residents’ appropriately. support needs and aspirations are assessed Opportunities are given for people to visit and “try out” the Home, prior to, and to inform, decisions about placement. EVIDENCE: There have been no new admissions since the last inspection, and there is currently one vacancy. This group of residents, who all have complex and high support needs, have been together for a number of years. Their care needs have been assessed as required. Conversations with the Manager indicated that any prospective resident would be given the opportunity to visit, and to stay at the house, prior to any decision about offering a placement. This exercise forms an integral part of the Organisation’s assessment and admissions process. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 6, 7, 9 Individual plans are based on good assessment information, but some development is required to incorporate goal setting. Residents are helped and encouraged to make decisions, as appropriate, taking account of their complex support needs. Staff support residents to take risks responsibly: some changes are needed to how related information is managed. EVIDENCE: Examination of records makes it clear that a good deal of work has been done to develop care plans. There is good assessment information identifying individuals’ skills, strengths and support needs. This needs to be built on and used to identify goals for incorporation in people’s care plans. Risk assessments are detailed, but need to be cross-referenced to the specific element(s) of the care plan(s) to which they relate, and vice versa. These should be reviewed in conjunction with each other, at least every six months. Records of reviews should indicate who is present, and how decisions are made. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 10 It was also noted that some information had been superseded by newer material, but remained on file. For example, on one person’s file there were a number of places where guidance was given about support required when bathing. It is recommended that only current information be retained on working files, so as to avoid the risk of confusion among care staff. Care plan information also needs to be better organised. Where possible, duplication of information should be avoided. Some of the information contained in risk assessments belongs more properly in the care plan. When dealing with residents whose care needs are as complex as those of the people living in this house, the way in which information is managed assumes a particular importance. This is especially true if the staffing situation makes it necessary to rely on agency personnel. Care plan information needs to be user-friendly and accessible. It has to be acknowledged that the volume of information that has to be kept for people with high support needs makes this a far from easy task. It was recommended that an accurate and detailed index of care plans and risk assessments be maintained to support this process. There is good evidence of efforts being made by staff to integrate personcentred approaches into care plan development, and this is to be commended. Staff should be supported to continue this to an effective conclusion. This will provide additional opportunities for the staff team to consider how best to support residents in choice and decision-making. Staff try hard to respect people’s wishes, encourage their independence and empower them, but the complex support needs of people living in this house make this a very challenging task. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 15, 16, 17 Staff try hard to support residents to pursue appropriate activities and to be part of their local community. Residents’ complex support needs and behavioural patterns sometimes make this difficult. Residents are supported to maintain contact with families and loved ones as much as possible. Staff respect residents’ rights and encourage them to be as independent as their abilities allow. Residents enjoy their food and have access to a varied and nutritious diet. EVIDENCE: Past inspection reports have indicated that residents have opportunities to pursue valued activities. Information provided by the Manager in response to the pre-inspection questionnaire indicates that some residents access local centres and colleges as part of their routine activities. Others have refused the opportunity to do this, preferring to follow chosen interests at home. Staff support residents to access community facilities where possible. A discussion Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 12 with the Manager indicated that there are specific difficulties with this for a number of the residents. Complex support needs and behaviour patterns regularly make this extremely difficult. Staff have to make judgements balancing the desirability of social inclusion for the residents with the distress that often appears to accompany such activity. One resident in particular lives a very reclusive lifestyle within the house, and appears to choose actively to follow this pattern. This was observed directly on the day of the inspection. Other residents have patterns of behaviour that make conventional access to facilities in the community very problematic. Advice and support has been sought from members of the multi-disciplinary team in the past, and the staff team continue to work with these issues as best they can. The complexity of their task should not be understated. The care team actively supports residents to maintain contact with their families and friends wherever this can be facilitated. One person spends weekends at her mother’s home on a regular basis. Another receives frequent visits from his brothers at the house. Some of the residents enjoy being involved doing domestic tasks around the home, and staff were observed supporting them to do this. A rolling menu programme is in operation, but this is flexible according to people’s needs and wishes. Pictorial aides are also available to help people make choices. Most residents take their meals together in the dining room, though this too is flexible. On the day of the inspection visit, the Inspector had lunch with four of the residents and observed staff supporting them to set the table, eat, and clear up afterwards. It was also observed that food stocks were good, with plenty of fresh produce in evidence. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18, 19, 20 Residents receive personal support in accordance with their needs and wishes, and their health needs are met appropriately. Policy and practice with regard to dealing with medication offers residents appropriate protection. EVIDENCE: Members of staff were seen giving support to residents in a warm and friendly manner, which was appropriately respectful and also good-humoured. As referred to above, the right of residents to choose to follow a particular lifestyle is respected. Records indicate that residents are supported to access the services of their doctor and allied health professionals, and there is evidence of significant involvement of members of the multi-disciplinary team. A new format for Health Action Planning has been introduced, and this is to be commended. A visiting therapist was interviewed informally, and she was very positive about the attitude of staff and the way in which support is given to residents. Medication was seen to be stored appropriately, and open containers of creams and lotions properly labelled. A requirement of the previous inspection that individual protocols be put in place for “as required” medicines (PRN) has now been dealt with. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 22, 23 Residents’ communication support needs make it difficult to assess fully whether or not they feel that their views are listened to or not. General policy and practice within the home affords residents with protection from abuse, neglect and self-harm, though some staff have not yet completed appropriate training. EVIDENCE: The Complaints Book was seen: a complaint has been received from a neighbour about the noise that one of the residents makes when she is out in the garden. The Organisation’s Service Manager is currently dealing with this. The communication support needs of people living in the house make it hard to complete an accurate assessment of whether or not they feel that their views are listened to and acted upon. A pictorial version of the complaints procedure has been given to each of them, but it is questionable whether or not this has any real relevance for them personally. Adult protection training has been completed by five members of the current care team, with five more yet to receive it. It is anticipated that this will be dealt with in the near future, under the Organisation’s rolling programme of training. A sample check of residents’ personal money was conducted: the balance tallied with the record, and receipts were available as required. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 24, 28, 30 Residents enjoy the benefit of a comfortable and safe home environment. Some work is required on communal areas of the house, including the garden. The home is clean and tidy. General standards of hygiene are good, but work required in order to improve laundry facilities needs to be completed. EVIDENCE: Residents are able to enjoy living in a home that is fairly spacious, comfortable, and generally well maintained. However, the décor and fittings (particularly in communal areas) are beginning to show their age and arrangements should be made for refurbishment as soon as possible. The garden area and outbuildings are similarly in need of some attention. The gate to the old garage at the side of the house is broken and in need of repair. The former access to the garage from the garden is boarded up and unsightly. It may be that the most appropriate course of action with regard to this part of the building would be to demolish the old wooden garage completely and to secure access to that side of the house and garden with a new fence and gate. Alternative arrangements would then have to be made regarding storage of clinical waste prior to collection, but there is an integral shed / store accessed Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 16 from outside which might be suitable. This should be assessed appropriately and action taken to rectify the existing situation. There are also two old garden benches at the back of the house, which should be disposed of and replaced. Previous inspections have identified issues with regard to the current provision for dealing with laundry, which is unsatisfactory at present. The Organisation has identified funding to build a small extension at the back of the house to accommodate a new laundry, obtained planning permission, and is now in discussion with the Local Authority in respect of certain building regulations. A contractor is on stand-by awaiting clearance from the appropriate department to commence work, and it is anticipated that this should be in the near future. The house is kept clean and tidy, and a good standard of hygiene maintained. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 Some members of the care team are not yet appropriately trained, and this must be rectified. Staff are appropriately supervised and well supported. EVIDENCE: As indicated earlier in this report, some staff have received training in the Protection of Vulnerable Adults From Abuse, but a number have yet to complete this. A requirement was also made at the time of the last inspection with regard to training in Epilepsy, and also Dementia / Alzheimer’s Disease. Conversations with the Manager indicate that while some staff have now done this training, there are still members of the care team who have not, and this must be addressed. Training is offered within the Organisation on a rolling programme, and staff are advised of forthcoming dates, so that they can book places. Senior Managers within the Organisation need to impress upon their employees that this should not be seen as an optional extra. Since her appointment, the Manager has endeavoured to hold formal supervision meetings at appropriate intervals, and currently meets required standards. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42 The home is generally well run, and the management approach is open and inclusive. The new quality assurance and monitoring system should ensure that all residents’ views are taken into account appropriately. General practice within the Home promotes the health, safety and welfare of the residents. EVIDENCE: The current manager has only recently been appointed, but has commenced working towards attaining NVQ level 4, and the Registered Manager’s Award. Although not formally qualified, she has several years of experience working in this field of care, in this Organisation, and specifically with this group of residents. In the relatively short time since her appointment she has clearly worked very hard to meet previous requirements, and has successfully dealt with all of those within her direct control. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 19 The style of management within the Home appears relaxed, open and inclusive, and the members of the care team have a positive attitude towards developing their service for the benefit of the people in their care. A new quality assurance and monitoring system is being implemented by the Organisation across all its homes in the near future. It will be important that due consideration is given with regard to representing the views of residents who have communication support needs, when this is put into practice. Records relating to servicing and testing of the fire alarm and fire-fighting equipment, and emergency lighting systems were checked and found to be in order. Four fire drills have also been carried out since the last inspection. Records of temperature tests on the fridge and freezer, food and calibrator, and water outlets were also seen to have been appropriately completed. Portable appliance testing of electrical equipment has been completed, and the hard wiring certificate is in date. A requirement was made that the rain water butt in the garden should be covered and secure. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 20 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 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 2 x 2 Standard No 11 12 13 14 15 16 17 x 3 x x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Upland Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x 3 x E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 21 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 YA 6 & 9 Regulation 15 & 13 (4) Requirement Further develop individual care plans to incorporate goals. Cross-reference care plans with relevant risk assessments, and vice versa. Review whole care package at least every six months, with written record indicating who takes part and how decisions are made. Ensure that all staff complete training in Adult Protection. Produce a plan for refurbishment of communal areas in the house. Assess repairs / maintenance required on wooden garage at the side of the house and arrange for work to be carried out. Remove / replace old garden benches. Complete work on laundry extension. Ensure that outstanding training is completed by all staff members. Complete an application to register the Manager and forward to CSCI. Implement Quality Assurance and Monitoring System and ensure that views of residents Timescale for action 30.09.05 2. 3. YA 23 YA 28 18 (1c) 23 (2) 30.09.05 30.09.05 4. 5. 6. 7. YA 30 YA 35 YA 37 YA 39 13 (3) & 23 (2a) 18 (1a) 8&9 24 (1-3) 30.09.05 30.09.05 31.08.05 31.08.05 Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 22 8. YA 42 13 (4c) with communication support needs are represented appropriately. Ensure that rain water butt in the garden is securely covered. Within 1 day 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 YA 6 & 9 Good Practice Recommendations Ensure that only current information is retained on working care plan files. Maintain an up to date index of care plans and risk assessments for ease of reference. Continue development of person-centred approaches and integrate with care plans. Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ 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. Extracts may not be used or reproduced without the express permission of CSCI Upland Road E54 S16883 Upland Road 24 V227197 300605 Stage 4.doc Version 1.30 Page 24 - 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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