Inspection on 06/11/06 for 24 Upland Road

This inspection was carried out on 6th November 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

24 Upland Road 09/02/09

24 Upland Road 11/02/08

24 Upland Road 15/12/05

24 Upland Road 30/06/05

24 Upland Road 17/11/04

24 Upland Road 30/06/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Upland Road, 24 Selly Park Birmingham West Midlands B29 7JR Lead Inspector Peter Dawson Key Unannounced Inspection 6th November 2006 09:00 Upland Road, 24 DS0000016883.V313302.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.V313302.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.V313302.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 Limited Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Upland Road, 24 DS0000016883.V313302.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 15th December 2005 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. Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector over a period of 8 hours from 9 am – 5 pm. A pre-inspection questionnaire was received from the service and also considerable other written information from the home which was helpful and forms part of the information in this report. Written feedback to the Commission was received from all 5 residents, from 2 relatives and 4 Health professionals: GP, Aromatherapist, Continence Advisor, and Optician. There was an inspection of the whole of the physical environment. All residents were seen and time spent in communication with them both separately and together. Observations of interactions and communication methods between residents and staff were important due to the limited verbal communication skills of some residents. Records were seen in the home relating to the inspection process. Upon arrival at 9a.m. some residents were up having breakfast others rising, one remained in bed. When later asked to rise by staff she refused and refused her medication. Staff later returned and persuaded her to rise, she had her medication and prepared her breakfast with staff oversight. The 2 staff on duty were new to the service but had a very professional approach in a relaxed way with the residents and had clear knowledge of the needs of all residents. A third member of staff had phoned to report absence earlier. Engagement was good and staff dealt with difficulties as they arose in a sensitive, competent way. Three residents have limited verbal communication but alternative means of communication were used. They appeared happy with their environment and several showed their bedrooms with clear pride of ownership. Throughout the day residents responded to staff positively and smiled many times even when they were persuaded to take a different course of action from their chosen one. Pictorial written feedback forms from all residents returned to the Commission included comments as follows: “I can make my feelings known to staff through my behaviours and body language” “ I don’t know how to make a complaint in writing. I make staff aware I am not happy through my behaviours, staff will advocate for me”. Comments were generally very positive. One resident said “I would like more support workers and drivers, I would like to go out a lot”. Two relatives provided written feedback direct to the Commission (there are only 2 residents with relatives). Both were satisfied with the overall care at Upland Road. One commented on the need for more drivers to increase access to the community. One said “the home is always nice & clean and the staff are helpful and friendly” Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 6 The visiting GP was satisfied with care provision and good communication with staff. The Continence Advisor commented: “Very impressed with procedures for toileting residents, they are very successful, documenting daily charts for individual continence monitoring” The visiting Aromatherapist said: “I visit one client and feel that her views are respected and taken into account when planning her day-care, home visits etc. Her privacy is respected at all times” The Optician reports: “A very well run home. Residents are cared for very well” The above views were confirmed during the inspection from observations and discussions with residents and staff. The fees for the home are reported to be £1,117.82 per week and £100 for transport costs. (this information taken from the pre-inspection questionnaire and Statement of Purpose.). What the service does well: What has improved since the last inspection? Individual care plans have continued to develop and incorporate goals which can be measured. Risk assessments are good and now cross-reference to areas of the care plans. Dated information has been removed from the files. The home now has a renewal/maintenance plan for the future. There has been redecoration of the hall, landing, stairs, corridor areas, kitchen, small lounge and two bedrooms. All areas are now decorated to a high standard. A new carpet has been fitted to the rear lounge area. The recently build laundry to the rear of the house is now operational and vastly improves the conditions and areas of infection control and hygiene. Residents can now safely access the laundry and some able to launder with staff supervision. Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 7 The home has produced a report following the Quality Assurance monitoring system. This reflects the views of residents. What they could do better: 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, 24 DS0000016883.V313302.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.V313302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1–5 The quality of these outcomes are good This judgement is made using available evidence including a visit to the service. There is adequate information to enable choice of home. Introductions seemed brief and a formal post-placement review involving resident and other professionals was not evidenced. EVIDENCE: There is a Statement of Purpose and Service Users Guide which have both been updated and are available in the home for residents and visitors. The Service Users Guide is pictorial and assists with interpretation for some residents. Both documents are comprehensive and provide all required information to make a choice about the home and give an accurate picture of care provision and the level of service at Upland Road. Previous inspection reports were seen available on tape in the home. Since the last inspection a resident has been transferred to another service in the Milbury Group and new resident admitted from there to Upland Road. This person had been resident in the former placement for 14 years and the reason for transfer to Upland Road was not clear from the records seen or known to staff on duty. The resident was seen and although he has limited speech he indicated that he was settled and happy in his new home. There had been 2 Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 10 introductory visits prior to admission, for several hours for a meal but no overnight stay. Records seen relating to this person were detailed and comprehensive from the previous placement. It was possible to provide continuity of care from the previous care plan (the format is the same for both homes). The placement was made 5 months ago and there had apparently been a review of placement but no document was seen recording the review, although there had been the usual 3 monthly review of care plans on 27/08/06. External parties had not apparently been involved. An independent advocate may have been helpful in this process. Upland Road, 24 DS0000016883.V313302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-9 The quality of these outcomes are good This judgement has been made using available evidence including a visit to the service. Time spent on improving care plans has been productive. Participation and empowerment could be enhanced by involving independent advocates. EVIDENCE: The two previous inspections indicated that work was needed and ongoing in updating and improving the quality of information and content of care plans. There were concerns that care plans and risk assessments were not crossreferenced. This work has continued and a sample of care plans seen provided directly linked reference to care provision and risk management. In a plan seen risk assessments were specific relating to: bathing, making tea, walks, college, laundry, epilepsy, medication, fire in bedroom, making sandwiches and external activity relating to seizures and road safety. All were directly cross referenced to the plan of care. Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 12 Previous concerns about developing specific goals, rather than broad statements, which could be measured had also improved. – Rather than “promote independence” specific activities to achieve that goal were outlined. There is considerable information relating to each resident across 3 separate files for each person - The main care plan, including social histories, reviews, risk assessments. The activities file recording the plan of activities for each individual and the outcomes. The Medical/general file containing diagnosed conditions, treatments, medication and outcomes. The information available was considerable although clearly dated information had been removed from the files as recommended in the last inspection report. The care plan relating to person who has been resident for several years, but who has presented concerns about self-harm and management of seizures was seen and gave quite adequate and satisfactory information about the management of those and other areas of concern. Assistance had been sought from external health professionals. Risk assessments were clear and concise and reviewed regularly. The standard of recording was good. Examples were seen during the inspection of residents making choices about daily routines – what food to eat, to have a bath, activity in the home etc. Staff were positive and responsive where residents clearly wished to take particular actions. Staff encouraged choices such as what clothes to wear. Two residents attended the GP surgery during the inspection for ‘flu injections. One declined upon arrival at the surgery and the matter was not pursued in that setting. The other was not given the injection – there had been a change of GP on recent transfer from another home and the GP wished to first check the previous medical history which he did not have. Further discussions will take place with the residents to arrive at a decision based upon their best interests. A resident of mixed race with limited verbal skills sometimes speaks at length in Urdu. This is encouraged by staff as a means of expression for him and they have sought some input in the same language. Advocates are presently not used. There are 3 people who do not have relatives or visitors. There is no known next of kin for them. Staff in the home advocate for these people but a recommendation is made to consider referral to the Independent Advocacy Service to ensure the rights and interests of residents are protected independently. Non verbal communications are understood between residents and staff and provide a baseline for communication. In written feedback to the Commission comments from a resident were reported as: “ I understand what staff are asking and telling me. I have very limited vocabulary but I can show behaviours if I do not wish to be disturbed or do anything that I choose not to. I can scream, hit and scratch. I am a contented person” Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 13 Residents meetings are held monthly (records not seen) it is possible that a member of a Service User Group could be involved in those meetings. Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 14 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): 11 -17 The quality of these outcomes are good. This judgment has been made using available evidence including a visit to the service. There are opportunities for personal development and social inclusion. The latter may be extended by increased transport availability. Daily routines are flexible and food provision good. EVIDENCE: The home provides opportunities for the development of social and personal skills. Residents are involved in the usual range of domestic activity: cleaning bedrooms, shopping, preparing food/drinks (risk assessed), taking clothes to the laundry. Promoting personal hygiene is also an important part of this development. Varying levels of skill or risk are mirrored with the required level of staff support. The objectives are to promote independence. Examples of success in these areas were evident. External activities are an integral part of this development. Three people attend college courses at St Andrews and Bournville Colleges for courses Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 15 relating to money management, living skills and computers. Two attend on 2 days another who attends one day requires staff to stay at college with her on Fridays, she then goes home for the weekend until Sunday evening. Her chosen lifestyle is accommodated in discussions with resident and family. This is documented in care planning information. There are external visits to the local community. Residents visit supermarkets, shopping centres, nature centre, banks, GP surgeries, clinics etc. The key to the level of external activity is, of course transport. The home has a dedicated people carrier. There are charges for this to residents recently increased to £108 per month for 2 residents and £35 per month for 3 residents. (rates based upon benefits payments). Staff available to drive this vehicle comprise only the Manager and Deputy plus helper from another home. Other staff do not drive/have licences. This limits the availability of transport. In written feedback a relative commented: “The home would benefit from more staff especially drivers. Then the residents would have more outings and 1:1 time. Although I must point out that the staff do make great efforts to spend as much quality time with the residents. I have been very pleased with my daughters progress over the years at Milbury”. A resident in written feedback said “I would like more support workers and more drivers and I would like to go out a lot”. It is recommended that consideration is given to extending the availability of transport. This is a service residents are paying for in addition to the basic fees. The two residents who do not attend college have a range of activities provided in the home. In fact all residents have a programme of activities which are discussed, documented, and staff allocated to ensure they are carried out. The results are recorded including activity objectives not met. Chosen lifestyles were summarised by a resident in feedback stating “Staff know my likes and dislikes, I decide what to do around my home” The statement of purpose states “ Milbury will provide costs and staffing for a 5 day group holiday per year” - It was reported that this takes place. Food provision was observed to be good. Sample menus were sent to the Commission prior to the inspection. On the day of inspection breakfast was being served with 6 choices of cereal on display in their boxes for choice. A resident then likes to have toasted crumpets with peanut-butter. She put them into the toaster, put on the topping and then clearly enjoyed them. A light lunch was later prepared for all with varying levels of resident input. Residents, staff and inspector then sat down together in the dining room to enjoy the proceeds with social exchanges too. Upland Road, 24 DS0000016883.V313302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 21 The quality of these outcomes are good. This judgement is made using available evidence including a visit to the service. Healthcare records relating to one resident were poor, in contrast to other records seen. EVIDENCE: Personal support was seen to be provided applying the principles of privacy and dignity. This was exampled when residents were seen rising and later bathing and changing clothes. Regular daily baths are a preference for some residents and they are encouraged to take time to soak and enjoy their chosen “bubble baths” etc. The process is clearly enjoyable, therapeutic and very important to some residents with behavioural and some limited expressions. A resident with very restricted verbal skills, was heard being encouraged to sing in the bath by a member of staff, who remained at a distance allowing freedom and privacy for the person. Health care matters were explored and tracked in care records. There is a separate file for each person and include medical diagnoses and interventions by health care professionals including GP, Consultant, Physiotherapist, Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 17 Community Learning Disability Nurse, Dietician, Clinical Psychologist, Chiropodist and dentists/opticians. Annual health care checks are arranged at the local Health Centre. Access to cervical checks and mammograms have been declined or abandoned as too intrusive or stressful. Two residents have input virtually weekly from a visiting Aromatherapist and Massage Therapist for which they pay independently. Some Healthcare records seen were good but in relation to a recently admitted resident they were poor. The Health Care record sheet which should include all interventions by professionals with dates and reasons was not completed. It was very difficult to ascertain when and why the person had been seen by the dietician. The records showed a further visit was arranged for November but it was possible to track the date only from the homes daily diary. The person had received a chiropody service in the previous placement, a written request made on 4/09/06 had not occurred. It was difficult to track the outcomes of these issues. Specific forms for chiropody and dietician had not been completed. The recording of weight was poor, records of weight were not consistent/correct - gain from 12 to 13 stones in 2 weeks etc. A requirement is made to provide Health Care Profiles for all residents – to include all interventions by health care professionals clearly identifying the dates, outcomes and future appointments made. The required documentation was present in the records mentioned but had not been completed. Three people suffer from epilepsy but there are clear instructions to staff indicating the course of actions which must be taken in the event of seizures. There was good recording of the date, time and severity of the incidents. PRN medication is provided (diazepam) for these residents with clear instructions for the point of administration. In more serious situations emergency action is outlined with instructions that staff must carry a mobile telephone at all times whilst away from the home. Serious injuries of a resident following seizures were well documented and had been reported appropriately to the Commission under Regulation 37. A resident who regularly self-harms over a long period is being closely monitored. A Clinical Psychologist is involved on an on-going basis and working closely with staff. A record is being kept of all incidents. Medication is supplied in MDS form (blister packs) from Boots Chemists. A good service is reported. Records relating to the receipt, storage, administration and disposal of medication were inspected and were satisfactory. The home notified the Commission under Regulation 37 some months ago that there had been an error in medication administration – a Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 18 resident had been given a double dose of Sodium Valporate separately by 2 staff, the MAR sheet was not checked. The GP was contacted, advice given, condition monitored and the resident did not suffer any ultimate effects. It has been restated that staff administer medication in pairs simultaneously and this continues. All staff administering medication have completed a certificated training course with Boots Chemists. Further medication training is booked for 3 staff on 19/10/06 and another in January 2007, they will not administer medication until training has been completed. Wishes of residents upon death were discussed. Three who have limited verbal communication do not have family/next of kin. Two have completed funeral plans, another has not. The wishes of a resident with good verbal skills are not known. This will be pursued in the future as she recently suffered the loss of a relative. This may be another area where independent advocates could assist. Upland Road, 24 DS0000016883.V313302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The quality of these outcomes are adequate. This judgement is made using available evidence and a visit to the service. The complaints procedure is concise, satisfactory and has been tested. Training for staff is still required in the Protection of Vulnerable Adults. EVIDENCE: There is a complaints procedure in place. This is posted in the home and in the service users guide. The procedure is pictorial allowing the opportunity for staff to discuss/demonstrate the actions to be taken if residents have concerns about any aspect of care. Two complaints have been received by the home since the last inspection. Were recorded in detail in the complaints book and had been dealt with swiftly and appropriately. One related to a resident who shouts repetitively. The complaint was made by a neighbour who said that she objected to hearing the resident constantly shouting whilst in the garden area. This occurred in July this year (very hot month) – all residents spent considerable time in the garden area (and the neighbours). This complaint was repeated 2-3 times in July. On each occasion the Manager spent time with the complainant and assured her that staff would try to monitor the time the resident spent near to her property and attempt to provide diversionary measures to reduce the intrusion. Staff were aware of this and took appropriate action. It was necessary to balance resident choice and freedom with the rights of other people to have freedom from intrusion. The balance appeared to have been ultimately achieved. There has been no subsequent complaint since July. The same resident is in fact, befriended by Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 20 the neighbours on the other side of the detached home. Staff promote this contact as a means of demonstrating her acceptance in the community. The other complaint related to a resident complaining about the state of her bed. A new bed was ultimately provided. A requirement of the last report was to ensure that all staff completed training in Adult Protection. This was an outstanding requirement of the previous report. There has been some training since the last inspection in Adult Protection but there are still some staff who have not received this training. This may be due in part to the many staff changes but is still required in relation to several staff. The requirement is repeated in this report. Upland Road, 24 DS0000016883.V313302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 – 30 The quality of these outcomes are good. This judgement has been made using available evidence including a visit to the service. Considerable improvements made to the environment presenting a homely, comfortable and safe environment. EVIDENCE: Some improvements have been made to the home since the last inspection. The recently built laundry is now operational providing adequate space and facilities. This has significantly improved the homes facilities. Residents take clothes to the laundry area and some able to launder with supervision. There has been considerable redecoration of areas identified in the last report. The smaller lounge area has been redecorated and new carpet fitted. The hallway, corridor areas, landing/hall stairs have been redecorated and also 2 bedrooms. The large kitchen area and dining areas have also been redecorated. A requirement to move the skip from the front of the building and fit a lock to the garage have been actioned. Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 22 There is a copy of the homes planned maintenance programme now available in the home. The whole of the interior now presents extremely well. There are no areas which can be identified as requiring redecoration. Furniture, fittings and equipment are to a good standard and there is a comfortable, homely appeal to the home. Most bedrooms were seen, were adequate in size furnishings. All were well personalised reflecting the individuality of residents. Three bedrooms have double beds and there is adequate space. All bedrooms are for single use, all have locks on doors, only one resident locks her door from the inside, staff able to over-ride the lock in an emergency. 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. Repairs to a wardrobe and vanity unit doors in 2 bedrooms on the first floor were identified Standards of hygiene throughout the home were observed to be high. The garden is private, well maintained and surrounded by trees. There are good seating areas with sufficient room to access sun or shade. It is easily accessed from the house and much used in the summer months. The development plan includes plans for a sensory garden, sensory room and assisted bathing facility on the first floor. Upland Road, 24 DS0000016883.V313302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 33 & 35 The quality of these outcomes are adequate. This judgement has been made using available evidence including a visit to the service. Outstanding training must be completed for all staff. EVIDENCE: There has been considerable turnover of staff over the past year 8 people have left, more than half the staff number. Replacements have been appointed and with recent appointments there are no current vacancies. On the day of this unannounced inspection two staff were on duty from 8a.m. – 3pm – a third member of staff had reported sick on the morning. The 2 staff were new to the home, one had been employed for only 2 weeks, but had considerable experience in similar settings over a long period and was completing her induction. The other has worked regularly in the home for 18 months placed from an Agency, was appointed permanently 1 month ago. The considerable ability, skill and sensitivity of these 2 members of staff, observed throughout the day, was excellent. They had a working knowledge of the needs of residents but their engagement with residents was high and professional. They sensitively managed some difficult situations arising in the course of the day – residents refusing to get up mid-morning or to take medication. Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 24 The staffing levels are for 3 staff 8-3 and 3 staff 3 –10. There is one waking night care worker and a person sleeping in and on call. Staff indicated that at times of staff shortages there were sometimes only 2 staff on the 3-10 shift. At weekends one resident goes home and the staffing for the remaining 4 residents is 2 during the day increasing to 3 on Sunday pm. The number of staff appear adequate for the perceived dependency levels of the current 5 residents. Two previous requirements have been made to provide training for staff in Adult Protection. Over the past year 7 staff have completed this training but several, including new staff have not. This must be done. Only 2 staff have completed training in Epilepsy Awareness. Three residents have seizures and the importance of this training for all staff is important. There is further planned training in First Aid, Health & Safety and Adult Protection. NVQ training is in place and must also be extended. A requirement of the last report was made to ensure that all documents under Schedule 2 were provided for all staff and available for inspection. On this visit the Acting Manager was attending a course and not in the home. Access to staff files, therefore was not possible. This will be pursued at the time of the next inspection. Upland Road, 24 DS0000016883.V313302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 - 42 The quality of these outcomes are adequate This judgement has been made using the available evidence and a visit to the service. The management of the home was not assessed. Application must be made for approval of a Registered Manager and many areas of training must be extended to include new staff. EVIDENCE: The Acting Manager has been working in the home for the past 3 years the home has not had a Registered Manager during that time. She completed the Registered Managers Award in July 2006. Application must now be made to the Commission for approval of a Registered Manager. The Acting Manager was not on duty at the time of this inspection. The home appears generally well run and managed. There are policies/procedures in place to inform practice and operation. These are Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 26 readily available to all staff. A quality audit has taken place and a copy will be sent to the Commission. Records seen were well written and to a good standard. Some health care records were incomplete. Regular monthly visits by the Responsible Individual under Regulation 26 have been forwarded to the Commission and notifications under Regulation 37 of notifiable incidents have also been notified to the Commission as required. Many were discussed during the inspection. Fire records were inspected and tests had been carried out as required. A very positive feature was that individual evacuation procedures had been established for each resident which have been discussed/made clear to them all. The last fire drill was 21/08/06 (3 monthly) but there are several new staff who have not had fire drills or fire safety training. It is a requirement of this report that this is arranged as soon as possible. There are sufficient numbers of staff trained in first aid to ensure there is a trained person on duty at all times. COSHH products are kept in locked cupboard (seen) off the kitchen area and data sheets for all items in the office area. Food hygiene training has been undertake by some staff. All are involved in food preparation, therefore extension of this training is needed. Similarly moving & handling training has been provided for some staff but others need to complete the this training. Upland Road, 24 DS0000016883.V313302.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 2 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 x 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 x LIFESTYLES Standard No Score 11 3 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 x x 3 3 2 2 x Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 28 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 YA23 Regulation 18(1) (c ) Requirement Ensure all staff complete training in Adult Protection. Outstanding since 30 September 2005. Healthcare profiles must be completed for all residents to include all interventions by Healthcare professionals & identify future appointments. Outstanding training must be completed for all staff. Fire drills and fire training must be urgently arranged for all staff. Repairs to wardrobe & vanity unit doors in bedrooms identified must be completed. Application must be made to the Commission to appoint a Registered Manager. Timescale for action 31/12/06 2 YA19 12(1) 07/11/06 3 4 5 6 YA35 YA42 YA24 YA37 18(1) 23(4)(a) (b) 23(2)(c ) 8 31/01/07 30/11/07 30/11/07 31/12/06 Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 29 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 YA13 YA8 Good Practice Recommendations Consider ways of extending availability of transport for residents. Consider referrals to independent advocacy service in relation to 3 residents with little verbal communication and do not have relatives or visitors. Upland Road, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 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, 24 DS0000016883.V313302.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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