Inspection on 09/02/09 for 24 Upland Road

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

24 Upland Road 11/02/08

24 Upland Road 06/11/06

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 17/02/2010.

CARE HOME ADULTS 18-65 24 Upland Road Selly Park Birmingham West Midlands B29 7JR Lead Inspector Brenda O’Neill Key Unannounced Inspection 9th February 2009 09:45 24 Upland Road DS0000016883.V374107.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 24 Upland Road DS0000016883.V374107.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. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 24 Upland Road 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 Mrs. Clair Ann McCarthy Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 24 Upland Road DS0000016883.V374107.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 11th February 2008 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 is an 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. There is information about the home on display in the entrance hall which includes the most recent inspection report. The statement of purpose for the home stated ‘The fees at the home are set out in the residency contract which is issued to each service user prior to admission. This will be fully discussed with the individual and their advocate (if appropriate) before moving in.’ These details were seen on peoples’ files. 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 people living in the home each had a contract and service user guide that detailed their individual fees. 24 Upland Road DS0000016883.V374107.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 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day in February 2009. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. One of the people living in the home was ‘case tracked’ and the care for another was looked at briefly. Case tracking involves establishing individual’s experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent three ‘Have your Say’ surveys to the people who use the service and five to staff. Five of the surveys were returned, three from the people living in the home and two from staff and these views have been included in this report. What the service does well: Information about the home had been updated. The service user guide has pictures to help people to understand the information more easily. This means they have the information they need about the home. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 6 The care files included very comprehensive details about the needs of the people living in the home and how they were to be met. This ensured staff had all the necessary information to meet the needs of the people living in the home in a way they preferred. The care files included numerous risk assessments and management plans to ensure people were safely supported by staff. People were encouraged to make decisions wherever possible for example, what to eat and what to wear and what to do during the day. This enabled people to live their lives in the way they wanted. Daily records and evaluations of activities sheets showed that people were involved in household tasks such as making their own breakfast, tidying their rooms and changing their bedding. This helped them develop their independent living skills. There were individual menus in place which ensured people received a healthy diet and the foods they liked. Systems were in place for recording and accounting for medication ensuring people receive their medication as prescribed. The people living in the home had a copy of the complaints procedure in their service user guide which is in an easy read format with pictures so that the information was easier to understand. Staff were able to communicate effectively with individuals and had learned how to understand what people were saying. Staff had received training in safe working practices ensuring they could support people safely. The health and safety of the people living in the home and the staff were well managed and systems were in place to ensure safety is checked on an ongoing basis. The home was well maintained and offered the people living there a very comfortable environment. What has improved since the last inspection? Staff had undertaken training in the safe administration of medication for epilepsy reducing the possibility of avoidable admissions to hospital. Staff had received training in equality and diversity so that they had greater awareness and understanding of the peoples’ diverse needs. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 7 Where decisions have to made on behalf of the people living in the home the relevant health care professionals are involved to ensure the decision made is in the individual’s ‘best interests. The manager had increased the opportunities available to the people living in the home to go out so they could enjoy a more varied social life. One of the bedrooms in the home had been redecorated and was very personalised and to the occupants liking. The signage around the home had been improved to support people in understanding which rooms they were in. 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. The summary of this inspection report can be made available in other formats on request. 24 Upland Road DS0000016883.V374107.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 24 Upland Road DS0000016883.V374107.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: Each of the people living in the home had their own service user guide which had been compiled using pictures to make it easier for them to understand. The manager of the home did acknowledge on the AQAA that it may be possible to improve the format of the service user guide further to make it even easier for people to understand. All the required information was included in the service user guide including a break down of the fees, how much the individual would contribute and who was responsible for paying the remainder. Also included was information about what additional charges were made, for example, contributions towards the use of the home’s vehicle. The files seen also included contracts detailing the terms and conditions of residence at the home. It was noted that the charges for the use of the home’s vehicle were different in the contract to the amount in the service user guide. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 10 The manager should ensure that both of the documents cross reference to avoid any confusion. There had been no new admissions to the home for a considerable amount of time therefore the pre admission assessment process could not be assessed. However at 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 agreed with the information detailed in the most recent Statement of Purpose for the home which was very specific about the admission criteria and the pre admission assessment process. 24 Upland Road DS0000016883.V374107.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, 9 and 10. 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. EVIDENCE: The care for one of the people living in the home was tracked and briefly looked at for another person. This involved sampling their care files and risk assessments, observing practice and speaking to the people living in the home. The care plans had been reviewed and the care files had been restructured since the last inspection. This was so that all the home’s owned by the organisation had the same file structure. The care files included very comprehensive details about the needs of the people living in the home and how they were to be met. There were details of what people were able to do for themselves, what they needed support with, and their likes dislikes and preferences. Their preferred daily routines were well 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 12 detailed including the order in which they liked things done. Areas covered in the support plans included communication, personal care, daily living skills, activities, physical health and any cultural needs. People were seen to receive the support needed as detailed in their care plans. Care plans were very clear about the extent the people living in the home could communicate and how staff would recognise if they did not understand. For example, ‘can communicate verbally’ and ‘keep questions brief and to the point’ it was then detailed ‘if I don’t understand I will let you know by walking away, slamming my door, swearing at you.’ The care files included numerous risk assessments and management plans to ensure people were safely supported by staff. Challenging behaviours presented were well detailed along with how staff were to respond to these. Staff were recording all incidents of challenging behaviour on ABC charts which described each incident and how it was resolved showing management plans were being followed. Other risk assessments with management plans in place included, epilepsy, manual handling, going out, using kitchen equipment and so on. Support plans were all accompanied by risk assessments which were well documented however they were repeated throughout the file. For example the seizure management plan was applicable to many areas of the support plan and there was a copy of this with all support plans. This made the files very bulky and there was a risk of staff missing a new risk assessment that was amongst all the repeats. It was recommended that risk/management plans that had already been included in a support plan were cross referenced to other support plans and the reader directed to where they were. People were encouraged to make decisions wherever possible for example, what to eat and what to wear and what to do during the day. On the day of the inspection people were seen to make decisions about what they ate and how they spent their time. Two of the surveys received from the people living in the home indicated they were able to decide what they did on a daily basis and they could do what they wanted. The other person did not respond to these questions. Support plans included details of the individuals’ abilities to make decisions, for example, ‘can make everyday decisions’ and ‘I need staff to advise me of my choices. For example I will choose not to attend health care appointments, however when staff explain the importance I will then usually attend.’ There was a statement saying that for major decisions people would be offered advocacy support. The manager had approached one advocacy service about this but they were not able to help due to a lack of staff. There were issues raised at the last inspection in relation to the people living in the home refusing to have medical examinations. The acting manager 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 13 agreed to refer the two people concerned to psychology services with a view to making a multi disciplinary decision about future health checks. This would enable relevant professionals and relatives to arrive at a decision as to whether proceeding with tests, on the basis of people’s “best interests” is necessary at this stage. The manager stated various health care professionals had been contacted about this and she had been advised that psychologists would not accept a referral for ‘best interest’ decisions for every day health concerns only if it was a major decision. Therefore when decisions have to be made the manager consults with a variety of people including G.P.s and community nurses to ensure decisions are in the person’s ‘best interests’. The manager had clearly contacted some health care professionals, for example, there were records from a G.P. that had responded to the request for a routine medical examination asking for this not to go ahead as it was not in the ‘best interests’ of the person concerned. The manager was also endeavouring to find an advocacy service that would be prepared to be involved in ‘best interest’ meetings in the future. It was noted that the care files included details of the financial arrangements in place for the people living in the home. This included detail of their income. 24 Upland Road DS0000016883.V374107.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. 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. The range of leisure activities and options for going out more had been increased so that people could enjoy a better social life and involvement in the community. People were involved in menu planning so that they enjoyed the food provided at the home. EVIDENCE: The support plans included details of what tasks the people living in the home were able to do around the house. These included such things as making drinks, laying and clearing the table, polishing and taking clothes to the laundry. Daily records and evaluations of activities sheets showed that people were involved in household tasks such as making their own breakfast, tidying their rooms and changing their bedding. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 15 There was also evidence of the activities on peoples’ activity plans being undertaken such as, listening to CDs, reading magazines and rug making. During the day of the inspection people were seen clearing away their dishes after lunch, choosing what they ate and drank and taking part in their activities, for example, doing jigsaws, sorting CDs and listening to the ones of their choice. One of the people living in the home had been unable to go out for a considerable amount of time due to an ongoing health concern. The activity plan for this person included trips out of the home for shopping, going to the library and so on. There were also cooking activities on the plan that we were told the person could not do at the moment. It was strongly recommended that the activity plan was updated or a temporary one put in place until the individual’s health improved. The individual should be consulted to establish if there are any other activities they may wish to do to fill their time. There was a recommendation last year that the manager looks at people going out more. This has been explored and people have joined the library and are taken by staff. One person had just started college and was escorted by staff. She was doing a computer course which she told us she was enjoying. The manager has also just registered two of the people living in the home at a centre where they have social evenings, drop in sessions, movie nights and arts and crafts sessions. She had been told about this by the community nurses. It was difficult to see how some of the activities detailed on the plans could be achieved due to staffing levels. For example, on the day of the inspection one of the people living in the home went to college and needed a staff member with her all the time. The same morning another individual’s activity plan stated she should go to the shops. There were only two staff on duty that day including the manager so this could not be achieved without also taking the third person shopping but this person does not like going out very often. Staffing levels should be reviewed to ensure the social lives and opportunities for people to go out into the community are not compromised. The support plans for the people living in the home detailed the relationships and family contacts that were important to them. One of the people living in the home went and stayed with family every weekend which they very much enjoyed. This individual also had their holidays with their family. Another person saw their family less but kept in contact with them on the phone. On the day of the inspection they told us they had spoken to their relative on the telephone. All the people living in the home had individual menus in place. We were told staff had worked with them for a considerable amount of time to draw these up. Staff had used their knowledge of the likes and dislikes of the people living in the home and pictures, recipe cards and so on to include as many choices as 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 16 possible. One of the people living in the home told us what her favourite foods were and that some of them were in the fridge left from the weekend. This person’s menus and food records indicated they did have their favourite foods. Food records also showed that if people did not want what was on their menu a range of alternatives were offered and which ever one had been chosen was indicated. There were support plans in place for mealtimes where necessary. For example for one person who may choke there was clear guidance that staff must sit with the person at meals and ensure they do not put too much in their mouth and that they chew their food. This was observed to take place at lunchtime. It was noted that one of the people living in the home was very shaky at lunchtime and using a fork was hazardous for them. A spoon was offered and accepted by the person but as this happens regularly these details needed to be added to the support plan. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 17 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 good. 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 and health care needs. The system in place for the administration of medicines was well managed and ensured people received their medicines as prescribed. EVIDENCE: The support needed by the people living in the home with their personal care varied. Their individual needs were detailed in their support plans which were very comprehensive, for example, one detailed the preferred toiletries, where these could be found and why they were not all found in the bedroom. The support plan sampled also indicated that the individual was able to choose their own clothes but may not always choose what was appropriate for the weather and would need staff guidance for this. 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. People were seen to be offered assistance with personal care discreetly. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 18 Records showed that people were supported to attend medical appointments and where there were any health care concerns these were followed up by staff. There was the odd occasion where regular appointments had not been documented and where appointments had not been attended and no reason was recorded. For example from the records it appeared that one of the people living in the home had not seen the chiropodist for seven months however the manager stated this was not the case. There was a letter stating a person should attend a dental appointment the person did not go. However there were no records detailing why or if another appointment had been made. There was evidence that the people living in the home saw the G.P., optician, psychologist and community nurses when necessary. One of the people living in the home spoke to us about the nurses coming every day to do her dressing and that she was getting better. Some of the medication continued to be administered via a 28 day monitored dosage system others were boxed. All medication was acknowledged on the MAR (medication administration records) when they came into the home. Any medication remaining at the end of the 28 day cycle was carried forward to the next MAR chart. The system was well managed and only one very minor error was seen. The manager had booked two tablets on the current MAR charts but these had been administered at the end of the previous month and should not have been on the current MAR chart. Protocols were in place explaining the reasons for medication being given and how people like to take their medication. Three boxes containing “as necessary medications” were checked and all were correct. Safe practice protocols, signed by a nurse, were on the file of a person with epilepsy, to support staff in the safe administration of midazolam medication. An issue was raised at the last inspection about the numbers of staff who had received the appropriate training to administer this medication. This had been resolved and staff had now received this. Proof of this training was seen on the two staff files sampled during the course of the inspection. 24 Upland Road DS0000016883.V374107.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 were in place for dealing with complaints and staff were trained to recognise and report suspicions of abuse to ensure that the people living at the home were kept safe from harm. EVIDENCE: The people living in the home have a copy of the complaints procedure in their service user guide which is in an easy read format with pictures. The manager was also looking at having an audio copy of the procedure. The manager was able to tell us how she would know if the people living in the home were unhappy. The records of the meetings held with the people living in the home showed that they were asked if they were ‘happy’. One of the people living in the home who had completed one of our satisfaction surveys was able to name the staff she would speak to if she not happy. There had been one complaint lodged with us since the last inspection. The organisation was asked to investigate this. This was thoroughly investigated by a senior manager and some shortfalls were found. A timed action plan was put in place to address the shortfalls, a copy of this was sent to us. Issues raised included repetitive menus, people not going out much and the need to review some of the care plans and risk assessments. These had been addressed at the time of this inspection. No adult protection issues have been raised with us in relation to the home. There was information on the files of the people living in the home in relation 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 20 to the protection of vulnerable adults. The manager told us she had sat with individuals and explained to them what this was but she could not be sure that they fully understood this. Staff training records showed that staff had received training in adult protection issues. All the required policies and procedures were on site. There was a system in place for the safe keeping of the money of the people living in the home. All the people living in the home had bank accounts. One person was quite independent and managed their own money and was heard talking to the manager about going to pay their rent. The other people living in the home needed full support with their financial affairs. The records for their accounts were sampled. All income and expenditure were recorded and receipts were available for all expenditure. Records showed that bank balances were cross referenced to bank statements to ensure they were correct. 24 Upland Road DS0000016883.V374107.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, 25, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were provided with a clean, comfortable and well maintained home that met their needs. EVIDENCE: The home is a detached house that fits in well with others in the road. It was well maintained and comfortable and the people living there were clearly at ease and able to find their way around independently. The AQAA detailed improvements to the environment since the last inspection as one person having had their bedroom decorated and signage on the doors around the house to support the people living in the home to understand which rooms they were in. These improvements were seen to have taken place. Bedrooms were all for single occupancy and were well decorated and suitably furnished to meet peoples’ needs. All were nicely personalised to reflect the likes of the people living in the home, for example, pictures of their favourite 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 22 animals and singers and art materials. Two of the empty bedrooms were being refurbished to ensure they were ready if anyone new moved into the home. There are no en-suite facilities but there is a bathroom on each floor. There is an assisted Aqua bath on the ground floor and a bath on the first floor that had a bath hoist. One of the people living in the home had been individually assessed for this hoist. It was recommended that the organisation explored the possibility of having a shower installed in the home. This would give the people living in the home the choice of having either a bath or a shower. There were also two additional toilet facilities. The home has two lounge areas. Both were adequately furnished and decorated. One of the lounges was not used to any degree but the manager told us it was good to have an area where visitors could meet with people in private or people could just have some quiet time if they wanted. There was a well laid out garden with furniture for the use of the people living in the home in better weather. One of the people living in the home clearly used the garden and had been out and built a snowman. The kitchen was clean and tidy. All the foods in the fridge had been dated on opening to assist with good infection control. Food stocks were adequate for the numbers of people living in the home. There were plans to have the kitchen refitted as it had not been refurbished for a considerable amount of time. 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 when carrying out care and domestic tasks and stocks of aprons and gloves were seen in various areas of the home discreetly stored for 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. 24 Upland Road DS0000016883.V374107.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, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels could restrict the activities the people living in the home were able to take part in. Staff were receiving training to equip them for their work and satisfactory recruitment procedures were in place to ensure that suitable staff were employed at the home. EVIDENCE: On the day of the inspection there were two staff on duty and this included the manager. The rotas seen indicated this was an ongoing situation and the manager was always included in the support staff rotas. This was discussed with the manager and she told us she used to get three days when she was not included on the rota but this had stopped due to the low occupancy in the home. As cited earlier in this report this had implications for the activities people could take part in. These staffing levels must be reviewed to ensure the people living in the home can engage in their activities and also that the manager can fulfil her role. Staff surveys returned to us indicated that staff feel there are ‘sometimes’ enough staff on duty to meet the individual needs of the people living in the home. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 24 The AQAA detailed quite a high staff turnover at the home over the last year which can have implications for the continuity of care of the people living in the home. Some staff had transferred from other homes owned by the organisation and the manager had also recruited new staff. The recruitment files for two staff were sampled. The only recruitment documentation kept in the home was application forms and evidence of ID. This has been agreed with us. Other information was detailed on a form including when CRB and POVA first checks had been completed and when references were received. The two staff files sampled stated their POVA first checks had been received in 2004 this was clearly a mistake as they did not start working at the home until 2007. Care should be taken when completing documentation to avoid any confusion. Staff training files and the training matrix for the home confirmed staff undertake a good range of training to equip them with the skills and knowledge they need to support the people living in the home. Training included induction training in line with the specifications laid down by Skills for Care, fire procedures, manual handling, food safety, first aid, epilepsy awareness, Epistatus, protection of vulnerable adults and equality and diversity. Records indicated and the manager confirmed that five of the twelve staff employed at the home had NVQ level 2 training which is below the required fifty percent. Two staff had completed and returned satisfaction surveys prior to the inspection both indicated that they get adequate training to do their jobs. One did comment: ‘I don’t think that the medication training and the first aid training should be on the El Box because it does not teach you the practical skills you would need.’ The El Box is computer based training and it may be advisable for the organisation to ensure other staff do not feel this training is not practical enough. The interactions between the staff and the people living in the home that were observed were very positive. Staff were able to communicate effectively with individuals and had learned how to understand what people were saying. The staff records seen indicated that staff were receiving one to one supervision with the manager at the required frequency to discuss their work. Appraisals were undertaken on an annual basis to plan training for the next year. 24 Upland Road DS0000016883.V374107.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 were in place for ensuring a quality service and good systems were in place for maintaining a safe living environment for people. EVIDENCE: The manager of the home had been registered with us since the last inspection. She had worked at the home for a number of years before becoming manager. She was able to demonstrate throughout the inspection that she knew the needs of the people living in the home. They were comfortable in her presence and she interacted very well with them. The day to day management of the home was good despite the manager being included on the support staff rota on an ongoing basis. All the records checked 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 26 were up to date, staff had received adequate levels of one to one supervision sessions and there were good systems in place to ensure the people living in the home were safe. There was a system in place for monitoring the quality of the service at the home. An annual service review was undertaken and this included such things as looking at the information on regulation 26 visit reports, surveys being sent out to relatives, professionals and being given to the people living in the home, the outcomes of meetings and so on. The results of these were used to contribute to a development plan for the coming year. This ensured the home were always striving to improve the service they offered. The health and safety of the people living in the home and the staff were well managed. Staff had received training in safe working practices. Several in house audits were undertaken such as medication, water temperature checks, vehicle checks and financial checks. The AQAA returned to us indicated that the servicing of the equipment in the home was up to date. The in house checks on the fire were sampled and these showed that the fire alarms and emergency lighting was checked at the required intervals. Fire drills were undertaken as required and the records indicated that the people living in the home were involved in these. 24 Upland Road DS0000016883.V374107.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 2 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 3 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 28 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. YA5 2. 3. 4. 5. 6. YA10 YA12 YA12 YA17 YA19 Refer to Standard Good Practice Recommendations The charges detailed in the contracts should cross reference to the service user guide. This will avoid any confusion for the people living in the home. To ensure the confidentiality of the people living in the home is maintained financial information should be stored securely. Adequate numbers of staff should be available to ensure the social lives and opportunities for people to go out into the community are not compromised. Activity plans should be updated as the needs of the people in the home change to ensure people are able to do the things that they enjoy. Dietary support plans should be comprehensive and detail the full support that may be required by the people living in the home. Medical appointments and there outcomes should be recorded. If not attended the reasons should be recorded. This will ensure there is a clear audit trail of peoples’ DS0000016883.V374107.R01.S.doc Version 5.2 Page 29 24 Upland Road 8. 9. YA27 YA32 health care needs being met. It is recommended that the organisation explore the possibility of having a shower installed in the home to increase the choices for the people living in the home. It is recommended that fifty percent of staff are qualified to NVQ level 2 or the equivalent. 24 Upland Road DS0000016883.V374107.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 24 Upland Road DS0000016883.V374107.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. 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