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Inspection on 10/05/05 for 26 Green Road

Also see our care home review for 26 Green Road for more information

This inspection was carried out on 10th May 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a team of enthusiastic staff who have a good knowledge of the needs of the people in their care. They are well motivated; participate in the day-to-day operations of the home whilst maintaining a clear sense of direction. Meals served at the home are at flexible times with a choice of food available depending on the personal preferences of service users. A wide range of activities are on offer, in line with individual service user needs. Care plans and relevant documentation are comprehensive, regularly reviewed and up dated when changes occur. Staff at the home seek input from other health and social care professional to assist in meeting individual need.

What has improved since the last inspection?

The manager of the home has recently been successful in the process to become registered with the CSCI. A visitors information file has been developed, this includes the provision of comment cards for visitors to enable the home to seek their views on the service provided. Meetings with the landlord / care purchaser have taken place to discuss development plans for the premises, the manager is confident that money for improvements has been secured. Extra funding for 1:1 staffing for one individual service user has now been agreed to ensure his needs can be met.

What the care home could do better:

The admission process requires improvement to ensure potential new service users have the information they need before making a decision to move, and to ensure the home is confident it can meet their needs. The home must ensure service user files and monies are stored securely. Some policies and procedures require further improvement. The manager needs to introduce stock control and auditing systems to ensure that service users are receiving the correct medication. The organisation needs to ensure the visits made to the home by its representative on a monthly basis are thorough with a satisfactory report of the visit available to ensure the organisation has an overview of the service.

CARE HOME ADULTS 18-65 Green Road, 26 26 Green Road Hall Green Birmingham B28 8DD Lead Inspector Kerry Coulter Unannounced 10 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Green Road, 26 Address 26 Green Road Hall Green Birmingham B28 8DD 0121 777 2896 0121 777 2896 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Optimum Care Services Mr Timothy James Burgwin Care Home 5 Category(ies) of Younger Adults, Learning Disability registration, with number of places Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. Date of last inspection 28th October 2004 Brief Description of the Service: 26 Green Road is a detached chalet style bungalow located in a quiet residential area in the south of Birmingham. The home is within walking distance of a range of amenities and is close to both bus and rail routes to the city. Accommodation for residents comprises of four single bedrooms on the ground floor and one en-suite bedroom on the first floor. The bedrooms vary in size, all are personalised to individual tastes and preferences. There is a large wooden panelled lounge with television and music centre. This room also has a dining area. The home has a large fitted kitchen with a small dining area, two bathrooms, a very small office/ sleep in room and an outbuilding used as a laundry. The home has a large garden to the rear of the premises with lawned areas, flowerbeds and a barbecue area. There is limited off road parking to the front of the home with additional parking available on the road. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out over five and a quarter hours. This was the first of the statutory inspections for this home for 2005/2006. During the inspection a tour of the premises was made, two service user and one staff files were inspected as well as other care and health and safety records. The inspector spoke with the manager and members of staff and met with three of the service users. However some of the service users do not have verbal communication and their ability to communicate to the inspector their views of the home was limited. The inspector therefore spent part of the inspection observing care practice. What the service does well: What has improved since the last inspection? The manager of the home has recently been successful in the process to become registered with the CSCI. A visitors information file has been developed, this includes the provision of comment cards for visitors to enable the home to seek their views on the service provided. Meetings with the landlord / care purchaser have taken place to discuss development plans for the premises, the manager is confident that money for improvements has been secured. Extra funding for 1:1 staffing for one individual service user has now been agreed to ensure his needs can be met. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 6 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. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 4 Prospective service users are not provided with the information they need to enable them to make a decision about moving to the home. Assessments need to be completed in more detail to ensure the home has the capacity to meet the needs of the service user. EVIDENCE: The home has a statement of purpose and service user guide in place that meets the required standard. A copy of the homes service user guide had been provided individuals who had lived at the home for some years. Unfortunately, a service user new to the home did not have a copy of the relevant guide but had a copy of a guide to the home that it is intended he will eventually move to. There was evidence that an assessment had been completed prior to the service user moving in to the home, this generally covered the required areas but was not detailed and consisted mainly of tick boxes. The home must further improve its assessment process to reflect the views of the service user and any relatives or advocates involved with the individual. Whilst it is acknowledged that this home may be a short term placement for the new service user there was no evidence that they had been consulted on the decision to move there or that the views of other people living at the home Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 9 had been sought. The service user had not had the opportunity to visit the home before moving in. Whilst due to time constraints there may not have been the opportunity for several visits and an overnight stay the service user should have been offered an initial visit to the home to enable him to make an informed choice about moving there. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10 The care plans detailed how the individual needs of the service users were to be met. The systems for service user consultation are generally good with a variety of evidence that indicates service users views are sought and acted upon. Strategies for managing risks were generally clearly identified with only minor improvement required. The systems for handling information about service users require improvement to ensure confidentiality is ensured. EVIDENCE: Two service user files were sampled. The care plans were observed to be well constructed, detailed and up to date, thus ensuring that staff have the required information to enable them to meet individual need and provide consistent care. The process of cross referencing care plans with risk assessments has also commenced but needs to be completed on some plans. It is positive that attempts to make the care plan accessible to service users had been made with the use of pictures and photographs incorporated into the plan. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 11 The inspectors saw some evidence of consultation with service users about the running of the home. One member of staff explained how service users had been supported to decide the destination for a planned holiday this year. Service users were observed being supported to make every day choices such as what to eat, when to have a cup of tea or when to spend time alone in their room. Since the last inspection service users have been provided with ‘listen to me’ pictures to facilitate communication. A wide range of risk assessments had been completed, all those sampled were up to date and recorded the likelihood of the risk occurring. Further attention should be given to highlighting the level of risk. Initially the file of one service user was not available in the home and staff had to fetch this from the home that it is intended he will eventually move to, subject to its registration. As the service user concerned was at Green Road it was unclear as to why his file should need to be elsewhere. The manager was asked to review the procedures for taking service user information away from the home to ensure files are kept safe and confidentiality maintained. Other service user information was observed to be left out on a dresser in the dining area. A member of staff stated that a lock was due to be fitted to the dresser to ensure files are stored securely. The inspector observed staff being mindful of issues discussed in the presence of service users but on occasion this presented difficulties for the staff. This is due to the fact that the home does not have a room that is suitable for staff handovers and meetings. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15, 16 and 17 Service users are offered a range of appropriate activities. Staff support service users to maintain and develop relationships with family and friends. Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: Service users have a planned timetable for attendance at activities outside of the home that includes attending college courses. The service user new to the home is not yet attending formal day-care but is being supported by staff to participate in a variety of new activities and experiences to assess what he would like to participate in on a regular basis. Discussion with staff and sampling of records evidence that staff support service users to maintain links with friends and family. Examples include writing to friends at another care home and telephone calls to relatives. An area of improvement since the last inspection is the introduction of a visitors file in the hallway. This contains the statement of purpose, CSCI reports and comment cards for visitors to use on their views of the service provided. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 13 Service users are free to access all areas of the home. Service users were observed to participate in the daily routines of the home, this included participation in housekeeping tasks. Staff were observed to knock on service users bedroom doors before entering. The food records sampled evidenced there was a good variety of meals on offer. Food stocks in the home were good and there was fresh fruit and vegetables available. Service users were observed to be appropriately supported by staff to eat their lunch. Staff ate with service users and the atmosphere was relaxed with service users included in conversation. One service user is currently receiving input from the Speech and Language Therapist regarding his meal time support needs. One service user stated he liked the meals on offer at the home. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The systems for the administration of medication are generally good with clear and comprehensive arrangements being in place to ensure service users medication needs are met. The arrangements in place to meet service users physical health needs are good. EVIDENCE: Service users are supported to health care appointments and records of these are well maintained within separate consultation forms. There was documented evidence that health care needs were being identified and followed up. One service user has a health action plan that has been completed with the involvement of the Community Nurse. Staff stated that it was intended that similar plans would be completed for all service users in line with the Government paper ‘Valuing People’. It is an area of good practice that staff at the home complete a detailed report following any seizures experienced by a service user. Medication management was generally in good order. A record of medication received was available but the record of returned medication could not be found. The manager stated this may be in the possession of the supplying pharmacist. The medication administration records (MAR) were sampled for all service users who live at the home. These were observed to be satisfactory. All medication was being acknowledged when received and two people signed Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 15 when it was administered. Discussion with a member of staff indicates that the home does not photocopy and retain a copy of the prescription before it goes to the pharmacist. This must be implemented to ensure staff can be sure the medication received is the medication prescribed. Since the admission of a new service user the home has increased stocks of medication that is not in a dosette system. The manager therefore needs to introduce stock control and auditing systems to ensure that service users are receiving the correct medication. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Arrangements for the secure keeping of service user monies are not satisfactory resulting in the safeguards in place being unsatisfactory. EVIDENCE: The home informed the inspector no complaints have been made since the last inspection. This standard was not further inspected. Service user finance records were not sampled, however it was of concern that a locked tin containing money was not kept in a secure place. The response from the provider to the inspection records that this money was petty cash and was not service users personal monies. During the inspection several revised policy and procedures were provided, intended for use in Optimum’s care homes. The adult protection procedure is generally satisfactory but the quick reference flowchart would benefit from some simplification to include the contact name and number of the homes local Vulnerable Persons Officer from West Midlands Police and relevant Social Workers and area offices. A revised physical intervention policy did not cover all the areas required in line with the Department of Health’s guidance on the use of physical intervention. Discussion with the manager indicates all staff have received adult protection training. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28 and 30 Aspects of the environment required attention so that the home provides a comfortable and hygienic environment for residents. EVIDENCE: Décor, furnishings and fittings provided within the home are generally of a satisfactory quality. The environment is not suitable for the needs of the service users. It has previously been recommended that the organisation provide an additional communal area where visitors could meet service users in private or to provide a quiet area for service users. This is now more urgent due to the change in needs of one service user, recommendations from the Speech and Language Therapist include the provision of an extra communal room within the home as this individual can on occasion be very vocal. This has an impact on other service users in the home. A room is provided for staff that sleep in. Space for the storage of staff’s personal belongings is limited as this room is small and also doubles up as the office. The home’s office does not comfortably accommodate more than two people, meetings are therefore held in the kitchen or lounge/diner. The home does not have an internal Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 18 laundry. The laundry facilities are situated in an outbuilding at the side of the house and staff and service users have to go outside to access the laundry. This is not adequate. The organisation must consider resiting the laundry or provide a covered walkway. The manager stated that recent negotiations with the owners of the home who are also the care purchasers has taken place. The manager is confident that agreement has now been reached to improve on the shortfalls of the premises. Some repairs were observed to be required, a tile was missing form the wall in one bathroom and the kitchen floor covering still requires repair or replacement due to a damaged area adjacent to the cooker. Three service user bedrooms were sampled. These had at least two double electrical sockets and a TV aerial point. All rooms contained personal items and were homely in appearance. One service user said that he had recently been and chosen some new wardrobes for his bedroom. The home has a sufficient number of bathrooms and toilets for five service users. One bathroom has the facilities of an assisted bath. There are locks on the bathroom doors and these can be opened from the outside in an emergency. The bathroom adjacent to the office was observed to require screening to the full length external window to ensure privacy is maintained. Although these windows are frosted glass they do not provide full privacy. All areas of the home observed were clean and free from offensive odours. Food in the fridge was observed to be date labelled when opened to ensure staff know when it requires discarding. Staff meeting minutes evidenced some problems with the storage of refuse outside of the home. It had been agreed that it would be more effective to store the rubbish in wheelie bins, this has yet to be actioned. This must be done as rubbish bags left in the open will be at risk of attracting vermin. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 34 Service users are supported by a team of stable and knowledgeable staff. The home does have some staff vacancies meaning that in future service users may not always be supported by familiar staff. The procedures for recruitment were robust and provide safeguards to offer protection to people living in the home. EVIDENCE: Minutes were available to evidence that staff meetings occur on a monthly basis contributing to service users being supported by an effective staff team. There is a core group of permanent staff in post who are familiar with the needs of the service users. The home does has some staff vacancies but this is not having a detrimental effect on service users as in addition to Green Road staff there are staff who are working in the home who will be working at Optimum’s new home, subject to its registration. However, once these additional staff are no longer at Green Road the current staff in post would not be adequate to meet the needs of the service users. Discussion with the manager indicates that additional funding has also now been agreed to meet the additional staffing needs of one individual. The recruitment records of one new member of staff were sampled. These contained evidence that references and a criminal records bureau check had been completed as part of the recruitment process. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39 and 42 The service users benefit from a well run home with the management approach being one of an inclusive style. Systems are in place to promote the health and safety of service users but two possible areas of risk had been overlooked. EVIDENCE: The manager of the home has recently successfully completed the registration process with the CSCI. Staff spoken with said staff morale had improved now that a permanent registered manager was in post. Throughout the inspection the manager presented as open, co-operative and welcomed constructive feedback. Staff spoken to at the time of the visit were enthusiastic about progress being made towards meeting the standards. Previous inspection reports were clearly on display demonstrating the homes open approach to their performance against the standards required. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 21 Systems of self review were observed to be in place, to include the recent introduction of service user, visitor and professional comment cards. The minutes of a staff meeting evidenced that a full environmental audit had also recently been completed, unfortunately this was not available in the home. As highlighted at the previous inspection in October 2004 improvement is still required to the format of the monthly visits undertaken by the representative of Optimum. It is also required that a copy of the reports is forwarded to the CSCI on a monthly basis. The systems in place to ensure the safety of service users was generally satisfactory. Staff had received updated training in fire procedures. In-house checks on the fire equipment, emergency lighting and fire drills had been completed appropriately. Where it had been identified that an emergency light was not working action had been instigated to arrange for repair. There was evidence on site of the servicing of all equipment. COSHH substances were stored securely and not a risk to residents. However, immediate requirements were made to ensure exposed hot water pipes leading to a shower were covered and that a carpet join was repaired to reduce the risk of injury to service users. Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x 2 x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 2 1 x 2 Standard No 11 12 13 14 15 16 17 x 3 x x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Green Road, 26 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x 2 x E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 23 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 1 Regulation 5(1) Requirement The home must provide prospective new service users with a copy of the service user guide. The home must further improve its pre admission assessment process to reflect the views of potential new service users and any relatives or advocates involved with the individual. Wherever possible potential new service users must be offered the opportunity to visit the home prior to admission. Further attention must be given to highlighting the level of risk within risk assessments. The procedures for taking service user information away from the home must be reviewed. Service user files must be stored securely when not in use. Medication- A photocopy of the prescription must be made and a copy retained in the home before it goes to the pharmacist. The manager needs to introduce stock control and auditing systems to ensure that service users are receiving the correct medication. Timescale for action 30/5/05 2. 2 14(1) 30/6/05 3. 4 12(1)(2) & 14 13(4) 12(4)(a) & 17(1)(b) 13(2) 30/6/05 4. 5. 9 10 30/6/05 15/6/05 6. 20 15/6/05 Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 24 7. 23 13(6) & 16(2)(l) Service users money must be kept in a secure place when not in use. 8. 23 13(6) 9. 10. 24 27 23(2) 12(1) & 23(2) 26 11. 39 12. 13. 42 42 13(4) 13(4) The revised physical intervention policy does not cover all the areas required in line with the Department of Health’s guidance on the use of physical intervention. The policy must therefore be further developed to ensure it is line with recognised current good practice. Flooring in the kitchen requires repair or replacement. (Unmet requirement from 30/1/05) Missing tile in one bathroom requires replacement. Screening at the window is required in the assisted bathroom. Improvement is required to the format of the monthly visits made by the representative of the organisation ( Unmet requirement from 31/12/04). Copies of the report must also be forwarded to the CSCI. Ensure exposed hot water pipes leading to the shower are covered. The carpet join in the hallway near to the lounge must be repaired to reduce the risk of injury to service users as it is a trip hazard. 30/5/05 The provider states that monies observed was not service users money. 30/6/05 30/6/05 30/6/05 30/6/05 18/5/05 11/5/05 Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 23 Good Practice Recommendations The adult protection procedure is generally satisfactory but the quick reference flowchart would benefit from some simplification to include the contact name and number of the homes local Vulnerable Persons Officer from West Midlands Police and relevant Social Workers and area offices. Additional communal space should be provided to include the provision of a new laundry. 2. 28 Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green Road, 26 E54 S16884 26 Green Road V226764 100505 Stage 4.doc Version 1.30 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!