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Inspection on 29/01/07 for 26 Green Road

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

This inspection was carried out on 29th January 2007.

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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The Staff were well informed as to the needs of the service users, interacted well, and managed to anticipate behaviours and keep service users safe. There was a good understanding of the communication needs of service users and staff have used this well, to support service users in making decisions about their life. Service users are supported to take part in a variety of planned indoor and outdoor activities, which they enjoy. Staff have had training to help them support the specialist needs of the people they support, they have skills and expertise in managing Epilepsy, and a range of complex healthcare needs. The service users had been supported to undertake personal care to a good standard, and the choice of clothes, was reflective of their age and gender and in keeping with their peers. Families spoken with were positive about the care offered and some of their comments were; `The level of care is always good, they know the men well, they are always clean, well dressed and the staff who work with them are genuinely caring, management set good standards.` `The atmosphere is good, I have confidence in the team.` `There is more choice for my son, and he has improved so much learning to do lots of things for himself.``Staff are good at communicating with us, we are always kept involved which is important when someone can`t talk for themselves.`

What has improved since the last inspection?

There have been lots of improvements to the facilities providing a more comfortable environment for service users. The bedrooms are particularly nice, decorated to a good standard with lots of sensory items such as fibre optic ceiling displays, soft cushions and floor mats, and music centres for service users to enjoy in the privacy of their own room. Care plans have been improved and now say exactly the type of support the person needs and prefers, targets are specific and staff have a better way of monitoring that the things the service user wants to do, are being done. There are very good health action plans which ensures the healthcare needs of the service users are known and planned for, this ensures they have the healthcare checks and support they need, without delay. There has been a successful recruitment of staff which has meant staffing levels have improved and better consistency for service users. Staff training opportunities are planned for, ensuring they have the training and skills necessary to supporting service users.

What the care home could do better:

Some minor amendments to the medication records will ensure better safeguards for service users and staff. There are some shortfalls in relation to the building, and meeting the needs of the service users. The main difficulty is the combined lounge and dining room. It has previously been recommended that the organisation provide an additional communal area for service users, who because of their specialist needs, may find group living at times difficult, and would appreciate additional space. The laundry facilities are in a poor state of repair and require a lot of work. Staff facilities are minimal and this creates difficulties for office work or meetings to take place in the house, without infringing on the service users. Optimum Care services do not own the building and need to ensure that the landlord is aware of these difficulties. A tour of the premises showed that there are a number of areas that require repair. Completion of these works will enhance the environment for service users.

CARE HOME ADULTS 18-65 Green Road, 26 Hall Green Birmingham West Midlands B28 8DD Lead Inspector Monica Heaselgrave Key Unannounced Inspection 29th January 2007 09:30 Green Road, 26 DS0000016884.V326997.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 Green Road, 26 DS0000016884.V326997.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. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Road, 26 Address Hall Green Birmingham West Midlands B28 8DD 0121 777 2896 F/P 0121 777 2896 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) Optimum Care Services Mr Timothy James Burgwin Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Green Road, 26 DS0000016884.V326997.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 10th November 2005 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 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, a very small office/ sleep in room and an outbuilding used as a laundry. There are two bathrooms, one of which has facilities to suit the needs of service users who require assistance this includes a hoist chair, raised toilet seat, and a level walk in shower. There is 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. The current charge for living at the home is £565.00 per week. Additional charges include hairdressing, arts and craft sessions, progressive mobility sessions, and activities. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork of this unannounced inspection took place over six hours enabling the morning and lunchtime routines to be observed. Prior to the inspection the inspector received a pre inspection questionnaire completed by the manager, this gave some information about the service and what it offers. The inspector spoke with two groups of relatives to seek their views about the service offered, without exception all the comments were positive. Three service users were in the house on the day of the visit. The care offered to them was observed. Service users living at Green Road have complex communication needs and were unable to articulate their views, the inspector looked at their care plans, activity plans and personal records to look at their lifestyle and opportunities. The manager, deputy manager and care staff were spoken with, and staff records relating to recruitment, training and work patterns were looked at. A tour of the building was undertaken to ensure it met with the accommodation needs of the service users. The procedures in place to protect the health and safety of services users were explored. What the service does well: The Staff were well informed as to the needs of the service users, interacted well, and managed to anticipate behaviours and keep service users safe. There was a good understanding of the communication needs of service users and staff have used this well, to support service users in making decisions about their life. Service users are supported to take part in a variety of planned indoor and outdoor activities, which they enjoy. Staff have had training to help them support the specialist needs of the people they support, they have skills and expertise in managing Epilepsy, and a range of complex healthcare needs. The service users had been supported to undertake personal care to a good standard, and the choice of clothes, was reflective of their age and gender and in keeping with their peers. Families spoken with were positive about the care offered and some of their comments were; ‘The level of care is always good, they know the men well, they are always clean, well dressed and the staff who work with them are genuinely caring, management set good standards.’ ‘The atmosphere is good, I have confidence in the team.’ ‘There is more choice for my son, and he has improved so much learning to do lots of things for himself.’ Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 6 ‘Staff are good at communicating with us, we are always kept involved which is important when someone can’t talk for themselves.’ What has improved since the last inspection? What they could do better: Some minor amendments to the medication records will ensure better safeguards for service users and staff. There are some shortfalls in relation to the building, and meeting the needs of the service users. The main difficulty is the combined lounge and dining room. It has previously been recommended that the organisation provide an additional communal area for service users, who because of their specialist needs, may find group living at times difficult, and would appreciate additional space. The laundry facilities are in a poor state of repair and require a lot of work. Staff facilities are minimal and this creates difficulties for office work or meetings to take place in the house, without infringing on the service users. Optimum Care services do not own the building and need to ensure that the landlord is aware of these difficulties. A tour of the premises showed that there are a number of areas that require repair. Completion of these works will enhance the environment for service users. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 7 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. Green Road, 26 DS0000016884.V326997.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 Green Road, 26 DS0000016884.V326997.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&3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have information in a format suited to their needs, which helps them to make an informed decision about moving into the home. Service users can be confident that the staff will support their individual needs and aspirations. EVIDENCE: Service users living at Green Road have a learning disability and complex communication needs. Their capacity to understand information is variable. It was therefore, positive to see that the staff team have tried to support access to information by presenting it in many different ways. The Statement Of Purpose and Service User Guide meets the required standard, and is in a format suited to the needs of the service users’ containing pictures and photographs. Copies of these were seen in each service users’ bedroom. The inspector also saw that the service user meetings have been particularly well utilised as a means of providing service users with information about the home, its service and their rights. This is very good practice because it ensures that service users have a number of avenues in which to seek and get information to help them make decisions. The staff should be proud of the effort and work that they have put into ensuring the service users have access to information. Copies of complaints information and details about the Commission were displayed on the notice board. This ensures service users have good access to Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 10 information concerning them and their stay at Green Road these too were in a pictorial format called ‘Listen To Me’. This was successfully used by the service users to register a complaint they had, and achieved a positive outcome for them. Due to the complex communication needs of service users, it was not possible to discuss with them their opinion about whether they had sufficient information about the service, however it is evident that every effort has been made to ensure information that concerns them is presented in a variety of formats; pictorial audio and explanation. There have been no new admissions for some considerable time, however there is a comprehensive assessment and admissions procedure, and hopefully this will guide future good practice. There was comprehensive information to show that when the needs of a service user can no longer be met, arrangements are made for re-assessments leading to alternative accommodation being sought. Such practices indicate that the staff have the capacity to meet the assessed needs of people living there. The service users were all resettled from long stay institutions, initially assessed by a social worker team. This was a number of years ago. Since then the staff have developed lots of new ways of supporting service users in the planning of their care. Booklets produced by the service users with support from the staff were implemented to support this process. These are called ’ Are you happy?’. These provide lots of good information about individual needs, preferences, likes and interests, and are in pictorial form. Staff, support service users to complete these on a regular basis, ensuring service users have an opportunity to review their experiences and their opinions help to formulate their care plan. This has meant that the service users expectations and aspirations can be met by the home. It was positive to see that the service user is central to this process so ensuring everyone knows what to expect from the home. Two groups of relatives were spoken with to obtain their views about the service their comments were positive and included; ‘The staff are good at communicating with families, I feel good about things when I drive away, the system is delivering us and I’m grateful for that.’ ‘The staff are very good people, visiting for me is very difficult but the staff keep me informed and have picked me up and taken me home, they are lovely caring people, it was the best thing that ever happened, moving to Green Road.’ Green Road, 26 DS0000016884.V326997.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): 6,7,8,9&10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs and wishes are well planned and reflected in their care plan ensuring staff know how to support them. There is good consultation with the service users ensuring they are enabled to make meaningful decisions about their lives and other aspects of the home. Service users are supported in taking some risks as part of an independent lifestyle. EVIDENCE: Service users care plans included lots of good information about their needs, preferences, likes and dislikes and the service users are supported to be fully involved in these. The care file was well organised, and in pictorial form to assist service users in identifying their interests and targets. A review is undertaken on a monthly basis to ensure the service user is still happy with their plan, this is undertaken with the keyworker using the ‘Are you happy’ format and any changes are then made to the plan of activities or targets. Service users have a range of complex needs and can be vulnerable to risks. Risk assessments were looked at and found to be in line with those needs highlighted in the care plan. There is a good system in place, which allows staff to highlight the level of risk to the individual this is done by using a colour code so that immediate risks can be highlighted from a number of risks recorded. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 12 The inspector also saw that staff are vigilant in their supervision of service users particularly where they were likely to ingest objects causing them harm. It was good to see that a number of environmental strategies were in place to minimise these risks, for instance bins are removed and locked away, clinical waste is secured outside, and staff presence is evident for one service user who will pick up and eat leaves or other bits to be found in and around the garden. The daily records showed that there is good information as to what service users have been doing during the day and this was seen to be in line with their care plan. Recent reviews had taken place to include the service users involvement. Service users are supported to make decisions about their lives, this includes activities they take part in, where they choose to go on holiday, day trips, how they celebrate festive events and birthdays. Service users meetings, key worker meetings and reviews show that staff support and encourage service users to make decisions about their lives and support them with their needs and aspirations. Staff support service users with information in many forms other than written. For instance using pictures to elicit choices around activities, food, clothing, using explanations to give service users information about events and procedures that may affect them. Two service users files were sampled these had risk assessments in place for many assessed risks, including choking, agitation management strategies. The files sampled showed that goals are clear, and it is easy to track if these are taking place. The daily records are used as a means of recording the activity and the care given and this ensures staff have a means of monitoring the goals set in the care plan. It is positive to see that service users are actively involved in their care plans and that opportunities for skills development are offered such as cooking meals, shopping, laundry. Comments from relatives confirm that service users have developed many skills since living at Green Road, and have a number of social and recreational activities they enjoy. One said, ‘He’s very independent washes up, does some laundry and enjoys making cakes. He goes out much more now and has a sense of freedom he didn’t have before.’ Another said, ‘ staff know him well and since his opportunities for social and leisure activities have increased he is much calmer.’ The interaction between staff and service users was seen to be of a positive and respectful nature, service users appeared to have good relationships with the staff and actively sought out their company. Records pertaining to the service users and the management of the home were found to be stored appropriately. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users take part in appropriate activities of their choosing enabling them to enjoy a meaningful lifestyle. Service users are supported to maintain contact with their family and friends. Service users are offered a balanced diet and enjoy their food. EVIDENCE: Service users have a planned timetable for attendance at activities outside of the home that includes attending college courses. The Provider has reviewed the transport arrangements to ensure that the Manager has adequate resources to enable service user activities away from the home to take place. Changes to the activities on offer have been sustained, visits to the home by an art therapist continue to be enjoyed and service users have started on the Handsworth College Programme. This enables them to take part in a variety of planned indoor and outdoor activities. It was good to see that staff are recording this using photography. An activity programme is displayed in the Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 14 kitchen this is in picture/photograph format informing service users of their planned activities for the day. One service user was being supported to attend his day care service and another was going to college. During the day service users were observed to go to the shops and help prepare lunch. One relative spoken with said his brother now participated in more activities than where he previously lived. Discussion with staff and relatives confirmed that service users are supported to maintain links with friends and family, this included visiting the home, collecting relatives that found visiting difficult and holding social events to which relatives are invited such as parties and going for a meal or a drink. A visitor’s file is located 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. Two relatives spoken with were very happy with the overall care provided at the home. 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 are supported to make meal choices using pictures. One service user has recently received input from the Speech and Language Therapist regarding his mealtime support needs. Records for this person show that appropriate risk assessments are in place to avoid choking and to monitor food intake. Weight records were seen and showed that one individual at risk had gained weight. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 15 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&20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have personal support in the way they prefer and require. There are good arrangements to ensure the complex healthcare needs of service users are met in a caring and safe manner. Medication is generally well managed some improvement is needed to the recording of medication which will provide better safeguards for staff and service users. EVIDENCE: Service users have a range of complex healthcare and social care needs, some have specific health needs relating to Epilepsy, Dysphasgia ( a swallowing difficulty), and mental health care needs, as well as a significant learning disability. Routines are flexible and seen to meet the individual needs of service users, each has a plan showing their particular routine and level of support needed. This ensures that those who require it have the structure they need and that personal support is given in a manner appropriate to individual preferences, this is particularly important where service users cannot easily communicate their needs or preferences. Plans to underpin healthcare needs were seen in the two service users files who were case tracked. These included contact with healthcare professionals such as the clinical psychologist, continence care team, dietician and speech Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 16 therapist. This ensured that the management plan for managing epilepsy was in place and staff knew what action to take to keep this person safe and well. Staff had good information as to how to meet the dietary needs of a service user and this included what action was necessary to prevent choking, or weight loss. Staff will need training in Altziemers, as this has recently been identified as a need for one service user. It was positive to see that staff have already looked at some of the other areas where they can improve the environment for this person, this has included redecorating his room and providing a sensory and relaxing area, where he chooses to retreat to in comfort. This is a positive choice for the service user concerned and his bedroom has been improved in a manner that is appropriate to both his age and gender. One service user had a plan to reduce anxiety this utilised the opportunities that the Handsworth college programme provided this was seen to be working well in reducing anxiety levels. A relative confirmed that with the increased level of understanding of his complex needs, staff had provided more opportunities for activity and this was working well in meeting the specific needs of this service user. The continence management plans were in place with a regular toileting programme, incontinence supplies and clinical waste collection in place. This service users bedroom was viewed and was appropriately furnished for his needs. Discussion with staff showed they had a good understanding of his personal care needs, and how to respond to these. The staff team are currently managing with competence and care, some challenging health care needs, and managing these well. The management of medication was generally good, the MAR charts, (medication administration records) were well kept. There was a photograph of each service user which ensures clear identification before medication is administered. Regular audits are carried out to ensure medication is given out correctly and any mistakes can be rectified quickly. Medication is secured in an appropriately locked facility. The inspector noted that prescribed PRN medication is currently handwritten onto the MAR chart, staff must arrange for the pharmacist to have this printed onto the MAR chart the same as other prescribed medicines. Prescribed food supplements must be signed for on the MAR chart as other prescribed medications. This will ensure that a regular audit trail is available showing the frequency of the food supplement being offered to the service user. The pre inspection questionnaire completed by the manager stated that staff are currently undertaking training in the safe handling of medication. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 17 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 & 23. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The Complaints procedure has been given a good profile ensuring service users know how to raise concerns. There are good arrangements to protect service users from abuse, neglect and self-harm. EVIDENCE: Green Road has a complaints procedure that includes a ‘Listen to me’ document. The format of this is pictorial and also in audio suited to the needs of service users. This is available in each service users bedroom. Service users are being listened to; this procedure was used with regards a transport issue which had a positive outcome for the service users. The preinspection questionnaire completed by the manager prior to the visit said this was reviewed in 2006, to ensure it is in line with current good practice guidelines. The Commission has not received any complaints with regards to this service. The complaints log was examined and showed that there is a good system for receiving, recording and acting on concerns or complaints, in a timely manner. It was advised that the concerns relating to staff pay are more appropriately maintained in staff files or personnel procedures as apposed to the complaints procedures. The needs of the service users are complex and it was positive to see that the manager has developed other platforms for the service users to express their views and reassure them that appropriate action will be taken. This was evident in the ‘Listen to me’ document and ‘service user surveys’ seen on those files sampled. These are called ‘ Are you happy?’, and staff support Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 18 service users to express their views to a range of questions, via responding to visual or pictorial cues. This is a positive and effective way in trying to seek the views of the service users and staff have done well to maintain this good practice. The adult protection procedure was not examined at this visit but met the standard at the previous visit. It includes a quick reference flowchart for contacts necessary to protecting vulnerable people. The training matrix showed that some staff require, adult protection training. Staff spoken to had a good awareness of what action to take if they suspected abuse, and this was good to see in terms of protecting vulnerable people. A physical intervention policy covers all the areas required in line with the Department of Health’s guidance on the use of physical intervention. Discussion with the manager and staff indicates that training in the use of physical intervention is planned for the near future. One service users’ care plan and risk assessments show that this training is in line with the current assessed needs, and will ensure that the safety and best interests of the service user is promoted. Risk assessments have been updated to identify any risks, and strategies put in place where it is considered that risks are evident. Staff was clear about the procedures and their responsibility in keeping service users safe. There were good observations made at the time of the visit that showed staff are vigilant and responsive in responding to situations where service users could cause harm to themselves, these were managed calmly and effectively. Service users money is kept in a secure place. There are appropriate records maintained and regular audits to ensure money is kept safe on their behalf. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 19 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&30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff seek to maintain a comfortable home environment, but the building has limitations that impact on service users and staff. It is a clean tidy and safe environment and good hygiene standards are maintained. EVIDENCE: Previous inspections indicate the premises has some design shortfalls in relation to meeting the needs of the service users. These remain. Primarily the difficulties relate to the combined lounge and dining room. It has previously been recommended that the organisation provide an additional communal area for service users, who because of their specialist needs, may find group living at times difficult, and would appreciate additional space. Staff accommodation is not adequate as it is a small room that doubles as an office and a sleep in area. There are no separate facilities for people to meet in private, in fact this was well demonstrated at the time of this fieldwork visit when the inspector had to utilise the lounge in order to carry out the fieldwork, this is far from adequate and infringes on the service users needs and rights. The laundry area is situated outside of the building in a converted garage/side building, this is not ideal as service users and staff, have to go outside to Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 20 access this facility. It was also seen to be in a poor state of repair; peeling paint, and no ventilation for the build up of condensation. The organisation must consider the relocation of the laundry or a covered walkway and improved ventilation. Optimum must ensure that the responsible landlord is alerted to these concerns to make the required changes. A full tour of the premises showed that there are some areas that require repair. These are summarised as follows; replacement flooring to the main kitchen and two bathrooms, replacement of tiles above the kitchen hob, several windows are cracked and a full audit and replacement programme needs to be initiated, bathrooms need re-grouting around the bath tub, a radiator cover needs to be replaced due to urine damage, The bathroom ceiling has water stains, this needs to be assessed further for roof leaks, New blinds are required to replace the broken one in the bathroom, and a ceiling in the second bathroom requires re-plastering due to recent electrical work. Completion of these works will enhance the environment for service users. On the day of the fieldwork the premises were found to be clean, warm and comfortable. Service users bedrooms have recently been decorated and these provide lovely bright, gender appropriate facilities for the men. Some very positive features have been added to include sensory stimulates and cosy comfortable furnishings that encourage the men to make more use of their rooms. One relative commented very favourably on how hard staff have worked to provide the service users with their own private space that is decorated and furnished for their comfort. The toilet and bathing facilities provide for the needs of current service users, one bathroom provides sufficient space for service users to be supported, and a hoist is available to access the bath. A level walk in shower meets the needs of service users. Raised toilets are suited to the current service users, and the one bedroom on the first floor has it’s own en-suite which meets the needs of the service user and provides additional privacy. There is a lack of shared space in which service users can engage in activities. The lounge and dining room are combined, the main kitchen has a small dining table and one service user currently prefers the privacy of this area as apposed to the busy lounge. The garden is spacious and is utilised by some service users who enjoy the sense of space this provides. Staff undertake a range of indoor activity including arts and crafts even though space is limited, but this may mean service users who do not wish to engage, retreat to their bedrooms or the kitchen. A second lounge would meet the needs of service users. Hygiene and infection control measures are known and practiced by staff. Training in infection control is planned. Standards of cleanliness were good and there were no unpleasant odours. Staff have in place strategies to keep service users safe from clinical waste or refuse, these were seen to be bagged and removed to a lockable facility away from service users who may otherwise interfere with this and cause harm to themselves. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35&36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are trained and supported to meet the service users specific needs. There are robust recruitment practices that provide safeguards for vulnerable people. EVIDENCE: The staff team is well established and consists of people who have got to know the service users well over a number of years. Previous staff shortages have since been recruited to. Staff rotas show that appropriate staffing levels are maintained which means service users have the level of support they need to meet their specific needs. The staff on duty actively engaged with service users, supporting them to undertake their daily tasks. There was good use of communication skills and skills for managing complex behaviours and anticipating difficulties and frustrations. One service user has one to one support, and staff were observed to be mindful of behaviours that could cause a risk to him. Discussions with staff demonstrated they had a good understanding of the specific needs of service users, this included communication needs, behaviours that can challenge, and the promotion of mobility, continence and self-care skills. The pre inspection questionnaire showed that the required percentage of staff have achieved NVQ level 2 in care, several have commenced level 3. The system in place for recruiting staff ensures that service users are protected by Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 22 the homes practices. The pre inspection questionnaire shows all have a Criminal Records Bureau check and Protection Of Vulnerable Adults check, this ensures that people are not recruited into care work without robust police checks being carried out. Key pieces of documentation including I.D., photograph, health declaration and completed application form with two references, are maintained for each staff member. Three new staff have commenced work and had a full induction using the LDAF framework, (Learning Disability Award Framework). This is an accredited training programme to provide underpinning training to staff working with people who have specific learning disabilities, it covers all safe working practices for staff working with people who have a learning disability. A training matrix was available which showed that mandatory training is kept under review and any gaps identified, are planned for. This showed that some staff require updates in Infection Control, Food Safety, Adult Protection, Health and Safety and Manual Handling. The pre inspection questionnaire showed, that training has been booked for Food Safety, Safe Handling Of Medicines, and Infection Control. Some service specific training in Altziemers is required to support staff in meeting the needs of one service user. Overall the training opportunities have increased in line with the successful recruitment of staff, this has meant staff can be released from their immediate care work in order for training to take place. A training matrix showing the updates must be maintained in order to have an effective audit tool. Staff said that they receive regular supervision at least six times a year, they felt this provided them with direction and support in their work. Each staff member has had an appraisal which enables an assessment of the staff teams needs and informs the training programme This is good practice and ensures staff are supported in translating their training into good care with the service users benefiting. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 23 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&42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home with a motivated staff team. There are good initiatives to seek the views of service users who have complex communication needs, and this underpins the development of the homes’ practices. Good arrangements for health and safety practices have ensured the safety of service users. EVIDENCE: The registered manager has many years experience in supporting service users who have a learning disability, he is qualified to NVQ level 4 in care and management and holds the RMA (Registered Managers Award). The deputy and senior workers have commenced NVQ level 3, and have City And Guilds and Appointed Person 1st Aid training. The style of management is open and inclusive. Two groups of relatives said that the manager is very approachable and has an open door policy, which makes them comfortable to refer any matters to him, or his team. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 24 The manager said that Optimum Care Services are working towards a quality assurance system. This was seen and showed that there is a system in place that identifies desired outcomes for all aspects of the care work. There is a monitoring tool in place that allows managers to audit the outcome. There are lots of examples of targets being met and the staff have the documentation to demonstrate this. This system is well underway the manager must now formulate this and show how the targets have been met. As stated previously, there are many good examples of practice, including the innovative ways in which staff seek the views and opinions of service users, this needs now to be incorporated into their quality assurance tool. This should seek to obtain the views of family, friends and external stakeholders and a means of feeding the outcome back to interested parties. Monthly visits to the home by the representative of the organisation are regularly sent to the Commission, these are detailed and cover all areas of the running of the home and clear points where action or follow up is needed. There are good arrangements to ensure the health and safety of staff and service users. The pre inspection questionnaire showed that servicing and maintenance of equipment is undertaken as required. Records sampled showed that fire safety, water testing, gas and electrical safety certificates were in place. Risk assessments were in place for the premises and safe working practices such as manual handling, control of substances hazardous to health, and all radiators were covered to prevent surface burns. Water outlets are fitted with valves to regulate the temperature and minimise the risk of scolds. Some good initiatives were seen to be in place in terms of keeping refuse and clinical waste out of the reach of service users, thus promoting their safety and welfare. Risk management is good, risk assessments were in place to ensure appropriate support and control measures are offered to service users, staff knew exactly what action to take in order to keep individuals safe from harm. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 25 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 3 4 x 5 x 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 2 25 3 26 x 27 3 28 2 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 20 Regulation 13(2) Requirement The manager must arrange for prescribed medication for PRN use to be included on the MAR chart provided by the pharmacist. Food supplements such as Esure that are for prescribed use, must be signed for on the MAR chart. All staff who administer medication must have training in the safe handling of medicines accredited training. Flooring in the kitchen requires repair or replacement. (Unmet requirement from 30/1/05). Replacement flooring to the two bathrooms is needed. New blinds are required to replace the broken one in the bathroom. The tiles above the kitchen hob require repair/replacement. Several windows are cracked and a full audit and replacement programme needs to be initiated. A copy to be forwarded to the Commission. Re-grouting is required around the bathtub in both bathrooms. DS0000016884.V326997.R01.S.doc Timescale for action 20/02/07 2. YA20 13(2) 20/02/07 3. YA20 18(1) 01/03/07 4. 5. YA24 YA24 23(2) (b) 23(2) (b) 01/04/07 01/04/07 6. 7. YA24 YA24 23(2) (b) 23(2) (b) 01/04/07 01/04/07 8. YA24 23(2) (b) 01/04/07 Green Road, 26 Version 5.2 Page 27 9. 10. YA24 YA24 23(2) (b) 23(2) (b 11. YA35 18 (1) (a) 12. YA24 & YA28 23(2) A radiator cover in the bathroom needs to be replaced due to urine damage. The bathroom ceiling has water stains, this needs to be assessed further for roof leaks, and repairs made. The ceiling in the second bathroom requires re-plastering due to recent electrical work. The manager must ensure that all staff are up to date in training in infection control, health and safety, manual handling, food safety, adult protection and Altziemers. A training plan to be submitted to the Commission. A review of the premises is needed and plans developed to ensure the design is better suited to meeting the long term needs of the service users. Specifically shared space, laundry facilities and staff accommodation. This is an outstanding requirement. A copy of the review should be made available to the Commission. 01/04/07 01/04/07 01/04/07 01/04/07 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 YA22 YA24 Good Practice Recommendations Information relating to staff pay should be filed in staff files or personnel files and removed from the complaints log book. Additional communal space should be provided to include a conservatory and internal laundry. Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green Road, 26 DS0000016884.V326997.R01.S.doc Version 5.2 Page 29 - 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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