Inspection on 01/08/07 for 3 & 3a Earlswood Road

This inspection was carried out on 1st August 2007.

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 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

3 & 3a Earlswood Road 08/01/08

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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 08/07/2008.

CARE HOME ADULTS 18-65 Monyhull Hall Road 68 & 70 Monyhull Hall Road Kings Norton Birmingham B30 3QD Lead Inspector Kerry Coulter Key Unannounced Inspection 01 & 03rd August 2007 09:45 st Monyhull Hall Road DS0000069052.V341577.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 Monyhull Hall Road DS0000069052.V341577.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. Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Monyhull Hall Road Address 68 & 70 Monyhull Hall Road Kings Norton Birmingham B30 3QD 0121 255 7000 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) South Birmingham Primary Care Trust Mrs Amanda Jane Haynes Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Not applicable as first inspection. Brief Description of the Service: The home is registered to provide accommodation, nursing care and support for up to eight adults with learning disabilities who may have challenging behaviours, all the people who live at the home are all men. People have lived at the home since 2002 but the home has only been registered since February 2007. The home is managed by South Birmingham PCT and the property is owned by Focus Futures. The home is made up of two separate houses next door to each other, each accommodating up to four people in single bedrooms. Bedrooms do not currently have en suite bathrooms but an undertaking was given at the time of registration to install en suites to 50 of rooms within two years. Each home has its own laundry, bathroom and shower room, kitchen, dining room, living room, sun room and office. There is a sensory room that is shared. The home also has a lift so that people with mobility problems can access the first floor of the home. There is good off road parking at the front of the house, and a private garden to the rear of the property. There is a wide range of community facilities in the area, including shops, pubs, restaurants and places of worship. Public transport links are good, with bus stops close by. The Manager was unable to provide information on the current fee levels for the home. Copies of CSCI inspection reports are available in the home for people who wish to read them. Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over two days, the home did not know we were coming. This was the homes first key inspection for the inspection year 2007 to 2008. It should be noted that the home has been given a new postal address of 3 and 3A Earlswood Road. This is not reflected on the front sheet of this report as the Provider has not officially informed the CSCI of this change. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) 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, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home (AQAA). People who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, 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. All people who live at the home were spoken to. Due to their communication needs most people who live at the home were not able to comment on their views. Discussions with staff and the Manager took place. What the service does well: Staff were observed to give support with warmth, friendliness and patience and treat people respectfully. The people living there were asked what they wanted to do and where they wanted to go. Staff offered them choice throughout the day and supported them to do the things they wanted to do. People who live at the home get to go out and do lots of activities so that they generally do the things they enjoy. Staff support people to keep in contact with their family and friends. People were well dressed in good quality clothes that were appropriate to their age, the weather and the activities they were doing. Everyone who lives at the home has their own bedroom. Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People need to be given up to date information about the home so that they know what services they can expect if they live there. Some care plans and risk assessments needed improvement so that staff have the information they need to meet people’s needs. Restrictions on people living at the home must be agreed within their care plan and be in their best interest. The menu should be reviewed to ensure meals offered to people are not repetitive in content so that people’s dietary needs are met. Systems to monitor people’s health must improve to ensure they get the health support they need. Adult protection systems need to improve to reduce the risk of abuse to people living at the home. Some areas of the home need redecoration and new carpets so that it is a nice place to live. Recruitment systems for new staff must improve so that people are not put at risk by having unsuitable people working with them. The Manager must ensure staff have all the training and support they need to do their job and to support the people who live in the home. Senior managers need to visit the home monthly and write a report to ensure the home is being well managed. Some areas of health and safety needs to improve to ensure people living at the home are not put at unessacary risk of injury. Please contact the provider for advice of actions taken in response to this Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 7 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. Monyhull Hall Road DS0000069052.V341577.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 Monyhull Hall Road DS0000069052.V341577.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, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have most of the information they need to ensure they can make a choice about whether or not they want to live at the home. EVIDENCE: The statement of purpose for the home was readily available, although it was signed as reviewed in June 2007 it was observed to require updating with the home’s new address and that it is now registered with the CSCI. A new service user guide has recently been produced with assistance from a Speech and Language Therapist so that the format is suitable for people who live at the home. This gives the information about what the home provides to people who are looking to see if the home can meet their needs and whether or not they want to live there. This will need minor amendment as it records that the home will be inspected twice yearly by the CSCI when in fact the number of visits varies according to the CSCI assessment of the quality of the service. Although the home is newly registered people have in fact lived at the home since 2002 and the home does not have any vacancies. If the home does have a vacancy in the future the admission criteria states that an initial assessment would be done followed by multi disciplinary meetings, informal visits, an overnight stay and an admission meeting. Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 10 The Manager said people do not yet have copies of contracts / terms and conditions. Copies of the terms and conditions need to be available to people who live at the home so they have information on what to expect from the home and the fees payable on their behalf. Monyhull Hall Road DS0000069052.V341577.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there is a clear care planning system, with personal profiles and risk assessments, these do not always provide staff with all the information they need to satisfactorily meet peoples needs. EVIDENCE: Four of the records of the people who live at the home were looked at. These included an individual care plan and these were generally up to date. Some of the care plans need to be developed so that they contain sufficient detail so that staff know what support to offer people. Care plans provided some information about how staff are to support people to meet their communication, social, spiritual, health, personal care, dietary and mobility needs but further detail was needed. Some people did not have a plan detailing the support they needed at meal times. Where a person has behaviours that challenge not all of these behaviours are included in the care plan with guidelines available for staff to enable them to manage the behaviour safely, in a manner that respects the individual. Some people had guidelines Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 12 about managing their behaviour but they were observed to need review to ensure the guidelines were still appropriate. Information in the care plans would benefit from being more person centred for example to include more details about peoples cultural needs, food likes and dislikes and the activities they enjoy doing. This will help to ensure staff provide support in the way people prefer and need. The Manager and staff have recognised that plans need to be more person centred and intend to complete a plan called ‘Good Life Plan’ for each person at the home. This work was seen to be in the initial stages. Each person’s records included individual risk assessments that had been regularly reviewed. These stated how staff are to support the person to reduce the risks from things such as aggression, burns, seizures, hot drinks, accessing the community and choking. Risk assessments sampled at this visit required further work to demonstrate that staff have accurate information to manage risk in a responsible way. For example the care plan for someone assessed at risk of choking said they needed their food cut up but this was not recorded in the risk assessment. Not all areas of risk had been assessed. There was no assessment for people who go swimming to include consideration of their health needs, staffing ratios and swimming ability. There is evidence that people who live in the home are supported to make some choices about their daily life. Staff were observed offering people choices about what they wanted to drink and whether or not to take apart in an activity. Some meetings have been held with people to seek their views on things such as activities and meals. However the behaviours of one person can impact significantly on the rights and choices of other people living at the home. The wardrobes of everyone who live at the home were observed to be padlocked. The Manager said this was because one person will go into other people’s wardrobes and take or damage their possessions. There was no evidence that people had been consulted or agreed to their wardrobes being locked and no evidence or other less restrictive measures being considered. Monyhull Hall Road DS0000069052.V341577.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 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that people living in the home experience a meaningful lifestyle. EVIDENCE: Records sampled show that people regularly take part in community activities to include swimming, walks, bowling, shopping and church. On the days of the inspection visit some people went swimming, bowling or for a walk to get an ice cream. One person did not want to go for a walk and decided to stay at home to watch the horse racing on television. One person who lives at the home said he ‘goes out a lot’. Discussion with staff indicates that people did not have the opportunity to go on holiday last year but it is hoped that people who want a holiday will go away this year, possibly to Centre Parcs. People who live at the home have a leisure assessment that details what type of activities they enjoy but this was not observed to link into their care plan. Also, where staff record that activities have been undertaken they usually do Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 14 not record if the person enjoyed the activity to assist in future activity planning. There is a snoozelen room in the home. All the equipment in the room was working so that people could spend time relaxing in there with the music and lights on. However staff said that people did not use the room very often as it was not something they really enjoyed. Perhaps people who live at the home should be consulted about the use of this room to see if they would like something else instead. People are supported to maintain contact with their family. Staff said and records showed that people’s family visit them and some people go out with their relatives. On the day of the visit a member of staff was taking one person to go and see their parents. Further work is needed to ensure people’s rights are fully respected. As stated earlier in this report people at the home are not able to access their own wardrobes without help from staff due to them being kept locked. One person has epilepsy and staff use a baby monitor in his room and the lounge to alert them to a seizure occurring. The person’s night time guidelines make brief reference to the use of the monitor but it is not clear if they have given their consent to its use as it impacts on their privacy. Its use needs to be agreed and recorded in the care plan detailing when it should and should not be used. Staff said the Manager has made improvements around menu planning and that people now choose the menu for the week ahead. The Speech and Language Therapist is in the process of doing food pictures to assist in how people with more limited communication can make food choices. One person who lives at the home commented ‘food is nice here’. There were generally satisfactory stocks of food but one of the houses had no supplies of fresh fruit whilst the house had lots of fruit available. However food records sampled did show that people had vegetables and fruit as part of their diet. Recording could be improved to enable staff to better monitor people are having a healthy diet as sometimes entries said ‘vegetables’ and did not detail what people had. Staff also need to ensure meals are not too repetitive as people had pizza and chips five times between 10th June and 24th July. Monyhull Hall Road DS0000069052.V341577.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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care records do not always clearly state how people’s needs should be met and so their needs may not always be consistently met by staff. People who live at the home generally receive their medication safely and as prescribed by the GP. EVIDENCE: The people living in the home were well dressed in clothes that were appropriate to their age, the weather and the activities they were doing. Attention had been paid to individual’s personal appearance. Staff were observed putting sun cream on one person before they went out for a walk due to the sunny weather so they would not get burnt. Care plans sampled did not include detailed information about individual’s likes and dislikes regarding their personal care to help staff support them in a way that would meet their preferences. One person had been unwell over recent weeks. Their records showed that staff had ensured he had seen the GP. Health records sampled showed that people had been supported to see the dentist regularly but did not show people had been to the opticians recently. Staff spoken with said that people had seen Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 16 the opticians about three years ago but two people were going to the opticians the following Monday and appointments would be made for other people to attend. One person has epilepsy and there was a care plan in place directing staff to monitor their seizures. The plan needed improving to detail the type of epilepsy, usual frequency and duration so that staff know what is usual for this person and know what to do if a seizure occurs. Records show that peoples weight is regularly monitored but for some people their plans did not record what their ideal weight should be. One person had a plan to reduce their weight to 97kg by October 2006. This has been achieved and the plan signed as regularly reviewed, however as the date and target weight has been achieved the plan needs to discontinued or rewritten to reflect a new target weight and date. Staff spoken with said that Health Action Plans were being developed for people. These are an individual plan about what the person needs to do to stay healthy. Medication is stored in a locked cabinet. The qualified nurses give the medication to the people living there. Three people’s Medication Administration Records (MARS) were sampled and found to be satisfactorily completed. It was good that guidelines were available telling staff how people like to take their medication. Protocols were in place for people who were prescribed PRN (as required) medication. These stated when the medication should be given. Some needed further details about how much medication should be given when people are prescribed a variable dose such as 1 – 2mg so that staff know in what circumstances the higher dose should be used. In one the houses the protocols were up to date but in the other house some of the protocols needed reviewing to make sure the information was still current as they were over twelve months old. Some people are prescribed creams on an as required basis and protocols need to be available so that staff know when they should be used. Monyhull Hall Road DS0000069052.V341577.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 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaint procedure if followed would ensure that people or their representatives would be listened to and concerns acted upon. Systems in place do not effectively protect people from abuse and these failings may well increase the risk to people living in the Home. EVIDENCE: The CSCI has not received any complaints about this home since it has been registered. The AQAA completed by the Manager says that the home has not received any complaints. The complaints procedure of South Birmingham Primary Care Trust was available in the home. An easy read procedure was also available, this included large simple print and pictures to make it easier for people to understand. There are also guidelines in place for staff to help people complain who have communication difficulties, this directs staff to consider their body language, facial expressions and behaviour. The personal monies of the people living in the home are held securely. Staff check these monies at the handover of each shift to ensure that the money is still there and any money taken out for people to spend had been calculated properly. Discussion with the Manager indicates that the majority of staff have not had training in the protection of vulnerable adults. A Trust audit of the home in November 2006 identified that staff needed this training but the Manager said she had been unable to get training places for staff. The Manager said she Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 18 would try and arrange some in house training for staff whilst they were awaiting places with the Trust’s training department. Protection of vulnerable adults training is important to ensure staff know how to protect people from abuse and what to do to keep them safe if they have suspicions of abuse occurring. Some people who live at the home have behaviours that may result in injuries to themselves or hitting other people. To protect people from harm staff need to have training and have clear guidelines so that they can manage behaviours in a consistent and safe manner. The Manager said that some staff had training in this area but needed refresher training and some staff had no previous training. As recorded earlier in this report some people did not have behaviour management guidelines or up to date behaviour management guidelines to ensure staff manage behaviours consistently and in the right way. An incident report in June involving a person who lived at the home recorded ‘staff restrained him from grabbing my shirt, he was redirected to dining area’. The record did not detail how this person had been restrained and so it was unclear if physical intervention had or had not been used. The Manager said she was unaware of the incident and neither the Deputy or a nurse were able to explain exactly how this incident had been managed as there was no other records about what happened. Systems of recording and reporting such events need to improve so that it is clear exactly how they were managed and the Manager of the home can ensure people are properly protected from the risk of abuse. The response of staff to critical incidents was tracked such as falls and injuries. In some instances there had been recordings of injuries of unknown origin and records did not indicate that they had not been followed up or investigated. Staff said that some bruises were often caused by people at the home hitting each other. The Manager must ensure that all accidents and incidents are reviewed and investigations are undertaken where there is any unknown injury or bruising to determine the cause and implement any actions required to prevent reoccurrences where possible. Satisfactory evidence was not available in the home that robust recruitment checks had been completed for all staff. This puts people who live at the home at risk of having unsuitable people working with them. This is further detailed in the staffing section of this report. Monyhull Hall Road DS0000069052.V341577.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, 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a clean, tidy well personalised home that generally meets their needs and reflects their taste and interests. Some maintenance issues need attention to ensure that the home continues to provide a safe and homely environment. EVIDENCE: The home was generally homely in style but the décor in some of the communal areas of the home is quite worn and will need redecoration. In one of the hallways there has been a leak, this has been repaired and the area of new plastering will need repainting once it has dried out. The seating in House 3 in the lounge was worn and stained and needs replacement. The Manager said that new seating was on order. Carpets throughout much of the home were observed to be very stained and will need deep cleaning or replacement. However, due to the severity of the staining it is likely new carpets will be needed. The office carpet in House 3A is very badly stained and gives a very poor first impression to visitors at the home. Focus, Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 20 who are the Landlords of the property visited the home in May and sent a report of their visit to the CSCI. This did not record the poor condition of the carpets and worn décor. The Manager said she had not been given a schedule for the required work by Focus. One of the first floor corridors was without curtains to the windows. Staff said they had been pulled down about six weeks previously by someone who lives at the home and that quotes for new ones were being obtained. Bedrooms seen were generally satisfactorily decorated according to individual’s tastes, interests, age and gender. Most bedrooms were very personalised with peoples possessions. The ceiling in one bedroom was observed to need repainting as it was stained where drinks had been thrown at the ceiling. Some people had not been provided with headboards on their beds. Staff spoken with said this was according to individual preference. This needs to be recorded in their care plan. People do not have en suite bathrooms and so have to share the two bathrooms and two shower rooms. An undertaking was given when the home was registered in February 2007 that 50 of bedrooms would have an en suite bathroom within two years. The home was generally clean and free from offensive odours. Satisfactory hand washing facilities were observed in the bathrooms, laundry and kitchen areas. Monyhull Hall Road DS0000069052.V341577.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, 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. The arrangements for staffing the home their support and development are variable and do not always ensure that staff are able to meet the needs of the people living in the home. People living there are not sufficiently protected by the home’s recruitment practices. EVIDENCE: Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. The Manager said 50 of staff have an NVQ and the Learning Disability Award Framework qualification is offered to new staff. This meets the standard that at least 50 of staff have achieved this qualification and contributes towards ensuring that staff have the knowledge and skills to work with the people living in the home. Rotas showed and staff said that there are usually six staff including a qualified nurse on each shift during the day. In addition there is a member of staff who works a twilight shift in the evening, five days a week. The Manager, Deputy Manager and a member of staff spoken with felt staffing levels met people’s Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 22 needs. The Manager said there are 43 vacant staff hours and there is some use of bank staff to cover this. The recruitment records of two recently recruited staff working at the home were looked at. For both staff there was a completed application form and two written references. For one member of staff there was a letter from a Trust recruitment officer saying a Criminal Record Bureau (CRB) clearance had been obtained but this did not record the level of the check or the disclosure number. For the other member of staff there was no evidence that a CRB check had been undertaken. The Manager said she had requested the missing CRB information from the personnel department. It was not possible to fully establish what training staff had completed as staff did not have training records. An audit completed by the Trust in November 2006 identified staff did not have training records so it is disappointed this audit has not yet been fully acted on. The audit also identified that staff needed training in Adult Protection and Minimising Confrontation. The Manager said she had been unable to get staff places on this training. The Manager said that the majority of staff had completed Manual Handling training recently and was able to provide certificates to evidence this. The Manager said that most of the nurses had recently done training about the new Mental Capacity Act and that training on epilepsy had been booked for staff. Staff do not receive regular, recorded supervision meetings at least every other month so that they receive the support they need to carry out the job or receive feedback on their performance. Staff meetings have occurred infrequently. This means that staff do not get a formal opportunity to be updated regularly about the changing needs of people, changes within the organisations philosophy or an opportunity to influence how care for people will be delivered in the future. Monyhull Hall Road DS0000069052.V341577.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 and 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management arrangements at this service do not always ensure that people living there benefit from a service that is run in their best interest. Arrangements are not sufficient to ensure that the health, safety and welfare of the people living in the home are always promoted and protected. EVIDENCE: Staff spoken with said the Manager is very open and approachable and will listen to staff’s ideas. The Manager is a Registered Nurse for people who have a learning disability (RNLD). She has several years experience of managing care settings for people who have a learning disability. The Manager has the required knowledge to manage the home but as indicated in this report the home is not being well managed in some outcome areas for people who live at the home. Some of the systems that are in place are not effective and as a result people are experiencing variable outcomes. This home was given a new Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 24 postal address in March but this was not communicated to the CSCI and nearly resulted in the inspection visit being abandoned as the home could not be located. The Manager said she thought her line manager was going to inform the CSCI of the new address. It is of concern that there is no evidence in the Home that the provider has carried out monitoring visits of the Home when discussions should take place with people living in the home and a tour of the premises should be made to form an opinion about how the Home is being run. The last report available was dated November 2006 which was before the home was registered with the CSCI. Given that the home has some poor outcomes for people it is important that the provider has good oversight of the areas for development so they can influence change. An audit of the home was completed in November 2006, this identified some areas that needed improvement to include staff training and person centred planning. It was not clear if the views of the people who live at the home had been taken into account as part of the audit. The Manager said that some people had completed questionnaires in the past but was unable to locate these. The Annual Quality Assurance Assessment (AQAA) was completed and returned to the CSCI on time, however some questions were not answered and others lacked detail or insight about the homes performance. The work place fire risk assessment was dated 2005. The Manager has the responsibility to ensure an up to date and effective work place fire risk assessment is in place so that people’s safety is promoted and protected. Fire records showed that staff test the fire equipment regularly to make sure it is working. Fire records stated that the last fire drill was held in May 2007. Certificates evidenced that the fire alarms and emergency lights had been recently serviced by an engineer. Records showed that eight staff have had recent fire training but it was not clear from records if all staff have had fire training due to the lack of staff training records. In October 2006 a Corgi registered engineer tested the gas equipment as required annually to make sure it is safe. A certificate was available to show that the passenger lift had been serviced in January 2007 and was safe for people to use. The temperature of the water is regularly monitored to ensure it will not pose a risk of scalding to people. Fridge and freezer temperatures are monitored daily in both houses. Records for one fridge showed that food was being stored at safe temperatures. In the other house fridge temperatures were high throughout July and ranged from 11°C to 14°C. Ideally the temperature should not exceed 5°C. This means that people were being put at risk of food poisoning as food was not being stored safely. The nurse on duty said that night staff usually test the fridges and they had not alerted senior staff to the temperatures being too high. Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 25 Environmental risk assessments were not available in the home on first day of visit, staff said they were at headquarters. They were available on the second day and observed to require review to ensure the assessment was up to date and the information still valid. The AQAA did not record a date for the electrical installation certificate for the home. At the inspection visit a certificate was not available and the Manager was not sure if home had a certificate. The hard wiring of the home needs to be periodically tested to ensure it is in a satisfactory condition and does not pose a risk to people a the home. Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 X X 2 X Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Not applicable as first 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 YA6 Regulation 15 (1) (2) Requirement A comprehensive support plan must be in place for each person detailing how the staff team will meet his assessed needs so that staff know what support to offer people. Care plans must include specific guidance for staff on how to manage individual’s behaviours. Risk assessments must be completed for all areas of risk to people at the home. They must be clear and specific about what the risks are and the action taken to minimize the risk so that people are protected from harm. Restrictions on people living at the home must be agreed within their care plan and in their best interest. There must be proper provision for the health and welfare of people so their health needs are monitored and planned for. Failure to do so puts people at risk of ill health. Arrangements must be made to ensure that all staff have a clear understanding of adult protection DS0000069052.V341577.R01.S.doc Timescale for action 30/10/07 2 3 YA6 YA9 15(1) (2) 13 (4) a, b, c 30/09/07 30/09/07 4 YA16 12 (4) a 30/09/07 5 YA19 12 (1) a, b 30/09/07 6 YA23 13 (6) 30/10/07 Monyhull Hall Road Version 5.2 Page 28 7 YA23 13(6) 8 YA23 13(6) 9 YA23 13(6) 10 YA24 23(2)(b) 11 YA24 23(2)(b) 12 YA34 19 13 YA35 18(c) and whistle blowing procedures. This is to ensure that people are not put at risk. Systems of recording and reporting incidents where physical intervention has been used need to improve so that it is clear exactly how they were managed and the Manager of the home can ensure people are properly protected from the risk of abuse. Accidents and incidents need to be reviewed and investigations undertaken where there is any unknown injury or bruising to people who live at the home to try and determine the cause and implement any actions required to prevent re-occurrences where possible. Staff need to have training in managing people’s behaviours so that they can manage behaviour in a consistent and safe manner. Areas of the home that require redecoration must be redecorated to ensure that the home is comfortable and homely for people to live in. An audit of the carpets needs to be undertaken and a schedule of carpet replacement implemented to ensure the home is comfortable and homely for people to live in. Staff recruitment procedures must be robust and evidence that Criminal Record Bureau checks have been obtained to ensure people who live at the home do not have unsuitable staff working with them. Staff must have the necessary training and a record of this must be maintained. This is to ensure that people are safe and their individual needs are met. DS0000069052.V341577.R01.S.doc 30/09/07 30/09/07 30/10/07 30/11/07 30/09/07 30/09/07 30/09/07 Monyhull Hall Road Version 5.2 Page 29 14 YA39 26 The owner representative must 30/09/07 do monthly monitoring visits of the Home when discussions should take place with people living in the home and they inspect the premises so that they can form an opinion about the standard of care provided to people and produce a report on the outcome. The hard wiring of the home needs to be periodically tested to ensure it is in a satisfactory condition and does not pose a risk to people a the home. The certificate to evidence this has been done needs to be sent to the CSCI. Where food is stored in the fridge it must be kept at a safe temperature so that people who live in the home are not put at risk of food poisoning. 30/09/07 15 YA42 13(4) 16 YA42 13(4) 30/09/07 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 Refer to Standard YA1 Good Practice Recommendations The Statement of Purpose should be updated to reflect the new address of the home and that it is now registered with the CSCI so that people have accurate information when reading the document. The Service User Guide needs amendment to reflect that the home will receive variable visits from the CSCI depending on the assessed outcomes for people who live at the home. Copies of people’s terms and conditions need to be available to people who live at the home so they have information on what to expect from the home and the fees payable on their behalf. Person centred plans should be implemented in a format DS0000069052.V341577.R01.S.doc Version 5.2 Page 30 2 YA1 3 YA5 4 YA6 Monyhull Hall Road 5 6 7 8 9 10 11 12 13 14 15 YA12 YA17 YA17 YA18 YA20 YA23 YA25 YA36 YA39 YA42 YA42 suitable for the individual so that it is meaningful and personal to them. Completed leisure assessments should link into people’s care plans to ensure they are offered opportunities to do the things they enjoy. Food records must be maintained so that there is evidence that peoples dietary needs are being met. The menu should be reviewed to ensure meals offered to people are not repetitive in content so that people’s dietary needs are met. More information about people’s personal care preferences should be included in their care plan to ensure they receive personal support in the way they prefer and need. Protocols for the use of ‘as required’ medication need review to ensure staff have up to date information about when people need medication. Behaviour management strategies should be regularly reviewed to ensure these are effective in managing the individual’s behaviour. The bedroom ceiling that is stained with drink should be repainted so that the room is homely and a nice place for the person who lives there to spend time in. Staff should receive the supervision and support they need to carry out their jobs and meet the needs of the people living there. Quality assurance systems require further development so people’s views are sought about the day-to-day running of the Home. The fire risk assessment should be kept under review so any risk to people in the home is minimised. The environmental risk assessments for the home should be kept under review so any risk to people in the home is minimised. Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-56 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 Monyhull Hall Road DS0000069052.V341577.R01.S.doc Version 5.2 Page 32 - 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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