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

This inspection was carried out on 8th January 2008.

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

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

Other inspections for this house

3 & 3a Earlswood Road 01/08/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 3 & 3a Earlswood Road Kings Norton Birmingham B30 3QZ Lead Inspector Kerry Coulter Key Unannounced Inspection 8th & 10th January 2008 09:20 3 & 3a Earlswood Road DS0000069052.V357534.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 3 & 3a Earlswood Road DS0000069052.V357534.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. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 3 & 3a Earlswood Road Address Kings Norton Birmingham B30 3QZ 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) 0121 255 7000 South Birmingham Primary Care Trust Mrs Amanda Jane Haynes Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1st August 2007 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. Information on the current fee levels for the home was not included in the Service User Guide. Copies of CSCI inspection reports are available in the home for people who wish to read them. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The visit was carried out over two days, the home did not know we were coming. The visit on the second day was undertaken to meet with the Manager and sample staff recruitment records. This was the homes second key inspection for the inspection year 2007 to 2008. 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 and reports 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. The focus of this inspection was on House 3A. Unfortunately at the time of the visit several people who live at House 3 had a stomach bug and so a visit to this house was not undertaken. All people at House 3A were spoken with but due to their communication needs most people who live at the home were not able to comment on their views. 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. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 6 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. There are enough staff on duty so that the people living there can be well supported. What has improved since the last inspection? What they could do better: 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 7 Restrictions on people living at the home must be agreed within their care plan and in their best interest. People should be consulted to ensure there views are actively sought rather than ‘being told’ about issues that affect them. This will ensure people are more involved in decisions about their lives. Staff need to have training in managing people’s behaviours so that they can manage behaviour in a consistent and safe manner. Some redecoration of the home and replacement of carpets needs to be done to ensure the home is comfortable for the people living there. Staff need to have regular fire training so that they know what to do to keep people safe if a fire occurs. 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. 3 & 3a Earlswood Road DS0000069052.V357534.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 3 & 3a Earlswood Road DS0000069052.V357534.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 and had been reviewed to reflects the home’s new address and that it is now registered with the Commission. A service user guide has 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. It did not state the fees charged and this information should be included. Although the home was registered in 2007 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. The Manager said that the Trust’s Assistant Locality Manager was in the process of updating the admission criteria to the home so that in the future people are not admitted who are vulnerable from the behaviours of people currently accommodated. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 10 The Manager said people do not yet have copies of contracts / terms and conditions as recommended at the last inspection in August 2007. 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. 3 & 3a Earlswood Road DS0000069052.V357534.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 good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need in care plans and risk assessments so that they know how to meet the needs of the people living there and keep them safe from harm. The people living there are supported to make choices and decisions about their lives and what happens in the home. EVIDENCE: The care records of four of the people living at the home were looked at. These included an individual care plan that stated how staff are to support the individual with their daily routine, sleeping, diet, their communication needs, the things they like and dislike including activities and leisure interests, the things they need help with, the things they can do on their own and the very important things staff need to know and do. Plans sampled had been regularly reviewed. Plans had been further developed since the last inspection so that they contain sufficient detail so that staff know what support to offer people. Staff have also 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 12 been working with people on completing ‘good life plans’, these contain information on people’s wishes for the future. It was identified at the last inspection that some people did not have up to date behaviour management guidelines. Where needed people now have an individual ‘Safe Handling Pack’ that details how staff are to support the person through different stages of their behaviour. This includes what the triggers for each of their behaviours may be and what to do to distract the person from behaving in this way. It was noticed that some of these new plans had yet to be signed or dated, the Manager said she would ensure this was done. 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 or 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 but records of meetings show that often people do not fully participate in the meetings. The Manager said that it has been decided to stop having group meetings and implement a system of individual meetings with people. It is hoped that people who have communication difficulties will find it easier to give their views this way. At the last inspection it was identified that wardrobes of people who live at the home were 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. At this inspection it was observed that for some people although there were padlocks on the wardrobes they were not actually locked. Staff said that for some people the wardrobes were still locked. Minutes of a meeting with people at the home held recently identified that staff had told people why wardrobes needed to be locked but did not evidence any actual consultation with people. 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, accessing the community and choking. It was identified at the last inspection that assessments had not been completed for some areas of risk such as swimming, this has now been done. 3 & 3a Earlswood Road DS0000069052.V357534.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 similar to others of the same age and culture. The people living there are offered a healthy diet to ensure their health and well being. EVIDENCE: Records sampled show that people regularly take part in activities to include swimming, walks, visits to a leisure centre, shopping and local parks. Records showed that people living in the home had been involved in helping staff to put up the decorations for Christmas. A member of staff said that one person really enjoys doing jigsaws so they had bought him some at Christmas. On the days of the inspection visit some people went out shopping whilst one person stayed at home and did some drawing with staff. Staff said that three people were going out in the evening for a meal and to a pantomime. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 14 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. Staff said that most people chose not to use this room but that one person really liked it. As identified at the last inspection people home have a leisure assessment that details what type of activities they enjoy but this was not observed to always link into their care plan. Some assessments would benefit from being reviewed. Often where staff record that activities have been undertaken they usually do not record if the person enjoyed the activity to assist in future activity planning. Records were also observed to detail that people went to places such as Kings Heath, Birmingham city centre or Yardley Wood without actually recording what they did there, for example if it was shopping. 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. It was good that when post was delivered to the home staff opened a letter addressed to one person who lives there with the person, respecting that this was their letter. Further work is needed to ensure people’s rights are fully respected. One person has epilepsy and staff use a ‘baby’ monitor in his room and the lounge to alert them to a seizure occurring. Since the last inspection it’s use has been agreed and recorded in the care plan detailing when it should and should not be used. However, 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. It was identified at the last inspection that some improvements were needing to increase the variety of meals on offer and improve the recording of meals offered. These improvements have been made. Food records sampled showed that a variety of food is offered that includes fruit and vegetables to ensure that people are having a healthy diet to ensure their well-being. Discussion with the Manager indicates that copies of the homes menus have also been sent to a dietician for their comments to see if they need further improvement. People are consulted about what meals they would like for the following week and a record is kept of this. Lunchtime practice was observed and people were given a choice of what they wanted to eat. Staff ate with people whilst also giving them appropriate support. 3 & 3a Earlswood Road DS0000069052.V357534.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 good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the personal care and health needs of individual’s are met so ensuring their well being. The systems for the management of the medication ensure that people get the right medication at the right time so ensuring their health needs are met. EVIDENCE: The people living in the home were well dressed in clothes that were appropriate to their age, gender, culture, the weather and the activities they were doing. Attention had been paid to individual’s personal appearance. Each person had an individual hairstyle and it was evident that people had their hair cut regularly so that their appearance was well maintained helping to maintain their self - esteem. Care plans stated how individuals are to be supported with their personal care. On the first day of the inspection visit staff said that some people in House 3 had a stomach bug and so they were limiting contact between House 3 and House 3A. For this reason this inspection visit focussed on House 3A. It was good that a few days later on the second day of the inspection that people in House 3 were recovering and that the bug had not spread to House 3A. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 16 Weight records showed that staff regularly check people’s weight to ensure they are not losing or gaining a significant amount of weight that could be an indicator of an underlying health need. Records sampled showed that health professionals are involved in individual’s care where appropriate. People had been supported to attend regular health checks so ensuring their health and well being. Each person now has an individual Health Action Plan. This is a personal plan about what help a person needs to be healthy and to stay healthy. For two people the plan needed to be updated to include the date when they last went to the opticians and dentist so that staff know when they need to go again. Medication is stored in a locked cabinet. The qualified nurses give the medication to the people living there. Medication Administration Records (MARS) were sampled for people living in House 3A and were found to be satisfactorily completed. It was good that guidelines were available telling staff how people like to take their medication. There was also a photograph of the person so if unfamiliar staff were giving it this would ensure it was given to the right person. Protocols were in place for people who were prescribed PRN (as required) medication. These stated when the medication should be given and had been reviewed since the last inspection so that staff have up to date guidance about when to give the medication. The pharmacist from the Primary Care Trust visits the home regularly to complete an audit and make sure the medication administration system is satisfactory. 3 & 3a Earlswood Road DS0000069052.V357534.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 adequate. 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. Arrangements to ensure that the people living there are protected from abuse, neglect and self-harm had improved. EVIDENCE: The CSCI has not received any complaints about this home since it has been registered and the Manager said that the home had not received any complaints directly. 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. Two staff were spoken with about where they would record a complaint if they received one. Whilst both were aware of the importance of documenting the complaint neither were sure if there was a specific record that needed to be completed. As a result of this the Manager said she would ensure all staff knew where to record any complaints received in future. It was identified at the last inspection that a large number of staff at the home had not received suitable training in the prevention of abuse / safeguarding adults. This 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 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 18 occurring. The training records show that a minority of staff have done this training but that the Manager and some staff are now booked on training. The Manager said it had been difficult to get this training and so she had managed to get hold of a copy of the course content and used it to do some in house training. The Manager said she had given handouts on the course to staff and intended to speak with staff to make sure they understood the information they had been given. 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. As stated earlier in this report people now have an individual ‘Safe Handling Pack’ that details how staff are to support the person through different stages of their behaviour. However many staff still need training to ensure they have the right skills to support people when they are displaying behaviours that may result in injuries to themselves or hitting other people. Discussion with the Manager and observation of records indicates that some progress has been made on getting training and fourteen staff have places booked between January and October 2008. Where staff have training booked in October the Manager needs to continue in seeking places for them at an earlier date. The CSCI and Social Services have been informed of incidents where people living there have become agitated and have hurt other people. Records and observation of staff practice show that action is taken following incidents to try and prevent future occurrences. The Manager said that the Trust’s Assistant Locality Manager was in the process of updating the admission criteria to the home so that in the future people are not admitted who are vulnerable from the behaviours of people currently accommodated. An incident occurred where one person may have been at risk from the behaviour of a visitor. This was reported by the home under adult protection procedures. The Manager said that the police and social services decided to take no further action about the incident. The Manager said that after discussion with the Trust’s Assistant Locality Manager they had decided on some measures that would reduce the risk of future incidents. These measures need to be recorded so that people are aware of them. At the last inspection it was identified that sometimes when people had bruises records did not indicate that they had not been followed up or investigated how they were caused. The Manager has now introduced a new log that should show where investigations have been done. The Manager said that she has also started to do an annual audit of all incidents and accidents and a breakdown of causes to see if their were any patterns so that measures could be put in place to reduce the incidence. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 19 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. Personal monies are also regularly audited by the Trust’s Assistant Locality Manager as part of their monthly visit to the home to ensure people’s money is being looked after properly. Each person had an inventory of their belongings but these were not up to date. The Manager said that more up to date ones had been completed but that they could not be located. These need to be found or a new record completed so that it is clear what belongs to them and if anything should go missing it can be tracked easier and hopefully found. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 20 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: House 3A was generally homely in style but the décor in some of the communal areas of the home is quite worn and needs redecoration. This was identified in the last inspection report. Focus are the landlords for the property and the Assistant Locality Manager from the Trust wrote to them in October requesting redecoration as the home was last decorated in 2001. The Manager said that a meeting had taken place with a representative from Focus but she was unaware of any agreement being reached on a schedule for the work to be done. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 21 The office carpet in House 3A is very badly stained and gives a very poor first impression to visitors at the home. Other carpets were seen to be adequate having been deep cleaned since the last inspection. The Manager said that some carpets in House 3 that had been cleaned but were still stained and needed replacement. It was previously identified that the lounge seating in House 3 was worn and stained and needed replacement. The Manager said that a new lounge suite had now been delivered and that one was also on order for House 3A. It was observed that a new dining table and chairs had been provided in the home and this makes the room look more homely. This would be further improved if the missing drawer fronts to the dresser were replaced. The first floor corridor has net curtains that are badly stained in one area. Staff said that this is from a small leak to the glazed roof. This is an ongoing issue and staff said that they were unsure what was happening about it. This needs to be repaired and new screening provided at the window so that the home looks nice and people have a homely environment. Bedrooms seen were generally satisfactorily decorated according to individual’s tastes, interests, age and gender. Most bedrooms were very personalised with people’s possessions. One person spoken with said that his bedroom was ‘nice’. At the last inspection in House 3 the ceiling in one bedroom was observed to need repainting as it was stained where drinks had been thrown at the ceiling. Staff said this had not yet been done. Some bedrooms needed some redecoration where heat from radiators had caused discolouration to the walls. People do not have en suite bathrooms and so have to share the two bathrooms and two shower rooms in House 3 and 3A. 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. Progress towards this was not discussed at this inspection. Satisfactory hand washing facilities were observed in the bathrooms, laundry and kitchen areas. The home was clean and generally free from offensive odours. A foul smell was evident from one toilet and sink on the first day of the inspection visit and staff took action to reduce the odour as well as reporting it to the maintenance department. The offensive odour was not apparent on the second day of the inspection. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 22 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. Arrangements for staffing, their support and development needs some improvement to ensure that the people living there are always supported by an effective staff team who are supported, supervised and have the knowledge to meet individual’s needs. 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. Evidence from the previous inspection and recent monthly reports from the home indicate that 50 of staff have an NVQ this 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 one or two qualified nurses 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. From discussion with staff and observation during the inspection staffing levels appear to meet people’s needs. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 23 The recruitment records of two recently recruited staff working at the home were looked at. These included evidence of references, application form and a Criminal Records Bureau (CRB) check had been undertaken ensuring that ‘suitable’ people are employed to work with the people living there. At the last inspection it was not possible to fully establish what training staff had completed as staff did not have training records. The Manager has now introduced a system to record training. This showed that some staff still needed training in first aid, food hygiene, epilepsy and Studio III (challenging behaviour and physical intervention). Some staff have been booked to attend the training they need but the Manager said she had not been able to get training from the Trust for all staff, but was working towards this. It was observed that autism training was not part of the home’s training plan but several people who live at the home have autism. This is an area that the qualified nurses would have covered as part of their nurse training but the home needs to provide support workers need to be provided with suitable training so that they can fully meet the needs of the people they support. As stated earlier in this report the Manager has been unable to access training for all staff on safeguarding people from abuse. As an interim measure the Manager is in the process of doing in house training with staff. The staff supervision records showed that some staff had not received regular, recorded supervision meetings at least every other month. This issue has also been raised by the Assistant Locality Manager in his reports of visits to the home. Regular supervision is needed so that staff 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. 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements have improved and are now generally sufficient to ensure that the health, safety and welfare of the people living there is promoted and protected. EVIDENCE: 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. Staff spoken with said the Manager is very open and approachable and will listen to staff’s ideas. It is evident that since the last inspection the Manager has been working towards improving outcomes for people who live at the home. At the last inspection there was no evidence that the Trust had carried out monitoring visits of the Home to make sure it was being well run. This has now 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 25 improved and visits are being done monthly and the reports of the visits are available in the home. 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. These areas have improved since the audit was completed. Discussion with the Manager indicates that plans are in place to improve how the views of people living at the home can be sought and contribute to the development of the home. As stated earlier in this report the home is changing the format for ‘residents’ meetings and people will now be met with on an individual basis. The Manager said she is also liaising with the Speech and Language Therapist to produce service user satisfaction questionnaires in an accessible format. Fire records showed that an engineer regularly services the fire equipment. Records also showed that a recent fire drill had been held in the home but reports of the monthly visits to the home by the Assistant Locality Manager show that the home had to be asked several times to arrange the drill as it had been overdue. The emergency lights are tested monthly and the fire alarms are usually tested weekly. The records did show the odd occasion where fire alarm tests had been missed, it is important the alarms are regularly tested to make sure they are working and people are alerted if a fire should occur. It was not evident that all staff had received regular fire training. Records evidenced that new staff had received information about the homes fire procedures and some staff had attended fire training in May 2007, but not all. All staff need regular fire training to ensure they know what to do to keep people safe should a fire occur. It was identified at the last inspection that the fire risk assessment for the home needed to be reviewed to ensure it was up to date. Records show that the Trust’s fire officer visited the home in December 2007 to update the risk assessment. The Manager said that she was awaiting the updated copy of the assessment. The passenger lift and assisted bath are regularly serviced to ensure they are safe and work well. Certificates were available to show that the gas appliances and electrical installations in the home were safe. Staff test the temperature of the water regularly to make sure it is not too hot or cold. Records show that the water was at a comfortable temperature and would not put people at risk of being scaled. It was identified at the last inspection that fridge temperatures were too high and could put people at risk of food poisoning as food was not being stored safely. This has now been addressed and records sampled showed that food was stored at a safe temperature. 3 & 3a Earlswood Road DS0000069052.V357534.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 2 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 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA16 Regulation 12 (4) a Requirement Restrictions on people living at the home must be agreed within their care plan and in their best interest. Previous requirement from 30/9/07 All staff need to have training in managing people’s behaviours so that they can manage behaviour in a consistent and safe manner. Previous requirement from 30/10/07 The leak to the window / roof area in the first floor corridor area on house 3A must be repaired so that the home is well maintained for the people who live there. Ensure a suitable program of staff training is in place so that staff have the knowledge and skills to meet the needs of people at the home. Previous requirement from 30/09/07 Ensure that all staff have had regular fire training so that they know what to do to keep people safe if a fire occurs. Review systems that are in place DS0000069052.V357534.R01.S.doc Timescale for action 30/03/08 2 YA23 13(6) 30/04/08 3 YA24 23(2)(b) 30/04/08 4 YA35 18(c) 30/04/08 5 YA42 23(4)(d) 28/02/08 6 YA42 23(4) 28/02/08 Page 28 3 & 3a Earlswood Road Version 5.2 to ensure fire drills and the testing of the fire alarms are completing regularly so that people are kept safe from the risks of fire. 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 YA1 YA5 Good Practice Recommendations The service users guide should include the fees charged so that people know how much the service costs. 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. Review how people are consulted to ensure there views are actively sought rather than ‘being told’ about issues that affect them. This will ensure people are more involved in decisions about their lives. Completed leisure assessments should link into people’s care plans to ensure they are offered opportunities to do the things they enjoy. Review the information recorded when activities are undertaken to indicate what people have actually done and if they enjoyed it. This will contribute towards planning of future activities for people. Update people’s health action plans to make sure they reflect when people last attended the opticians and dentist to make sure all staff know when people are due to attend their next check up. Staff need further information or training to ensure they know where to record any complaints received, in line with the home’s complaint procedures. Where measures to protect one person following an incident with a visitor have been agreed these should be documented. Each person’s inventory of their belongings should be updated regularly so it is clear what each person owns. Where carpets remain stained following recent cleaning these should be replaced so that the environment is homely and well maintained for people. DS0000069052.V357534.R01.S.doc Version 5.2 Page 29 3 YA7 4 5 YA12 YA12 6 YA19 7 8 9 10 YA22 YA23 YA23 YA24 3 & 3a Earlswood Road 11 12 13 YA24 YA24 YA25 The communal lounges in both houses need redecoration so that the environment is homely and well maintained for people. Where walls have been stained above radiators due to the heat these areas need redecoration so that the environment is homely and well maintained for people. 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. 14 15 YA36 YA39 3 & 3a Earlswood Road DS0000069052.V357534.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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