Inspection on 11/09/07 for 34-36 Langstone Road

This inspection was carried out on 11th September 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

34-36 Langstone Road 22/02/08

34-36 Langstone Road 14/11/06

34-36 Langstone Road 22/02/06

34-36 Langstone Road 17/08/05

34-36 Langstone Road 17/02/05

34-36 Langstone Road 03/09/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 34-36 Langstone Road Russells Hall Estate Dudley West Midlands DY1 2NJ Lead Inspector Jayne Fisher Unannounced Inspection 11th September 2007 09:15 34-36 Langstone Road DS0000024966.V343923.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 34-36 Langstone Road DS0000024966.V343923.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. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 34-36 Langstone Road Address Russells Hall Estate Dudley West Midlands DY1 2NJ 01384 234510 01384 234510 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) Langstone Society Mrs Patricia Joan Brookes Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14th November 2006 Brief Description of the Service: Langstone Road is a residential care home registered for eight people with a learning disability. Originally two semi-detached properties It maintains a similar appearance to other residential properties in the area and is situated close to local shops and public transport links. The Registered Provider is Langstone Society which is a Registered Charity who rent the premises from the Churches Housing Association of Dudley District Limited (CHADD). Facilities include 6 single and 1 double bedroom, kitchen, dining room, 2 sitting rooms, and sufficient numbers of bathrooms and toilets. Car parking is available at the front of the property with gardens at the rear. A statement of purpose and service user guide are available to inform residents of their entitlements. There was no information made available regarding fee levels at this inspection visit although we saw that there were additional charges for activities, transport, hairdressing and toiletries. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 09.15 a.m. and 6.15 p.m. and was undertaken by one inspector with the home being given no prior notice. We met all of the seven residents who live at the home. Formal interviews were not appropriate so we relied upon brief chats and observations of body language and interactions with staff. The manager was on holiday and we spoke with five members of staff and met a senior manager who visited the home. Three questionnaires were received from relatives and five from visiting professionals. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. We were also assisted by an Expert by Experience (in this report known as the Expert). This was someone with personal experience of a learning disability who has been trained to accompany inspectors during a visit to a service. Experts by Experience observe what happens in the home and talk to residents to get their view of the home. This Expert talked to most of the people living here and provided a report of her findings, parts of which have been included in this report. What the service does well: What has improved since the last inspection? Residents have more opportunities to go out into the local community and there are extra staff on duty to help them do this. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 6 Staff are more closely following the specialist dietary needs of one of the residents and there is improved record keeping by staff to demonstrate what residents have chosen to eat. Health screening has improved and efforts have been made to explain this to residents through leaflets and attending a drama session. Residents have visited the dentist and optician. Some parts of the premises have been redecorated and refurbished and residents confirmed that they are asked about how they would like this carried out. There is a quality assurance system in place and a visit has been undertaken by a self advocacy group to look at how the home is run. The manager has clearly defined hours dedicated to management and support. Fire safety is improved with staff receiving training and participating in fire drills. What they could do better: This service has deteriorated and there are many areas which need to improve. Negative feedback was received from professionals and the Expert by experience regarding the service provided to residents. Care plans and risk assessments need further development in order for them to ensure that they are working tools for staff to help them in providing support to residents More efforts are needed at enabling residents to participate in the planning of their own care and identifying their aspirations and wishes. Further support is required to help residents in leading more stimulating and interesting life styles and helping them to develop and learn new skills. Residents are not offered enough opportunities and support to help plan, prepare and shop for their own food. Both the manager and staff have demonstrated a lack of knowledge regarding safeguarding residents and poor practices have developed that have the potential to place people at risk. There are no male staff employed to support the male resident who lives at the home. Although residents live in a comfortable home, some aspects could be improved in order to provide them with a lifestyle more suited to their age and which promotes their dignity. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 7 The manager and staff group need further training in how to promote residents’ rights and in understanding the social model of disability. There is a continued breakdown in communication between the manager and staff group which has impacted upon the service provided to residents. At present there is a lack of evidence to demonstrate that this home is being run in the best interest of the residents. We are aware that the organisation is actively trying to resolve issues which have come to their attention in order to improve the quality of the service provided to residents. 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. 34-36 Langstone Road DS0000024966.V343923.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 34-36 Langstone Road DS0000024966.V343923.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): 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an holistic assessment process so that new residents can be assured their individual needs will be measured and met. Residents would benefit from updated contracts/terms and conditions of occupancy whereby they could have accurate information regarding what is included as part of their basic contract fee and additional charges. EVIDENCE: There have been no new residents admitted to the home since our last visit. Although there is an assessment tool in place, so that this can be used to evaluate a new person to ensure that their needs can be met before they are admitted to the home. There has been a long standing requirement for the manager to review the contracts/terms and conditions of occupancy so that they meet the national minimum standards. In the past we have also raised issues about residents paying for activities and staff entrance fees when we have been told by the manager that there is a centralized activity budget (and whereby this is normally included as part of their basic contract fee). We note at this inspection that residents are still paying for their activities (even the resident 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 10 who does not attend a day centre or college during the week). In the absence of the manager, staff could give us no indication as to whether this has been discussed with the Local Authority Commissioners and there was no written information available in care plans or other documents which could be found. There was no information supplied by the manager in the annual quality assurance assessment (AQAA) which was completed prior to our inspection, as to whether these items had received attention. It is suggested that there still needs to be discussions held with the Commissioners so that clear guidelines can be established for residents in the service user guide and contracts as to what they are expected to pay for out of their own money and how this is organised. 34-36 Langstone Road DS0000024966.V343923.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 are care plans in place, the practice of actively involving residents in the development and review of their plans is variable. Risk assessments are completed but are basic and are not always individualised to the resident for whom they are intended. They therefore do not provide clear guidelines for staff regarding how to manage the risks posed to residents. EVIDENCE: We looked at a sample of care plans. Whilst there are a number of care plans in place, information is difficult to retrieve as it is contained within a number of folders and books. For example, there is a care plan folder, key worker folder, daily report folder, residents’ handover book, an incident report book, priority for health screening tool booklets and separate person centred planning books. Staff struggled to find information upon request and do not always know the 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 12 contents of care plans (see comment in standard 23). Feedback from staff was that the systems in place were confusing with comments “there’s bits everywhere”. There were limited care plans in place regarding how residents are supported to develop or maintain independent living skills. For example, one person’s care plan aim was identified as: ‘to encourage X to use self help skills’, the action required by staff to meet this aim was stated: ‘to encourage X to help around the house i.e. dusting, clearing the table’. Although there are annual review meetings there was no evidence to demonstrate that residents, relatives and other professionals are invited to attend six monthly reviews of care plans. We looked at person centred planning booklets. Feedback from staff was that they are no longer used. We saw that one person’s person centred plan was only partially completed. It had not been updated since it was originally established and consequently was out of date. The section entitled ‘my hopes and dreams for the future’, ‘my goals’ and action sheets, had been left blank. Each resident has a communication dictionary in place which identifies how the resident communicates. Care plans should be developed regarding how residents are supported with decision making and choices in line with the new Mental Capacity Act 2005. There were no care plans in place regarding how residents are supported to manage their finances. Risk assessments are in place but some are generalized. For example, one person has a risk assessment regarding the use of the electric bath chair which according to staff she does not use. There were no risk assessments in place for the management of challenging behaviour in two residents’ case files which we looked at. One of these residents had recently had increased behaviours which had resulted in medication changes. Another person’s behaviours had recently been referred to the Local Authority Safeguarding Manager. Some risk assessments were out of date and some review dates were recorded by staff as ‘on going’ with no clear indication that they had been reviewed and the outcome. In some instances control measures to minimize risks were vague and not meaningful. For example the control measure identified for one resident with weight gain was stated as ‘diet controlled from L/road itself. X has lost weight at the moment. Doing very well’. This is not a control measure and in addition as it was entered in 2006, is out of date. As the resident was referred to the dietician in 2007 for concerns over her weight gain this would indicate that this risk assessment was not being actively reviewed. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 13 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents are able to access the local community, staff need to offer them additional support for them to be able to lead more fulfilling and stimulating lifestyles based upon their individual preferences and needs. Staff help residents to maintain their important relationships with their families. Residents are not always actively supported to make choices about their food. More efforts could be made in helping them plan, prepare and serve their own meals. EVIDENCE: Six of the seven residents who live at the home attend day centres during the week. One resident remains at home. There was no activity programme in 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 15 place or displayed. Staff record activities which are undertaken on a monthly planner sheet which is completed retrospectively. During our visit the resident asked to go out and was taken on a walk by a member of staff. For the remainder of the day she either chatted and listened to staff talking, or spent time sitting on her own. We looked at her monthly planners and the daily reports completed by staff. They demonstrated a number of outings but gave very little information as to how she spent her day when at the home other than watching television. Feedback gained from staff was that her day was largely unstructured although they would take her out whenever she requested. Feedback from the Expert who visited to talk to residents was that staff could try to encourage residents to do more when it comes to tasks within the home, and to do activities inside or outside of the home. She said “the residents I spoke to said that they go out sometimes for a meal and it was one resident’s birthday the day after my visit, and she told us staff were taking her to a restaurant. She told us that going for a meal only happens on special occasions”. One resident told the Expert “it’s boring here, there’s nothing to do”. The Expert stated that residents told her that they watch television on an evening and do nothing else at all. She felt that there were lots of activities that staff could do with residents such as arts and crafts or board games. As the manager was not present we were not able to determine whether residents still pay for their own annual holiday. This will remain as a recommendation. We received feedback from three relatives who said that the care home ‘always’ or ‘usually’ helped their family member to keep in touch with them and that they were usually kept up to date with important issues. We saw that some daily routines were flexible for example one person was having a lie in when we arrived at 9.15 a.m. However some aspects could be improved for example there is little emphasis on developing independent living skills with no detailed care plans in place providing guidelines for staff. According to staff there is only one resident who is able to make her own drinks. Feedback from professionals was negative. Comments included “Some members of staff have worked at the home for a number of years, this has been good for the stability of the home, however, some of these staff have views that focus upon caring rather than supporting people. It is then harder for newer staff to express their opinions to make changes”. ‘They (staff) appear to be over-controlling at times’. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 16 “Some staff treat the residents in a rather old-fashioned, patronizing manner. Overall the service is caring but could nevertheless be improved”. Feedback from staff was that there have been improvements with regarding to them being able to offer foods to residents which they prefer and enjoy. We saw that cupboards/fridges and freezers contained a range of food products and there was a large bowl of fresh fruit on the table. We saw lunch being served to one resident. She asked for a banana sandwich which was followed by fruit. It was pleasing to see that staff ate their lunch with the resident. However, one member of staff brought in a bag of doughnuts and when the resident asked if she could have one was told “you can’t you’re on a diet”. We discussed this with the senior on duty. There is better record keeping with regard to residents’ daily food intake and clearer systems in place for one resident’s specialist nutritional requirements. A small menu pictorial booklet has been produced. However, this has only a limited amount of pictures, and these may not be understood by all residents. Photographs may be a better format and could be displayed so that residents are able to see what their choices are available for the day. Although residents choose different options for their breakfast, they usually have the same meal for their dinner. Feedback gathered from staff was that they were unclear as to how offer choices to those residents with more complex communication needs and how to include them in menu planning. Food shopping is still carried out in the week when the majority of residents are at their day centres. Feedback from the Expert was she did not feel that residents had a lot of choice when it comes to food. She said “they have choice of cereal at breakfast but only one choice of a hot meal and if they don’t want that then they have to have a sandwich. Supper is usually a milky drink, pop or crisps. I don’t think this is very good at all”. Not all residents that the Expert spoke to knew what they were having for tea. She stated “this isn’t very good, and I feel that they obviously didn’t choose what they wanted for tea, otherwise they probably would have known”. The Expert also commented upon the fact that the menu was written in a book rather than displayed. She felt the book containing pictures of meals should be updated and have more pictures added to it. She asked the residents about the shopping list which staff said that they do on Saturdays together with residents. She said “I didn’t get a consistent answer from residents, they all gave different days of the week. This has led me to believe that the staff write the list and residents don’t really get a say”. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 17 The Expert felt that staff should encourage residents to prepare and help out in the kitchen. She stated “I feel that staff could start a rota so that the residents could have certain days when they help in the kitchen and this would help to alleviate some of the boredom and bring some routine to the house”. We asked to look at nutritional screening and assessments as we had recommended that these be reviewed at our last visit. These could not be located by staff. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 18 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. Further development is needed so that residents receive personal support in a way which meets their individual preferences and needs. Improvements have been made in enabling residents access to routine and health screening appointments. Slight improvements are needed with regard to the management of medication so that any potential risks to residents are minimized. EVIDENCE: We saw that there are guidelines in place regarding how residents like to receive their personal support. Feedback from staff confirmed that residents are no longer routinely checked during the night time without any justified medical or behavioural reason. However one person did state that she checked on residents when she came on duty at 10.00 p.m. although they may be asleep in their rooms because ‘it’s the mother in me’. The home employs only female staff so that the male resident does not have a choice about whether he would like male or female staff to support him with his personal care needs. Feedback from staff was that he previously enjoyed 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 19 the company of male staff, when they were employed. Feedback from health professionals who completed surveys regarding whether the service respected residents’ privacy and dignity was varied. They said that staff ‘usually’ or ‘sometimes’ respected individuals’ rights to privacy and dignity. One person commented “impression is given that residents need to fit in, rather than an individualised service”. They also commented that ‘sometimes’ or ‘usually’ residents’ health care needs were met by the care home. One professional said that although they usually sought advice, recent referrals had come from other professionals. They said “I felt it disappointing that the request for advice from our team did not come from the home”. We saw that improvements had been made with regard to residents access to opticians and dentists. Residents have also received health care screening; there were leaflets explaining examinations in their case file and some had attended drama productions explaining how the tests were undertaken which is good practice. There are no up to date health action plans however a senior explained that the community learning disability nurse is visiting to review these with staff. We noted that one resident had recently seen a dentist and had been put on the waiting list for scaling under sedation due to ‘very poor hygiene’. We looked at medication practice and saw that whilst some improvements have taken place, there are some areas which still need attention. We saw that prescriptions are held securely and guidelines have been obtained from the General Practitioner with regard to the maximum dosage of ‘as and when required’ (PRN) medication. However the G.P. had included all residents’ details on one letter which was held in each residents’ case file. We explained that information relating to other residents should be deleted from the letter. Senior staff told us that they have recently undertaken accredited training in safe handling of medication although they were still awaiting their certificates. We spoke to a member of staff who told us that she occasionally gives medication to residents but has only had basic training. All staff should receive accredited training if they administer medication. There is still no drugs trolley and we saw that medication was currently stored in three drawers in a filing cabinet. The third drawer in which medication was stored also contained a number of paper files. Consent still needs to be obtained from residents regarding the administration of medication (or 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 20 decisions made in their best interests and fully recorded as per the Mental Capacity Act 2005). There were some handwritten changes which had been made to the medication administration record (MAR) sheets which had not been signed to confirm they had witnessed by a second member of staff as an accurate transcription. There were a number of ‘as directed’ dosages on computerized MAR sheets which should be clarified with the prescriber. We noted that nutritional supplements are not always recorded on the MAR sheets as we previously recommended. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 21 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. There is a complaints procedure in place although more efforts could be made to ensure that this is routinely brought to the attention of residents. Current practices and procedures do not offer suitable safeguards to residents and have the potential to place them at risk. EVIDENCE: There is a complaints procedure and this has been reproduced in a pictorial format although this is not on display in the home. How to make a complaint is not discussed with residents in their regular meetings. It is also suggested that when residents make requests in their meetings that a record is maintained of what follow up action has been taken by staff. Feedback from relatives was that they generally know how to make a complaint. Feedback from professionals was that staff ‘usually’ or ‘sometimes’ responded appropriately when they raised concerns. One person told us “it depends on which staff you talk to, some are quite receptive, others not”. We looked at the complaints log. It had been updated as we had previously asked to include details of a complaint made in 2005, although the nature of the complaint had not been recorded. The manager provided information in the annual quality assurance assessment 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 22 (AQAA), that there have been two complaints in the last twelve months, one of which was not resolved within twenty eight days. However, there were no records of these complaints in the complaint log book. Although management and staff have received training in adult protection they have repeatedly failed to adhere to the Local Authority multi-agency safeguarding adults procedures. In May 2007 a resident made a disclosure to staff and management but this was not reported to the Local Authority safeguarding adults manager nor were the Commission for Social Care Inspection notified. In June 2007 the Commission received notification from the home regarding an incident involving two residents. Staff were advised to discuss this with the resident’s social worker in view of the fact that it could be interpreted as an incident of potential abuse. We spoke with the manager a few days later who said that she had not received this information from the staff member and no further action had been taken. On 23 August 2007 the Commission received notification of another potential incident of abuse. The manager had failed to take appropriate action by immediately informing the Local Authority safeguarding manager, the police or the Commission. Other procedures had also not been followed. The investigation is currently on-going and it is therefore not appropriate to make further comment in this report. Staff are not always following behavioural support plans which resulted in an incident of challenging behaviour in June 2007. The behavioural support plans are not dated or signed. It was concerning to see that one resident’s behaviour was described by staff as ‘X can be stubborn’. Guidance also given to staff to manage the resident’s behaviour was also subjective and had not been updated given the recent adult protection findings. For example staff were instructed to ‘explain to her that these things are not true’. When we were chatting to one resident she told us that she had been out with a member of staff in the morning and had visited her house. We spoke with the staff member who confirmed this, and told us that she had taken the resident home with her to see her dog whom she liked. She said that she had never been told that this practice is not considered safe or professional. During interviews not all staff gave satisfactory responses as to how they would deal with potential incidents of abuse and did not understand or were able to locate the Protection of Vulnerable Adults (POVA) scheme guidelines. There has been an outstanding requirement to carry out a risk assessment with regard to staff who withdraw monies on residents’ behalf. Whilst this has been produced it makes no mention of any control measures in place with 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 23 regard to staff who are given residents’ personal identification numbers (P.I.N.) and who leave employment. Another requirement was made for a written procedure to be established regarding residents who pay a contribution towards another resident’s car. This has been approved by someone from the community learning disability team. The care service is responsible for helping residents manage their monies. The recording systems are slightly confusing. There are personal expenditure sheets which contain no receipt numbers or receipts. A second record book is used to record this information and duplicate records maintained as to what has been purchased. We checked one resident’s record sheet and monies which balanced accurately. However, we raised concerns that once again residents are purchasing items which are normally included as part of their basic contract fee. For example, some residents have recently purchased their own bed linen and duvets which staff told us was to replace worn items. Residents must either be reimbursed or it must be demonstrated that this has been agreed with the Local Authority Commissioners and included in the contracts and service user guide. We identified another discrepancy in one resident’s personal expenditure sheet. On 28 June 2007 staff withdrew £50.00 from his money to pay for ‘bedding’. According to the second record book a receipt showed that this purchase totalled £33.90, yet according to his personal expenditure sheet the remaining £16.10 was not returned to the resident until six days later on 4 July 2007. The senior could give us no satisfactory explanation as to the delay or where the money had been held until it had been returned. We also noted that there is no daily auditing of residents’ monies and records. We looked at one resident’s personal expenditure sheet. The last entry was dated December 2006. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 24 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is on-going redecoration of premises in order to try and keep it well maintained. Residents live in a comfortable home, but some aspects could be improved in order to provide them with a life style more suited to their age and which promotes their dignity. Generally infection control improvements are necessary. EVIDENCE: We toured the building and entered some residents’ bedrooms with their consent. We saw that some improvements have taken place since our last visit. One resident has recently moved into a vacant bedroom and this has been redecorated and furnished to a good standard although the bedside cabinet was slightly worn. The resident confirmed that she had chosen the colour scheme herself. Worn bedding has been replaced as we previously required. measures are satisfactory although some 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 25 We saw that at least two residents’ bedrooms are still in need of redecoration. The television wire we noted hanging from the wall in the sixth bedroom has not been removed. As we identified at our last inspection, some of the furniture is worn and dated and does not reflect the gender or age group of the residents. For instance there is a small chaise longue in one male resident’s bedroom, a worn painted green wooden chest of drawers in a communal bathroom and a disused ‘hostess’ trolley which is used as a cabinet in the dining room. There is a steel stationery cupboard in the upstairs corridor used for storing bedding. There is a television in the small lounge but not enough room for all residents to sit comfortably together (if they wished). As some residents do not have their own television sets in their bedrooms we recommended at the last inspection that residents should be asked if they would like a second television in the larger lounge/dining room. Staff said that they did not think this had yet been actioned. In the Annual Quality Assurance Assessment (AQAA) the manager states that a written maintenance programme has recently been produced and this should be forwarded to the Commission. It was also stated that new garden furniture had also recently been purchased. We saw that the carpet in the small lounge is very stained. The settees in this area were also stained. The carpet in the larger lounge/dining room is also slightly stained in areas. In the AQAA the manager states that the cleaning is regularly included in the ‘Jobs book’ (as we previously recommended) and staff reported that a professional cleaning company had recently visited. However if the stains cannot be removed, then these items must be replaced. A new bathroom suite has been installed in the first floor communal bathroom. The carpet no longer fits this area and must be replaced. There was a commode stored in the bathroom which according to staff belonged to a former resident. This should be removed. In addition, a supply of personal protective clothing used by staff and laundry sacs for washing infected laundry were on open display in the bathroom which also does not promote resident’s dignity. There was no supply of paper towels. There is a communal shower room also on the first floor. The grouting around the shower is badly stained. There was no supply of liquid soap. Both bathrooms contained a number of old and worn bath and hand towels which we asked to be removed. It is disappointing that communal towels are used by residents. A digital lock has now been fitted to the laundry room although on our arrival 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 26 in the morning the area had been left unlocked. The manager has stated that the office is due to be refurbished and a second toilet to be provided as previously requested. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 27 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 Whilst there is a stable and qualified staff group, they would benefit from specialist training in order to promote residents’ rights and demonstrate a better understanding of the social model of disability. There are good recruitment and selection procedures although slight improvements would offer more safeguards to residents. EVIDENCE: Information supplied by the manager states that twelve out of twenty staff hold an NVQ II or above and three staff are undertaking this qualification. It is also stated that 17 staff have completed training in managing challenging behaviour. We sampled training certificates which confirmed that staff had received this training. Relatives who completed comment cards that that staff ‘always’ or ‘usually’ had the right skills and experience to look after people properly. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 28 There was negative feedback from professionals. Comments included: “some staff have outdated attitudes towards caring for people with a learning disability”. They added that in order to improve staff needed to “recognise changes in service provision and attitudes that have been taking place over the 10 years e.g. Valuing People” “most, but not all staff appear to be pleasant, caring and well intentioned” and “I feel that residents could be given more real choice and responsibility for their own lives. Some of the care methods are now dated and as the needs of residents change, as they get older. Some staff have not adapted their own methods of delivering care to allow for this”. The training plan indicates that twelve out of the nineteen support staff have completed training in epilepsy and ten have undertaken training in autism. Feedback from one member of staff was that ‘a lot of them have got it’ when asked about autism. One of the seven people living at the home has autism. Further training is recommended. Training is also recommended in the Mental Capacity Act 2005. We looked at the duty rota and saw that the manager is now working two supernumerary shifts out of four per week. There are three or four staff on duty per day time shift including weekends. We noted that the duty rota was slightly inaccurate as it depicted that one member of staff on duty when they are currently not working at the home. Correctional fluid is used on the duty rota which we suggested should cease. We looked at recruitment and selection records and saw that appropriate procedures had been followed in all but a few areas. Two written references had been obtained for one new member of staff which were both from the same previous employer (a second referee would have been more beneficial). There was a gap in employment history and no written explanation to confirm that this had been explored. Consideration should be given as to how residents can actively participate in the recruitment of staff. We looked at a new member of staff. There was no record of her induction apart from letters in her personnel file stating she would be undertaking this training. Although commencing work in April 2007 she has not completed specialised induction training by an accredited learning disability awards framework (LDAF) provider. We examined the duty rota and saw that the new member of staff completed an induction day on 9 April 2007 and then completed a night shift on her own on 25 April 2007. We did not have an opportunity to discuss this with the manager but would suggest that staff 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 29 should be given more time to work with other staff prior to completing shifts on their own. Staff have not received training in equality and diversity which has been outstanding since 2005 (although feedback from the manager indicates that this will be undertaken in November 2007). There is regular supervision for staff and discussions include training as we suggested. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 30 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 poor. This judgement has been made using available evidence including a visit to this service. More work is needed to ensure that the management and administration of the home is based on openness and respect and run in the best interests of residents. Generally the home promotes residents’ health and safety. EVIDENCE: Mrs. Brooke has been Registered Manager at Langstone Road for the past six years, and has worked at the Home for the last thirteen years. She is qualified having obtained an NVQ in management and care and is also an NVQ assessor. Mrs. Brooke was not present for this inspection and therefore was unable to be afforded an opportunity to respond to some of the findings and feedback 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 31 gathered from staff and health care professionals. Whilst some improvements have taken place since we last visited, there as been a deterioration in other aspects such as safeguarding practices. Feedback gathered indicates there is still a breakdown in communication between the manager and staff which has impacted upon some areas of the service provided to residents. We are aware that senior managers have been meeting with staff in order to highlight areas of concerns and identify action needed. There were negative comments made by all three health care professionals about the management and conduct of the home which we shared with a senior manager. One person stated “This service often gives a poor impression. Staff seem to be allowed to follow their own agenda and are poorly managed. There are divisions among the staff which makes it difficult for other professionals to rely on the information they receive. Some staff appear to struggle to manage some of their residents but don’t necessary ask for, or accept help and advice”. Another professional said that whilst staff care about the people they support, they need to take on board ideas and suggestions that are made to improve the service. Since we last visited the home has now been provided with a fax machine and photo-copier although as yet there is no internet access. There is a professional quality assurance system in place and a visit has been undertaken from a self advocacy group to look at the running of the home. It highlighted some issues at the home that need further improvement including how staff interact, communicate and support residents. The senior manager tells us that he has devised an action plan which he will forward to us. According to information supplied by the manager an annual development plan has yet to be produced. Staff personal files are still held centrally at the organisation’s headquarters. Upon request this information was promptly retrieved from the head office. However, as we have previously stated, guidance was issued by CSCI in November 2005 and republished in 2007, regarding retention of staff records and in particular criminal record bureau (CRB) disclosure checks. The provider needs to decide whether this is applicable to their organisation and make applications for a formal written agreement to CSCI to retain documents at their head office in line with this guidance. We sampled fire safety records and saw there is regular checking of fire safety systems and staff have received training which included a fire evacuation drill. Residents also participate in fire evacuation drills as is good practice. There has been annual testing of portable electrical appliances. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 32 We sampled training certificates to ascertain if they correlated with the training matrix. They mostly confirmed that the majority of mandatory training had been carried out although there was no certificate in place for one person who is supposed to have completed infection control training in 2004. The moving and handling certificate was dated 2002 although according to this training matrix this was undertaken in 2004. It is recommended that an audit is undertaken to ensure that all training certificates are in place to validate training which has taken place. There has only been a small number of accidents at the home when we examined the accident book. We did note however that according to the incident report book, one person cut her hand in March 2007 but there was no accident report completed. We saw that the kitchen was clean and tidy. Foods were appropriately stored although frozen foods should be labelled with the date of freezing. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 33 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 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 x LIFESTYLES Standard No Score 11 X 12 1 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 1 X 2 X 2 2 x 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 34 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 YA9 Regulation 13(4)(c) Requirement All areas of risks posed to residents must be fully assessed, regularly reviewed and kept up to date. They must identify clear control measures for staff in order to support them to minimize risks to residents and keep them safe and well. Timescale for action 01/12/07 2. YA12 16(2)(n) 3. YA23 13(6) This is a repeated requirement which was to have been met by 1/3/07. To provide opportunities for 01/12/07 all residents to engage in more varied and stimulating activities which are based upon their individual needs and preferences - thereby promoting residents’ welfare. Arrangements must be made 01/11/07 for management and staff to receive suitable training and guidance so that they fully understand and adhere to the Local Authority multiagency safeguarding and protecting adults procedures at all times – thereby DS0000024966.V343923.R01.S.doc Version 5.2 Page 35 34-36 Langstone Road offering residents suitable safeguards. 4. YA23 13(6) All allegations of misconduct or any events that affect the well-being or safety of residents must be reported to the Commission for Social Care Inspection without delay and in line with their guidance issued in February 2007. 01/11/07 5. YA23 13(6) 6. YA23 13(6) 7. YA24 23(2)(d) This is a repeated requirement which was to have been met by 1/4/07 All residents’ behavioural 01/12/07 support guidelines must be reviewed to ensure that they are up to date, do not use subjective language and give suitable guidelines for staff to help support residents in managing their behaviours. These must be adhered to by staff as well as being discussed and agreed within a multi-disciplinary team. Improvements must be 01/12/07 made to supporting residents to manage their finances in order offer them suitable safeguards – these include ensuring that staff immediately return any monies which are not spent on purchases. In addition residents must not pay for items that are included as part of their basic contract fee and must reimbursed for any monies they have spent following a documented consultation with the Local Authority Commissioners. To either clean and fully 01/01/08 remove stains from carpets DS0000024966.V343923.R01.S.doc Version 5.2 Page 36 34-36 Langstone Road in the lounge/dining and second lounge areas, or to replace them. This is to promote residents’ health and welfare. 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 YA5 Good Practice Recommendations To review the contract/licence agreement to include all information contained within Standard 5.2 of the National Minimum Standards for Younger People. To undertake a documented liaison with the Local Authority Commissioning Department to establish the exact nature of what the basic contract fee covers in terms of residents’ expenditure on activities and the nature of the central activity fund and how this is to be disseminated. Details regarding additional charges should be contained within residents contracts and in the service user guide. To expand care plans to ensure that they cover all areas of personal, social and health care needs in sufficient detail for example with regard to independent living skills, finances. To demonstrate that care plans are actively reviewed on a six monthly basis with the involvement of the resident, relative and significant professionals. To review and update person centred planning booklets together with residents and to ensure that these are fully completed and that they identify people’s wishes and aspirations. 3. 4. YA7 YA12 It is recommended that care plans are developed as to how residents are supported with decision making and choices in line with the Mental Capacity Act 2005. To consider establishing individualised activity programmes for residents and producing these in pictorial DS0000024966.V343923.R01.S.doc Version 5.2 Page 37 2. YA6 34-36 Langstone Road formats which can be displayed for residents’ information. To consider seeking specialist advice with regard to establishing residents’ activities programmes. Residents should be given the option to have a minimum seven-day annual holiday, outside of the home, as part of the basic contract price. To carry out reviews of nutritional assessments (using a suitable tool such as one recommended by the community dietician). The assessments should demonstrate whether there is a high, medium or low risk and should identify the ideal weight for the resident using the body mass index. To ensure that residents are offered opportunities to plan, shop, prepare and serve meals. Care plans and risk assessments should be completed. To consider different strategies for how residents are supported and enabled to plan and choose options from the menu (such as taster sessions). To expand the current pictorial menu book and consider reproducing this in varying formats and how to display to this information aid residents’ understanding. 7. 8. YA18 YA20 To consider employing male staff so that residents can have a choice about who they wish to support them. To pursue plans to ensure that all staff who administer medication receive training in the safe handling of medication from an accredited trainer. To obtain written consent from service users with regard to the administration of medication and record in care plan (or to make a decision in their best interests as in compliance with the Mental Capacity Act 2005). To clarify any ‘as directed’ doses with the prescriber and ensure detailed administration instructions are recorded on the MAR sheet. To ensure that when any changes of medication are made on the MAR sheets by staff, such as the addition of new medication, two staff initials are obtained to confirm accurate instructions have been recorded. To consider obtaining a more suitable drugs cupboard. Preferably one which has been designed specifically to 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 38 5. 6. YA14 YA17 store medication. It is recommended that nutritional supplements administered to a service user are recorded on a MAR sheet. 9. YA22 To ensure that the complaints log is kept up to date with details of any complaints which are made, the outcome and action taken. To consider introducing strategies for helping residents to be aware of how to make complaints such as displaying complaints information and discussing this at their meetings. To maintain a record of what follow up action has been taken by staff when residents make requests at their meetings. To review written risk assessments regarding how residents are safeguarded from financial abuse in view of staff’s access to their P.I.N. numbers. To review and update residents’ personal inventories. To consider introducing a system for daily auditing of residents’ finances. To forward the recently established maintenance and renewal programme to the Commission. To complete the programme of redecoration and replacement of worn furniture in all areas of the home. To undertake a written consultation with service users with regard to the provision of a television in the 2nd lounge/dining room area. To clean and remove stains from settees in the second lounge area. 12. YA30 To replace ill fitting carpet in the first floor bathroom. To cease storing the ironing board in the laundry area. To carry out an audit of all bath and hand towels and remove and replace those which are worn. Consideration should be given to providing residents with their own towels. 10. YA23 11. YA24 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 39 To ensure that there is a supply of paper towels and liquid soap in all bathrooms. To clean or replace stained grouting in the shower room. 13. 14. 15. YA32 YA33 YA34 It is recommended that all staff receive training in autism awareness and the Mental Capacity Act 2005. To ensure that the duty rota is kept accurate and up to date. All gaps in employment history should be explored with a written explanation obtained. It is suggested that two different referees are obtained rather than two references from the same employer. Consideration needs to be given as to how residents can actively participate in recruitment of staff, such as training in how to interview and take part in the interview panel. All staff should receive structured induction (within six weeks) and foundation training (within six months) to Sector Skills Council specification and provided by a LDAF (Learning Disability Award Framework) accredited trainer. There should be a written record maintained of any inhouse induction programme completed by new staff (which should include working alongside other staff before completing shifts on their own). 17. YA37 All staff should complete training in equality and diversity. It is recommended that the home is enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. To continue to develop an effective quality assurance system to include feedback from service users, stakeholders in the community. To produce an annual development plan based on a systematic cycle of planning-action-review, reflectng aims and outcomes for service users and to explore methods for obtaining feedback from service users. 19. YA41 To obtain and hold information and documents on the premises in respect of persons carrying on, managing or working at a care home as listed in Schedule 2 and 4 of the Care homes Regulations 2001. (Or to make a formal DS0000024966.V343923.R01.S.doc Version 5.2 Page 40 16. YA35 18. YA39 34-36 Langstone Road 20. YA42 request to CSCI to retain documents at head office and obtain approval in line with guidance published by CSCI in January 2007). To carry out an audit of training certificates to ensure that they are up to date and reflect the training that has been carried out according to the training matrix. To ensure that all accidents are recorded in the accident book. It is recommended that fresh foods are labelled with the date of freezing. 34-36 Langstone Road DS0000024966.V343923.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Halesowen Records Management Unit West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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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