Inspection on 22/02/08 for 34-36 Langstone Road

This inspection was carried out on 22nd February 2008.

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

Other inspections for this house

34-36 Langstone Road 11/09/07

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 Mrs Mandy Beck Key Unannounced Inspection 22nd February 2008 09:00 34-36 Langstone Road DS0000024966.V360055.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.V360055.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.V360055.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.V360055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2007 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 7 bedrooms, 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.V360055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home. This means that nobody knew we were coming to do an inspection. In this report we have made judgements using the evidence made available to us. This included the Annual Quality Assurance Assessment (AQAA) and the improvement plan completed by the manager. This tells us how the home feel they have improved since their last inspection and the things they still need to do to make things better for the people who live there. We looked at some of care plans for two of the people who live there in some depth. This is what we call case tracking and helps us to make decisions about whether the home is meetings the needs of the people who live there. We also spent time talking to some of the people who live at Langstone Road, the staff who work there and the manager. We did this so we could find out their views of living and working in the home. We looked around the home to see what improvements have been made since the last inspection. We would like to thank all of the people who live at Langstone Road and the staff for their hospitality during this inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes What the service does well: What has improved since the last inspection? Care plans and risk assessments have been further developed, this means that they reflect the individual needs of the people who live there. People’s activity plans have been updated and now offer more structure and interesting activities for people to take part in. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 6 The home has improved the way it reports safeguarding issues to relevant professionals. The home has acted appropriately in two Vulnerable Adult Referrals since the last inspection. Staff training has also been arranged for staff so that gaps in knowledge can be addressed and people will be protected. There have been some improvements to the home environment, such as decoration of the lounge and dining area. More improvements are planned this will include the redecoration of all the residents bedrooms. Staff told us that since the last inspection “things are getting much better, we are doing more and being supported”. “we feel that we are able to say things and they will be listened to now, this wasn’t happening before”. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is adequate. People who live in this home have their needs assessed. Residents do need clearer information on fees and the service the home provides. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a Statement of Purpose and a Service User guide. We have recommended that both these documents be updated. This is because the home has now reduced the number of places to seven rather than the eight places they are registered for. This means that there are no shared bedrooms in the home any more. As in the last report there have been no new admissions. The home does have an assessment process in place so that people’s needs are kept under review. It was pleasing to see that some of the assessment records have been updated following reviews by social workers and other health care professionals. We recommended that people’s contracts should be reviewed to include details of additional charges regarding activities. The home’s improvement plan told us “head office to forward information to CSCI”. Head office have not done 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 9 this. The manager also told us “the contracts should be looked at but not yet”. This means that people are still not being provided with clear information about their individual fees. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. Improvements have been made that reduce the risks to residents. individual choices are now being listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we visited last time we saw that residents information was disjointed and staff struggled to find information. It was pleasing to see that improvement has been made. Residents information is now kept in place and is easier to read. Staff also said “we have been involved in planning and reorganising things, we feel much more confident”. Care plans we looked at had been reviewed and included details of specialist recommendations for meeting needs. For instance one person had been seen by the psychologist, the recommendations from this visit had been included into the service user plan for this person. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 11 The key worker system has been improved. This means that residents have an identified person they can talk to and to help them plan their care. Each key worker holds an individual meeting with the resident to make sure that this happens. By doing this the home is involving the people who live there in the planning and review of their own care. The manager told us that he is arranging staff training so that they are aware of their roles and responsibilities to the residents under the Mental Capacity Act 2005. This will help staff understand how they need to support people when making decisions and when recording individual choices. Individual risk assessments have been rewritten since our last visit. Each person now has risk assessments that individually recognise their needs. There are good descriptions of the risk, such as being at risk of falling over because they are unsteady on their feet. There are then good descriptions of the actions staff must take to reduce the risk to the resident. Staff told us “we have spent a lot of time getting risk assessments done so that they do show the residents needs” 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. People are supported to take part in activity but improvement could be made so that residents have more structure to their day. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All but one of the residents who live at Langstone Road go out during the week to day centres. We recommended during our last visit that all the residents should have a well thought out and planned activity rota. We were concerned that one person had no structure to their day and asked that this be addressed. It was pleasing to see that the home has taken time to sit with the resident and plan activities so that there is much more structure to their day. Some of the activities recorded included visits to “tranquillity”, a sensory environment designed to help people relax. Other activities included playing bingo, bowling and going out for lunch. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 13 Residents do not have planned activities at the weekend. The manager said that there is the opportunity for this to happen. Some of the residents have said that they prefer not to have things planned at the weekend because they have been busy all week attending day centres. Individual plans could be further improved with a little more detail, for instance putting the specific day when each activity is due to happen so that residents are kept up to date and know in advance what they are doing. Staff have improved their record keeping practices so that there is now a clear record of activities that residents take part in. Residents are invited to take part in residents meetings on a monthly basis. These meetings give them the opportunity to learn about changes in the home, to be able to discuss things that are on their mind and to make decisions about holidays and other important events. The home is also taking part in a new project with the Community Learning Disability Team. This project will be looking at developing better communication passports for each person and will be easier to understand and look specifically at communication standards on an individual basis. The home has taken expert advice from dieticians about meal planning and healthy eating. The dietician is currently in the process of reassessing all of the residents; this is to make sure that their needs are being met. The home is now making accurate records when residents have dietary supplements and weights are being recorded regularly in each person’s personal health plan. There is still room for improvement in record keeping. For instance in one person’s care plan, it states “give food that she likes”. When we looked further we found that there was no record of this persons particular likes and dislikes for food and drink. Residents have the opportunity to go out shopping for food and are included in the planning of menu’s this helps to make sure that at least they have one choice of their own per week on the menu. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. Improvements have been made and resident’s healthcare needs are being addressed and kept under review. Medication practices are improving this means residents well-being is being protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff have worked with the residents in rewriting their individual care plans. These plans tell the reader how to support people when giving personal care. Although not all of the plans are completed there has been very good progress. Staff told us “we feel that we have got to know the residents again”, “its been good because I’ve felt more involved”, “the residents have enjoyed it too saying what they want”. Some of the care plans we saw had made good attempts at a person centred approach. We saw one person’s care plan said ““bathing” xxxx likes personal touches like bubbles in her bath, the day she likes to have a bath and the help she needs drying herself”. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 15 The home now has a one male member of staff this is of benefit to the male service user who had previously indicated that he enjoyed being supported by male staff but this choice had not been available to him. When we looked at healthcare records we saw that much improvement had taken place. The manager told us that healthcare screening had taken priority and all the residents were being regularly reviewed by their own GP’s, dieticians, opticians and dentists. On the day of this inspection two of the residents had been to the dental hygienist for an assessment and to arrange further treatment. We saw recommendations from a psychologist for one person following their visit. It was pleasing to see that some action had been taken and most of the recommendations had been completed. This meant that the resident now had a much more structured day and a good care plan for dealing with their needs. Medication practices are being improved. The home told us that more staff have now received training in “safe handling of medicines”. There are satisfactory systems in place for dealing with the ordering, safe storage and return of medication. The home has purchased a new storage cupboard for all medication, this means that residents medicines are being stored more securely. There are improvements to be made to some areas of medication practice. This includes staff signing the Medication Administration Record (MAR) sheet when they make amendments to it. Staff have been recording on the back of the MAR sheet when they have given “as required” medication but we saw no care plan that would describe to them the situations when this medication should be given. This was discussed with the manager during the inspection. We have recommended that care plans detail the circumstances when “as required” medication is to be given and encourage staff to record the effectiveness of this so that there is a clear record when residents needs are being assessed. Staff should also be writing clearly the reasons why this type of medication is given. We saw some entries that simply said “shouting a lot PRN given”. This does not give a clear understanding of why medication was needed. Another person has been diagnosed as having epilepsy. There was no care plan in place to address this. The manager told us this was because the person has never had a seizure. We recommended that a care plan be introduced and include a clear plan of what to do if the person had a seizure. This will mean that residents needs have been planned for and staff will be aware of what to do should a seizure happen. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. People who live in this home can express their views and concerns and expect them to be listened to. Staff do need training to update their knowledge to make sure that residents are protected from abuse at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our last visit the home has not received any complaints. We, the commission have also received no concerns, complaints or allegations about the service. The home is making attempts to improve the way residents are encouraged to air their concerns. The pictorial complaints procedure is displayed in the office for residents to access freely. Residents are encouraged to talk about their concerns with their own Key workers during their one to one sessions, or in a more open manner during residents meetings, which are held monthly. The home is now keeping regular minutes of these meetings but better records could be kept of the actions the home takes to address the issues raised. The manager told us that all of the staff have been enrolled on further training in Safeguarding adults. This training will also include information about the Mental Capacity Act 2005. This means that staff will have been given up to date information about their roles and responsibilities in supporting people who may lack capacity in their care. We spoke to staff during this inspection about the actions they would take if allegations of abuse were disclosed to them, or they witnessed abuse taking place. They told us “we would call the manager 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 17 straight away”, “its unacceptable, we would definitely get the senior on shift or the manager”. “we have to protect residents don’t we”. Staff confirmed that they had not yet received training but knew that this has been arranged for them. Since the last inspection the home has referred two allegations of potential abuse to the appropriate authorities. They have worked with them in accordance with local guidance. This is an improvement upon our last visit when we found evidence to show that this was not happening and residents were being placed at risk. The home has also improved the way in which it handles resident’s money. There are more stringent systems in place to deal with this and reduce errors occurring. All monies are checked by two staff at every shift change and when money is taken out and returned. Receipts are kept for all transactions so that money can be audited. We were concerned on our last visit that some 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. This has not happened. The manager told us that he was not aware that residents had been reimbursed any money. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 18 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): 24,30 Quality in this outcome area is adequate. The home environment must be improved so that residents can feel comfortable and safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been some improvements to the home environment since our last visit. The large lounge and the dining room have both been redecorated and do look very pleasant. This was done after consultation with the residents who were involved in choosing the colour scheme. One person said “it’s nice, it’s good”. The manager told us that there is still much to do at Langstone Road to make the home more “homely” for the people that live there. He told us that bedrooms are still to be decorated and carpets to be replaced. He has also obtained quotes for a new washer/dryer and a “wet room”. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 19 We saw the bathroom and the shower room both look dismal and uninviting. We were concerned about the safety of the “Jacuzzi” bath located on the first floor. The manager could not provide us with evidence to show that the bath was fit for use. There were no service or maintenance records, this was concerning because the bath has an electrical supply going to it. We have said that this bath must not be used until the home can supply evidence that it is fit for the purpose and does not pose a risk to residents. The home has improved its infection control measures by adding liquid soap and paper towels by each hand washing facility. It could add to this improvement by arranging more training for staff in infection control. This would mean that staff have up to date knowledge of current best practice in this area. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. Staff are more aware of and support residents needs. Training for staff has been improved and they are supported through regular supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last time we visited staff have had more training. There are more numbers of staff that have completed their National Vocational Qualification (NVQ) level 2 and a small number of staff have completed their level 3. This means that staff will have the knowledge to care for the people living in the home. Greater numbers of staff have had training in Equality and diversity. The manager told us that more training has been arranged in this area so that all of the staff get the opportunity to go. This will mean that people who live here will be supported by staff who understand their needs. The manager also told us that he has arranged training in specialised areas such as Autism and Mental Capacity Act 2005. This was a recommendation from our last visit. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 21 Staff have been involved in care planning and risk assessment writing. They told us “it has helped us to get to know people better”, “I’ve really enjoyed it, I feel more confident”. “We have had training from other professionals like the psychologist, it’s helped us much much better”. The manager also told us that he has spent time with the staff encouraging them to learn and to take on roles that they previously had no knowledge of. Such as talking to other healthcare professionals, helping people to plan their activities and learning how to take care of some finances safely and securely. Staff supervision is happening regularly. Records show that staff are working through their training needs and making themselves aware of the organisations policies and procedures by selecting three policies per supervision session to read and discuss. The staff team at Langstone Road is stable, some staff have been there for over 5 years. This gives the people who live there some stability and continuity in their care. The manager also told us that since the last inspection there has been a reduction in staff sick leave and agency use. The new staffing rota is in place and is clearly visible for everyone to see. There are generally four members of staff on duty in the morning and three or four in the afternoon. At night time there is only one member of staff on duty. This worker is not supported by a “sleep in” member of staff in case of emergency. The manager was asked to consider this so that people have the support should they need it. We recommended on our last visit that new staff should be supported in completing a structured induction and foundation programme. We were unable to assess this during our visit because no new workers have been employed since then. The manager did however show us a new format for induction that would support new workers. It was recommended that the organisation look at the Skills for Care induction standards to make sure that there current TOPSS induction is up to date. Staff recruitment files were limited in their information. We saw no application forms or references. The manager explained that staff files are kept at Head Office. The organisation had arranged for photocopies of the current staff groups Criminal Records Bureau (CRB) checks to be available. It was noted that some of these checks were originally dated 2003 it was recommended that the organisation consider renewing CRB’s to include Protection of Vulnerable Adults (PoVA) as well. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. The home is beginning to be run in the best interests of the people who live there but more improvements are needed to make sure this happens for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of this home is currently not at work. Another of the Langstone Society’s managers is managing the home in the interim. He has been responsible for encouraging staff and making the improvements we have found during this inspection. Staff said “he is very good, we’ve had training off him”, “ yes he explains things to us, made us work hard we feel able to talk to him and get things off our chest”, “the office was a no go area before now we all come in here including the residents its much better, we can find things and feel part of the care, it’s down to him”. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 23 The manager told us “I want this to be a good service for the staff but mostly for the residents”, “I have worked hard but I’m frustrated I haven’t got more done”. The home’s quality assurance system is yet to be put into place. The manager told us that a new system is ready and this will be done shortly but he wanted to concentrate on getting the requirements from the last inspection addressed. The home is taking some steps to make sure that they are acting in residents best interests such as regular key worker, staff and residents meetings. The responsible individual for the service also visits the home on a monthly basis. This visit is required under regulation 26 and records of the visit are kept in the home. 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. A review of all staff training has been undertaken. Where gaps in training and knowledge have been identified the manager has taken steps to address this. There has only been a small number of accidents at the home when we examined the accident book. We also looked at daily records that staff keep in relation to residents. We have made a recommendation that information should be directly related to the individual care plan rather than a routine entry “ate well, slept well took part in activity”. 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 24 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 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 x 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 X X 2 X 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA19 Regulation 15 Requirement Residents must have care plans that reflect all of their needs. This will include care plans for “as required” medication and residents specific health needs such as epilepsy. Improvements must be 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. (previous timescale of 01/12/07 part met) The jacuzzi bath must not be used until the home can provide evidence that it has been serviced and is fit for use. This will mean that no residents are DS0000024966.V360055.R01.S.doc Timescale for action 30/04/08 2 YA23 13(6) 30/04/08 3 YA24 13 (4) (a) 23/02/08 34-36 Langstone Road Version 5.2 Page 26 put at risk until this happens. 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 statement of purpose and service user guide need to be updated so that they reflect the current practice in the home and the reduction in numbers. 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. 3 YA6 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. 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. It is recommended that all staff have training and an understanding of their roles and responsibilities under the Mental Capacity Act 2005. 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 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 27 4 YA7 5 YA17 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. Staff should make sure that entries into residents daily notes reflect the details of their care plans and risk assessments. 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. Consideration should be given to supplying all residents with a copy of the pictorial complaints procedure, rather than just being able to access it in the office. To maintain a record of what follow up action has been taken by staff when residents make requests at their meetings. To complete the programme of redecoration and replacement of worn furniture in all areas of the home. Consideration should be given to arranging more infection control training for staff. It is recommended that all staff receive training in autism awareness. The home should consider the use of a “sleep over” member of staff on nights to support the lone worker in case of emergency. 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 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 28 6 7 YA18 YA20 8 9 10 11 12 13 14 YA22 YA22 YA24 YA30 YA32 YA33 YA34 15 YA35 should include working alongside other staff before completing shifts on their own). – not assessed because there have been no new workers since the last inspection 16 YA37 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, reflecting aims and outcomes for service users and to explore methods for obtaining feedback from service users. 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 request to CSCI to retain documents at head office and obtain approval in line with guidance published by CSCI in January 2007). 17 YA39 18 YA41 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 34-36 Langstone Road DS0000024966.V360055.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!