Inspection on 05/07/06 for 34 Walsall Street

This inspection was carried out on 5th July 2006.

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

Other inspections for this house

34 Walsall Street 20/01/09

34 Walsall Street 05/02/08

34 Walsall Street 18/07/07

34 Walsall Street 07/11/05

34 Walsall Street 23/05/05

34 Walsall Street 18/01/05

34 Walsall Street 13/09/04

34 Walsall Street 27/02/04

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 Walsall Street Willenhall Walsall West Midlands WV13 2ER Lead Inspector Jayne Fisher Unannounced Inspection 5 and 6th July 2006 09:30 th 34 Walsall Street DS0000020850.V301109.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 Walsall Street DS0000020850.V301109.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 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 34 Walsall Street Address Willenhall Walsall West Midlands WV13 2ER 01902 632211 01902 421941 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) Swan Village Care Services Limited Care Home 5 Category(ies) of Learning disability (3) registration, with number of places 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service users with physical disability aged 18-65 years to be admitted. 7 November 2005 Date of last inspection Brief Description of the Service: 34 Walsall Street is a registered care home for up to five adults, owned by Swan Village Care Services. The home provides care to four residents and one respite service user. The home is a large, detached house set it its own grounds situated in a residential area of Willenhall. The local town centre is within easy access, just a short walk away. The home is also situated on bus routes, enabling service users to access the town centres of Willenhall and Wolverhampton. The building consists of five single bedrooms, two of which are located on the ground floor with en-suite shower facilities, lounge, separate dining room, kitchen and laundry. There are also two bathing facilities located on the first floor of the building near to the remainder of bedrooms. On the third floor there is a large room that is not accessed by service users, this is used as a storage facility for the home and the proprietors of Swan Village Care Services. The main aim of 34 Walsall Street is to enable people with learning difficulties to have an Ordinary life. Staff at the home aim to achieve this by encouraging and working with service users to be fully integrated into the community in which they live and to take part in activities according to their individual needs, abilities and interests. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels were provided on 12 June 2006 which are between £478 - £1,198.75 per week. There are additional charges for chiropody, hairdressing and magazines. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days between 10:00 a.m. and 18:00 p.m. hours on the first day, and 09.15 and 14:30 hours on the second day. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the manager, service co-ordinator and four staff. Feedback was received from two visiting professionals via comment cards. Questionnaires were sent to residents and relatives but not returned at the time of writing this report. Two residents were at home during both days of the inspection, two other residents were seen briefly on return, or before going to their day centres or job. Formal interviews were not appropriate with all residents. Therefore the inspector relied upon brief chats, observations of body language, eye contact, gestures, responses and other observations of interaction between staff and residents. All residents’ care plans were examined and care was case tracked by reading and assessing care documents, observing interactions and by talking to staff and chatting to residents. Three meal times were observed and drug administration. A tour of the premises was undertaken to assess the standard of the environment. Staff personnel files were accessed and a sample of maintenance and service records were examined. Other documentation was reviewed including a pre-inspection questionnaire completed by the manager and action plan sent by the provider, plus copies of visits undertaken by senior managers and other relevant information. Since the last inspection a manager was appointed whose employment was later terminated. A new manager has now been appointed and has been working at the home for the last six weeks. There has also been a change in ownership and a new larger company has taken on the running of the home. What the service does well: Residents receive a flexible service which is geared towards meeting their individual needs. They can choose for example when to get up in the morning or when to go to bed, whether they wish to attend their day centres or colleges and when to go out. They are encouraged by staff to maintain their independence and are able to make their own drinks whenever they wish, travel on their own and find employment. The needs arising from residents differing ethnic backgrounds are fully met by staff. Privacy is fully respected and promoted. Staff assist and support residents to maintain important links with families and friends. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 6 They demonstrate good knowledge regarding residents’ methods of communication and their individual likes and dislikes. Meals and mealtimes are relaxed and unhurried with staff taking time to assist residents with choice making. There was lots of positive interaction observed between residents and staff, residents looked happy and relaxed in their surroundings, the atmosphere being warm and friendly. Staff and management displayed a caring and dedicated approach towards residents and their responsibilities through out this visit. What has improved since the last inspection? What they could do better: Issues remain unresolved with regard to the latest admission of a resident who is a smoker and the lack of suitable facilities to meet needs without compromising the health, safety and wellbeing of other residents, some of whom are said to be ‘anti-smoking’. The premises is in urgent need of redecoration and refurbishment as at present not all areas promote a comfortable, homely or safe place for residents to live. Serious concerns requiring immediate action were identified with regard to the management of residents’ diabetes and food hygiene practice in relation to safe temperatures of frozen foods. A proactive response was made by management. Improvements are also needed with regard to vulnerable adult abuse procedures including the recruitment and selection of staff as more safeguards are needed to protect residents from abuse. More opportunities are needed for residents to participate in community based activities particularly for those who are wheelchair users. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 34 Walsall Street DS0000020850.V301109.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 Walsall Street DS0000020850.V301109.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 The overall outcome for this group of standards is judged to be adequate. The amended service user guide and assessment tool ensure that prospective and existing residents are informed of their entitlements and assured that their needs and aspirations are assessed. As before, the home is not meeting all the needs of people who live there, if allowed to continue this could affect their quality of life. EVIDENCE: Since the last visit the new manager has produced a service user guide in a more suitable format for residents; this is now in a pictorial and photographic format. Management has also amended the assessment tool to include a section on compatibility with existing service users as previously requested. It is pleasing to see that on examination of case files there are a number of comprehensive assessment tools in place which as is good practice, are being used on a continual basis to reassess existing service users’ needs, for example an independent living skills assessment. There have been no new residents admitted to Walsall Street since the last inspection. There are no vacancies. At the previous inspection visit concerns were raised as the former manager had allowed a resident who smokes to be admitted to the home. The home has no smoking facilities such as a separate smoking room. Therefore, the resident is allowed to smoke in the communal dining room as well as outside of the premises. There was a distinct smell of 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 10 cigarettes on entering the dining room and ashtrays (although clean) had been left on the dining room table and not removed whilst a resident was eating their breakfast, as observed on the first day of the inspection. There is a bucket of sand as an ashtray located outside of the home and whilst this promotes good fire safety practice, the proximity of the ashtray is located next to a table and chairs used by residents when sitting outside and on occasion eating meals. As discussed with the manager, this should be relocated to another area when residents are eating. During interviews staff confirmed that there are at least two of the existing residents who are ‘anti-smoking’. There are a number of outstanding requirements which still need action in relation to this practice. It was however pleasing to see that some action had been taken by the new manager with a smoking policy and procedure established and this had also been produced in a pictorial format for residents. At the last inspection it was noted that one resident’s care plan stated that they should be enabled to visit their temple on a twice weekly basis however that this was not occurring. During this visit there were also no records to demonstrate that the resident in question was visiting their temple at this frequency. For example, during a one month period there were no visits to the temple. The key worker who was interviewed stated that staff regularly offer to escort the resident but that he frequently refuses. This was also discussed with the resident who confirmed that he could visit his temple. As discussed with the manager, refusals must be recorded in order to demonstrate that the resident is continually offered this opportunity. It is pleasing to see that the needs and preferences of service users from minority ethnic groups are well met. There are specific care plans in place which identify needs in relation to dress, religion, meals and personal care as well as guidelines for staff regarding different religions and cultures. Residents are able to choose staff to support them from the same gender and ethnic background. A number of training courses are planned in the near future to provide staff with the skills to deliver the services required by residents. 34 Walsall Street DS0000020850.V301109.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The overall outcome for this group of standards is judged to be adequate. The system for care planning needs improvement as it does not provide all staff with easy access to information necessary in providing the care required by service users. Risk assessments are in place but not for all of the risks which are posed in delivery of care; an improved system would offer more protection to service users. EVIDENCE: The new manager is already attempting to improve care planning and new formats are currently being introduced. It is pleasing to see that staff are being wholly involved in this process and during interviews they were supportive of the new systems. All five residents’ care plans were examined. As highlighted previously care planning is poor and inadequate however, one resident’s care plan has almost been transferred into the new format (a care plan regarding financial support and assistance is still to be produced). On examination there were excellent care plans in place with regard to personal support and hygiene, challenging behaviour, communication and socialization. This is a huge improvement on 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 12 the previous system, and provides a model of good practice for staff to follow when implementing new care plans for the remaining residents. There is on-going progress towards ensuring that all residents have six monthly review meetings. Advice was given with regard to ensuring that relevant other professionals and families are invited to these meetings. Service users are now fully involved in the monthly key worker meetings and the minutes have also been produced in a pictorial format which is an excellent initiative. Some attempts have been made at person centred planning in order to enable residents to participate in the development of their support systems. However, it is recommended that different person centred planning styles be considered in order to meet the varying communication needs of residents and allow them to identify their aspirations, needs and wishes. For example, some residents may benefit from essential life style planning and life story books, others may benefit more from PATH or MAPS and personal futures planning. Risk assessments like care plans are poor. For example, one resident is a wheelchair user and whilst there is a risk assessment in place, control measures are vague and non specific. None of the risks have been assessed as identified by the Medicines and Healthcare products Regulatory Agency (MHRA) with regard to posture belts, seating and accessories There were no risks assessed with regard to using the wheelchair in the community. There was no risk assessment in place with regard to tissue viability or incontinence. A risk assessment for challenging behaviour had not been reviewed since it was established in April 2004. Similarly as with care plans, the new manager is attempting to address this issue and new risk assessments are being drawn up. There were concerns at the last inspection with regard to one resident’s challenging behaviour and lack of appropriate management. It was pleasing to see the progress which has been made upon interviews with staff and examination of documentation. All incidents are now fully recorded and analysed. Staffing ratios have also been increased. The new manager has introduced more low arousal techniques including improved communication strategies, as a result, this resident’s behaviours have reduced which is an excellent outcome. There is a detailed care plan in place. The risk assessment however needs further expansion and as discussed with the manager must include all of the control measures identified in the care plan as well as staff training, debriefing for staff and service users etc. Any other items discussed during inspection of these standards is detailed in the Requirements section of this report. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15,16 and 17 The overall outcome for this group of standards is judged to be adequate. Improvements are needed in activity planning and recording. Service users need to be offered more opportunities to participate in varied community based activities. Residents are supported to maintain important links with their families and friends. Residents are offered a healthy diet and mealtimes are relaxed although more efforts are needed to promote dignity. EVIDENCE: One resident who was able to be interviewed stated that he liked living at the home and had plenty of things to do during the day time. He particularly liked going to an evening disco on a fortnightly basis. It was pleasing to see that he had choice with regard to whether or not he attended his college. Independent living skills are encouraged and he was seen (without prompting), to assist with bringing in the shopping and making drinks (including asking staff whether they would like a drink). During interviews the manager discussed proposals to offer more encouragement to all residents in 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 14 independent living skills tasks as is good practice. All residents at Walsall Street (with one exception) attend formal day care or college provision. One service user has a job and travels independently. It was encouraging to see that a pictorial activity planner has recently been introduced by the new manager as a communication tool. Each service user has a weekly activity planner in place. However, upon case tracking it was not possible to determine whether or not activities identified regularly take place particularly with regard to the service user who does not attend formal day care. There are activity sheets which are useful monitoring and evaluation tools although these are not consistently completed by staff and neither do daily reports identify precisely what activities are undertaken on a regular basis. One resident has four community based activities identified on their weekly planner but upon discussion with staff (and examination of records), these are not taking place on a regular basis because of lack of transport. This includes attendance once a week at a day centre. According to staff this has not taken place for over six months because of issues with transport, which is disappointing. Staff attempt to access public transport but places are limited and therefore the resident who is a wheelchair user was unable to visit the evening disco along with other service users on the previous night. The local town of Willenhall is within walking distance and therefore staff escort the resident on local trips to the town centre although other destinations are not always possible. This must be addressed. Progress is being made towards providing residents with a choice of an annual holiday, there was evidence to demonstrate that planning is underway and staff had obtained leaflets and information regarding prospective holiday choices. Staff interviews and examination of documentation confirms that support is given to residents to maintain links with families and friends. One resident who was interviewed chatted about his family and confirmed that staff take him to see his family every week despite this being some distance away from the home. Daily routines are flexible and respect residents’ rights. For example, on the first day of the visit, one resident had chosen to lie in, because of the hot weather and staff felt that they weren’t sleeping very well. Staff had thoughtfully purchased a fan for her bedroom to reduce the temperature which is commendable. On the second day of the visit one resident had chosen not to visit their college and wished to stay at home. During interviews one resident stated that he liked staff and confirmed that they always knocked on his bedroom door before entering and that he had a key to his own bedroom. Case files contained risk assessments with regard to restrictions upon residents’ rights, for example, some residents are not able to hold a bedroom door key. Consent forms are in place where staff have to open residents’ mail on their behalf; during interviews staff confirmed that where possible residents 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 15 were encouraged to do this themselves. A visiting social worker who completed a comment card prior to the inspection confirmed that they could see their client in the privacy of their own bedroom if they wished. Only one issue was identified with regard to staff using various terms of ‘endearment’ to address residents. As discussed with the manager, care must be given by staff to ensure that the language they use is appropriate, respects residents’ dignity and differing forms of address must be agreed with residents and recorded in their care plans. Interviews with staff, examination of menus and food intake charts confirms that a healthy diet is promoted. Good records are maintained by staff. It is pleasing to see that food is discussed at residents’ meetings on a regular basis. Residents’ cultural dietary needs are understood by staff and two service users are also diabetic (controlled by medication). Menus do not identify the specialist needs of residents however it is acknowledged that this is a small group of residents and staff, and reassuringly during interviews staff were fully aware of their needs. Residents are able to assist with food shopping; one resident’s activity planner included an activity observing staff preparing food which is an excellent initiative although it would be pleasing to see all residents involved in some food preparation in the future. A number of meal times were observed during the two day visit. It is evident that residents are given choices and meals were well presented and looked appetizing. During interviews one resident stated that he liked the food particularly the Asian food; he stated “staff do ask me what I want”. The new manager has introduced a pictorial/photographic menu which is an excellent strategy for promoting choice. Staff were observed assisting residents to make choices appropriately. There are a couple of issues which need addressing. Residents have nutritional assessments and screening in place however, some of these were not fully completed and had not received an annual review. It may be helpful to include the resident’s actual body mass index (BMI) in these tools. Tables were not laid with tablecloths or condiments and staff were seen to be standing over a resident whilst supervising meals rather than sitting down to promote a more congenial atmosphere. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The overall outcome for this group of standards is judged to be adequate. Generally service users receive personal support according to their preferences. There are good systems in place with regard to ensuring health care needs of residents are met with one exception which needs urgent attention. The arrangements for the control and administration of medication are adequate although some areas require slight improvement to enhance safety. EVIDENCE: During interviews one resident confirmed that he could go to bed when he wished and get up when he wanted; he also confirmed that other residents had the same choices. Observations during the visit also confirmed this flexibility. Residents were seen to be dressed in clothing and accessories which reflect their personality and age. During interviews staff gave excellent examples of how they support residents with maintaining their individuality and in decision making for example with regard to choosing clothing. As already stated a new care plan format had excellent details regarding the resident’s preferences and needs with regard to personal care and hygiene which it is hoped will be replicated in all residents’ care plans. Feedback was positive from two professionals who completed pre-inspection questionnaire comment forms. They both stated that they were made to feel welcome when visiting. One 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 17 social worker confirmed that they were satisfied with the overall care provided by staff and were kept informed of important matters. All residents receive two hourly night checks during the night time. The manager has already identified this as a practice which requires review. If there is a justified medical or behavioural reason for this level of monitoring it must be agreed with the resident and a multi-disciplinary team with a relevant care plan in place. Examination of records and interviews with staff confirm that there are good systems in place ensuring that health care needs are assessed and recognised. For example, case tracking confirmed that residents receive regular reviews of medication, dental checks, eye tests and hearing tests. There is monthly (or weekly if necessary), checking and recording of residents’ weight. Any potential health care issues are identified and quickly dealt with. For example, the new manager had identified an issue with one resident’s decreasing mobility and had arranged an urgent review which took place on the second day of the inspection. There are plans to ensure that residents’ attend appropriate well person clinics. Care plans must be developed to introduce strategies for supplementing annual checks in relation to screening for potential complications such as breast, testicular and cervical cancer, such as staff observing any physical abnormalities or introducing a programme of self examination. There is only one concern relating to health care which needs immediate action and that is in respect of management of diabetes. Two service users are diabetic controlled by medication. Staff have recently undertaken responsibility for carrying out blood glucose monitoring for one resident. They have received no formal training and there are no formal procedures or care plan in place which adequately describes in detail how this must be carried out. There was no written consent by the resident with regard to this procedure. During interviews staff were unsure as to what constitutes a normal blood sugar level. One resident takes responsibility for carrying out their own blood glucose monitoring, a detailed risk assessment is required for this practice. In addition the resident is not always carrying this out on a regular basis and staff need to seek advice from medical practitioners about what constitutes a safe blood sugar level, what action to take in the event of unsafe levels, or if the resident refuses to undertake their own blood glucose monitoring. On 7 June 2006, one resident’s blood sugar level is recorded as very high at 15.1 mmol but there are no records to demonstrate that this was identified by staff or what action/further monitoring had been undertaken. Care plans need expansion to include all forms of monitoring and levels of support by varying health care professionals, all potential complications and management, aims of care and metabolic targets, side effects from hypoglycaemia and hyperglycaemia etc. An Immediate Requirement was issued to address these concerns. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 18 Interviews with staff and examination of documentation and records confirm that generally there are adequate arrangements in place regarding medication. It was pleasing to see that progress has been made in ensuring that medication for the respite service user is administered more safely with staff no longer responsible for secondary dispensing. Good practice seen included: copies of original prescriptions being held in case files, medication profiles, written consent by service users to administration of medication by staff, a key holding policy, clean and tidy drugs cupboard with internal and external medication held separately and good records for receipt of medication. There were a few issues which do need to be addressed however and these include: - Medication policy which needs updating (although it is recognised that the new owners may introduce their own policy and procedures). - Gaps in the medication administration record (MAR) sheets mainly with regard to the administration of creams and ointments. - Failure to ensure that there are two staff signatures to confirm that hand written instructions entered onto MAR sheets have been witnessed as correct and accurate. - Clarification is required for any “as directed” dosages which are entered onto the computerized MAR sheets by the pharmacist. - Detailed guidelines for the administration of any ‘as and when’ required (PRN) medication. - Ensuring that all creams are labelled with the date of opening. - Ensuring that the temperature of the manager’s office where the drugs cupboard is located does not exceed 25 oC. Another issue which needs exploring is with regard to one respite service user who is administered medication with food (yoghurt), rather than water. There is a letter provided by a relative to the home instructing that this practice is carried out for ease of ingestion. However, as discussed with the manager this practice must be agreed within a multi-disciplinary team and advice taken to ensure that there are no contra-indications in administering medication in this way. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The overall outcome for this group of standards is judged to be adequate. There is a good complaints system which ensures that users’ views are listened to and acted upon, although varying formats would further enable that all residents are able to access this procedure. There are good procedures in place to safeguard service users from abuse only slight improvements are necessary to enhance current practice. EVIDENCE: The Commission for Social Care Inspection (CSCI) have received no complaints regarding the service since the last inspection. Two complaints have been dealt with internally by senior management in a swift and proactive manner with a satisfactory conclusion. This was in respect of the previous manager whose employment was subsequently terminated. During interviews staff gave good examples as to how they would as support residents in making a complaint. Feedback from one visiting professional confirmed that they were aware of the complaints procedure which is openly displayed within the home as is good practice. There are only a couple of issues. The existing complaints procedure identifies the name of the National Care Standards Commission as opposed to the CSCI and also gives the address of the Wolverhampton office instead of Halesowen (this office no longer exists). It is also recommended that different formats be explored for the complaints procedure such as audio or pictorial. The majority of staff have received training in vulnerable adult abuse awareness. During interviews staff gave good responses as to how they would deal with any potential incidents of abuse. There are copies of relevant 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 20 documentation on the premises in relation to adult protection with the exception of the Local Authority vulnerable adult procedures of which a copy must be obtained. On the whole there are good procedures in place with regard to the management of residents’ finances. Residents’ monies are either managed by the Local Authority appointeeship or residents’ relatives. One service user has a bank account. There are good financial records which balanced accurately with finances held on the premises. All transactions are signed by staff and/or the individual resident with daily audits undertaken by senior staff. At the previous inspection a requirement was made with regard to the funding of takeaway meals. This has now been addressed and residents no longer fund these meals. However, on examination of personal expenditure sheets residents are funding the cost of meals when out in the community. As discussed with the manager, the basic contract fee covers all meals and therefore any meals replacing those which should be provided by the home should be funded by the home rather than the residents. If this practice is to continue it must be discussed with the commissioning authorities and the service user, and a formal procedure agreed and included in residents’ care plans together with guidelines for staff regarding expenditure. There are occasions where staff have been unable to obtain receipts for all purchases made. It is recommended that in this instance more detailed records of purchases made should be recorded. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The overall outcome for this group of standards is judged to be poor. The quality of décor and furnishings is once more beginning to deteriorate and is regarded as poor in certain areas, which together with unsatisfactory fire safety, infection control and food hygiene practice, has the potentially to make this unsafe environment for residents and visitors. EVIDENCE: A tour of the building was undertaken and with their consent residents’ bedrooms were also inspected. It was disappointing to see that the standard of the premises has deteriorated once more. Whilst the main lounge area is comfortably furnished, walls require redecoration as paintwork is damaged as is varnish on doors. It was reassuring to see that the subject of redecoration of the lounge area had recently been discussed during a residents’ meeting and they had confirmed that they disliked the current colour scheme. The dining room gives the overall appearance of a dark and dingy area, the dining table is worn, wall paper damaged and there was a number of files containing confidential information stored on the window sill and these must be removed. The kitchen also requires some refurbishment as unit doors are worn. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 22 The corridor leading from the dining room to the garden area is a fire exit and must be kept free from any obstructions such as the stack of cardboard propped up against the walls. Almost directly outside this fire exit was a large stone slab which had previously been propped up against the wall and had fallen down. As discussed with the manager and service co-ordinator this needed to removed immediately as a trip hazard and also in view of the proximity to the fire exit. The garden area is bare and uninteresting. The lawn overgrown and unkempt. There was some garden furniture but no suitable shade such as an umbrella or gazebo. The new manager has tried to make this area more appealing by purchasing plants and hanging baskets (out of her own money), which is commendable. The large waste bin was located adjacent to the kitchen which is in direct conflict with the advice given by the fire officer during his visit in November 2005. It is also unpleasant for residents to have to sit and eat their meals next to this bin as was observed on the first day of the visit. Upon pointing this out managers moved the bin to another area. The crazy paving at the side of the building is not wholly appropriate for wheelchair users or for residents with decreasing mobility. Carpets in communal areas and residents’ bedrooms were stained. Some residents’ bedrooms were decorated and furnished to a good standard with evidence of personal possessions and belongings, however other residents’ bedrooms were sparsely furnished and bedroom furniture was worn and broken. Colour schemes did not seem to be reflective of residents’ own personalities or tastes. There was at least one mattress (in the respite room) which requires replacement. Some of the bed linen was worn and in particular there were two badly stained pillows which were required to be immediately replaced on the day of the inspection. The manager arranged for a member of staff to purchase a new set of pillows, as there is no supply of spare bed linen on the premises which is unacceptable. Communal bathing areas are uninviting and austere, there were no shelves or storage for residents to store their personal belongings whilst bathing. A plastic jug was found in one bathroom. This must be labelled with the name of the individual service user to whom it belongs. One resident is using the corridor outside of their bedroom to store suitcases and trolleys. These must be removed as they pose a obstruction to a fire exit. There is a small laundry located on the ground floor. The washing machine does not have a sluice cycle however this was said to meet the current needs of residents (although must be kept under review). There was a supply of protective clothing and liquid soap and paper towels as is good practice, and laundry procedures were displayed. It is also suggested that information relating to the control of substances hazardous to health (COSHH) is also held in this area. The laundry walls are not impermeable with paintwork flaking in areas which needs addressing. Sealed baskets or laundry bags are required for the transporting of dirty laundry through the premises. See standard 42 for comments regarding food hygiene. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 23 The condition of the premises was discussed with the service co-ordinator who stated that there were plans to redecorate the home in the very near future. A maintenance and refurbishment programme must be established and forwarded to the Commission for Social Care Inspection by the timescale given in this report. Any other items discussed during inspection of the environment are contained within the requirements section of this report. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 The overall outcome for this group of standards is judged to be adequate. Staff demonstrate a good knowledge and understanding of residents’ needs although further vocational, statutory and specialist training would be beneficial to meet residents’ complex needs. Staff morale is improved with increased staffing levels and extra staff recruited. Improvements are needed in recruitment and selection procedures in order to offer greater protection to residents. EVIDENCE: Seven support workers are employed two of whom are qualified to NVQ II or above. The home is therefore not meeting the National Minimum Standards with regard to 50 of the staff team who should be qualified by 2005. Specialist training with regard to communication and challenging behaviour is outstanding however, there was evidence to confirm that this training is planned for the new future. Staff are currently undertaking training in nutrition and health which is an excellent initiative. Since the last inspection improvements have taken place with regard to staffing. Three new staff have been recruited and staff reported that the atmosphere is much ‘calmer’ and relaxed with less pressure to do overtime and work longer shifts. As requested the duty rota demonstrates the ancillary 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 25 hours and the number of residents who are at home during any given time. The home now provides an extra sleeping in member of night staff. Management and staff during interviews feel that there are sufficient staff on duty to meet residents’ needs. Extra staff are able to be provided to accommodate residents’ planned activities and outings. Examination of the duty rota confirms that there are three staff on duty at peak times when the home is fully occupied. Examination of personnel files for new staff confirm that improvements are necessary. For example, there were gaps seen in one person’s employment history with no written explanation. A full employment history must be obtained with a satisfactory written explanation of any gaps as required by the Care Homes Regulations 2001, Regulation 19. One member of staff is currently employed without a completed satisfactory criminal record bureau (CRB) disclosure check. A Protection of Vulnerable Adult - POVAFirst check had been completed although was not on the premises (this was faxed through to the home by the service co-ordinator). There was no written risk assessment in place with regard to the control measures adopted pending the return of the CRB check in order to protect residents. This member of staff is not supernumerary and was seen to be working unsupervised with residents attending to their personal care needs. This is not good practice. The duty rota did not identify a supervisor who had been appointed to supervise the new worker, and who is so far as is possible, on duty at the same time as the new staff member as required by the Care Homes Regulations 2001, Regulation 19. The appointment of any new staff without a completed CRB should be discussed with the CSCI and a copy of the risk assessment forwarded. There is an aromatherapist who visits on a regular basis. There was no copy of the therapist’s CRB or POVA check, public liability insurance or qualifications held on the premises. These must be obtained. Good progress has been made by the new manager with regard to establishing a central training matrix and individual training assessment and profiles. Dates will be added of training which has been undertaken and that which is planned. New staff complete induction programmes, however this is not induction or foundation training which is provided by an accredited learning disability awards framework (LDAF) provider as required. Progress is required in order to ensure that staff receive more frequent supervision sessions as previously identified. For example, one staff member has not received a supervision since January 2006. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The overall outcome for this group of standards is judged to be adequate. The manager has a clear development plan and vision for the home which she is effectively communicating to service users and staff. Quality assurance systems are improving so that residents and stakeholders’ views are sought and underpin the development of the service. Improvements are needed in health and safety as some working practices compromise residents’ safety and wellbeing. EVIDENCE: There has been a period of instability within the management of the home which has affected the overall quality of the service. However, a new manager has been appointed and during the last six weeks has introduced considerable improvements as indicated in this report. All staff who were interviewed were positive about the new manager and the changes currently being made. Staff feel that the new manager is approachable and helping them in adopting better 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 27 working practices which benefit the residents. Staff stated that there was less friction between the team and any problems are more quickly resolved. There was also positive feedback from a visiting social worker regarding the new manager and her professionalism. The manager is experienced and in the short time that she has worked at the home had already identified a number of shortfalls which she is attempting to address. There are regular staff meetings with good records maintained. The new manager has added to the existing quality assurance systems with monthly and quarterly checks being undertaken in a number of areas including health and safety. An improvement plan is in place and questionnaires have been sent to stakeholders and relatives. Service users’ questionnaires are being undertaken and the manager has identified advocates to assist in this process. There is evidence of forthcoming statutory training being planned. Not all staff have yet received training in moving and handling, infection control and health and safety. Fire safety training was undertaken by seven staff in February 2006 and senior staff are due to undertake fire marshall training in the near future. The fire officer undertook an inspection in November 2005 and requirements identified have been carried out, for example, the serving hatch in the kitchen has been filled in with suitable materials. Fire safety needs improvement in respect of ensuring that the fire alarm is more consistently checked on a weekly basis. There was no test undertaken between 19 June 2006 and 1 July 2006. Not all zones are being tested. The emergency lighting system is now being checked monthly. The manager must ensure that all staff participate in a bi-annual fire evacuation drill (it is advised that if this is undertaken as part of the training, then staff names should be recorded on the fire drill report sheet). A sample of health and safety records were examined. Some improvements are required. For example, there was no certificate to demonstrate that the a wheelchair had received an annual inspection and service. There are no records of routine health and safety checks undertaken on wheelchairs by staff. Testing of portable electrical appliances was undertaken in December 2005. A serious concern was identified with regard to food hygiene practice. Records of freezer temperatures confirmed that the freezer had been running at unsafe temperature for a period of time; staff had failed to identify this as an issue and to take appropriate action. For example during the previous week the majority of twice daily checks indicated that the freezer was operating at below the safe temperature of –18 oC. On occasion the temperature had been recorded as –12 oC and –13 oC. Compartment doors in the freezer were broken possibly as a result of trying to store too much frozen produce in the rather small freezer. An immediate requirement was issued to address the problem. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 28 A procedure needs to be introduced for the calibrating/testing of the food probe on a regular basis. Frozen meat was seen to be defrosting on top of the sink area rather than in the fridge (which is also too small and crammed full of produce). Other aspects of food hygiene practice was found to be acceptable. For example, there is regular and consistent checking of cooked food temperatures, all high risk products are labelled with the date of opening and seen to be stored appropriately. Any other items discussed during this inspection are contained within the Requirements section of this report. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 2 4 X 5 X 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 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 3 34 1 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 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 3 X X 1 X 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 30 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 YA3 Regulation 12 Requirement The home must be able to demonstrate it can meet the needs of smoking and nonsmoking service users. This must include: A separate smoking area away from non smoking service users Seeking legal advice regarding passive smoking and the homes responsibilities to protect nonsmoking service users Seeking the views of permanent service users and their representatives e.g. social workers with regards to people who smoke moving into the home. (Previous timescale of 21/11/05 is not met). The home must be able to demonstrate that the religious needs of service users are being met. (Previous timescale of 31/1/06 is partly met). Timescale for action 01/10/06 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 31 2. YA6 15 All residents must have six monthly multi-disciplinary review meetings to review their care plans. (Previous timescale 31/7/05 is partly met). The home must develop service user care plans in order that they clearly detail the primary care needs (as listed in Standard 2). (Previous timescale of 31/7/05 is partly met). 01/11/06 3. YA8 12(2) The home must involve service users in the day-to-day running of the home, and development and review of its policies and procedures. (Previous timescale of 31/7/05 is partly met). The home must be able to demonstrate that service users are involved in the recruitment and selection of new staff. (Previous timescale of 31/7/05 is partly met). 01/11/06 4 YA9 13(4)(c) Risk must be appropriately managed for the new service user who has moved to the home. This must include: Detailed risk assessments being completed for challenging behaviours. (Previous timescale of 11/11/05 is partly met). To continue to expand the risk management system to ensure that all areas of risk associated with individual service users are fully assessed and documented such as use of wheelchairs, tissue viability, incontinence etc. 01/10/06 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 32 5. YA13 16(2) The home must ensure transport is available for wheelchair users to access the community, activities and further education establishments. (Previous timescale of 31/7/05 is not met). Activity plans must be followed and the reasons documented if this does not occur. Evaluation sheets must be completed for all activities. (Previous timescale of 31/12/05 is not met). The home must seek legal advice in relation to employment law with regards to the payment of staff when escorting service users on holiday. This information must be forwarded to CSCI. (Previous timescale of 31/12/05 is not met). The home must implement a policy regarding the payment of staff when escorting service users on holiday (including payment for meals and activities). (Previous timescale of 31/12/05 is not met). All service users must be offered a annual holiday or the equivalent in day trips. (Progress is on-going towards previous timescale of 31/12/05 which is not yet fully met). 01/09/06 6. YA14 16(2) 01/11/06 7. YA16 12(5)(b) 8. YA17 12(1)(a) To ensure that service users’ preferred forms of address are used at all times; any other forms of address used must be agreed and detailed in individual care plans. To review and up date nutritional DS0000020850.V301109.R01.S.doc 01/10/06 01/11/06 Page 33 34 Walsall Street Version 5.2 9. YA18 12(1)(a) 10. YA19 12(1)(a) screening and assessment tools and to ensure that they more accurately describe the risks and control measures associated with service users’ individual needs. To review the practice of two 01/11/06 hourly checks undertaken during the night for all service users. Practice must be based around service users’ preferences and individual needs - outcomes to be documented in individual care plans. 01/11/06 To establish and implement a written improvement plan with regard to diabetic management. This must include staff training together with timescales for completion. To forward to the Commission for Social Care Inspection by 13 July 2006. – IMMEDIATE REQUIREMENT To continue to progress plans to introduce a procedure for the monitoring of service users’ health with regard to potential complications such as breast, testicular and cervical cancer. Details of screening and monitoring must be included in A care plan. Risk assessments must be completed that demonstrate if service users are able to self medicate and what support is needed if any. (Previous timescale of 31/7/05 is partly met). To improve practice in relation to the control and administration of medication as highlighted within the body of this report. To ensure that detailed guidelines are established for all ‘as and when required’ (PRN) 11. YA20 13(2) 01/10/06 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 34 medications – for example: when precisely the medication can be administered, what the initial dose to be administered is, what the maximum daily dosage is, how long the treatment should be continued for before further advice is sought from medical practitioners. Copies must be held on individual service users’ case files or central medication folder. 12. YA23 10(1) 13(6( To obtain a copy of the Local Authority Vulnerable Adult Abuse Procedures. To review the practice of service users funding the cost of their own meals whilst out in the community and which are in place of meals provided by the Home, (for which the service user is already funded by the Local Authority). If this practice is to continue, it must be negotiated with funding authorities and service users. A formal procedure must be agreed which is contained in individual service users’ plans. The shower in room 2 must be usable. (Previous timescale of 31/7/05 is not met). An assessment by a qualified person must be arranged for aids and adaptations for the service user with physical disabilities. (Previous timescale of 31/1/06 is not met). All of the environmental and premises issues identified in the sections of the inspection report as needing attention must be addressed, (i.e. general maintenance, décor, food 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 35 01/10/06 13. YA24 YA30 23(2)(b) 31/08/06 safety/kitchen and infection control/laundry room. A detailed plan of action for each issue with dates for completion should be submitted to the Commission for Social Care Inspection by 31/8/06. To ensure that all wardrobes are securely fixed to walls. 14. YA32 18(1) All staff must undertake communication training relevant to meeting service users needs. (Previous timescale of January 2004 is not met). All staff must hold a care NVQ 2 or 3 or be working to obtain one by an agreed date. (Previous timescale of 31/7/05 is not met. All staff must undertake challenging behaviour training appropriate to the needs of the new service user. (Previous timescale of 31/1/06 is not met). To undertake improvements to recruitment and selection procedures and address shortfalls identified within the body of this report thereby ensuring greater protection of service users. For example, risk assessments for staff who do not have a satisfactory CRB and ensuring that all gaps in employment are fully explored with records maintained. To ensure that the visiting aromatherapist has a valid and up to date POVA and CRB check, insurance cover and relevant qualifications held on the premises. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 36 01/11/06 15. YA34 13(6) 19 01/09/06 16. YA35 18(1) A training needs assessment must be carried out for the staff team as a whole, and an impact assessment of all staff development undertaken to identify the benefits for service users. (A central staff training matrix to be established). (Previous requirement made in January 2005 is partly met). The home must be able to demonstrate that staff use Learning Disability Award Framework (LDAF) accredited training. (Previous timescale of 31/7/05 is not met). Staffs’ individual training assessments must be updated regularly. (Previous timescale of 31/7/05 is partly met). To ensure that all staff have received training in disability equality. 01/11/06 17. YA36 18(2) All staff must receive at least 6 supervision sessions per year. (Previous timescale of 31/3/06 is partly met). The provider must ensure that an application to register the manager in respect of Walsall Street is submitted to CSCI by the date given. All staff must hold up to date food hygiene, first aid, moving and handling and infection control certificates, with records maintained at the home for inspection. (Previous timescale of January 2005 is partly met). DS0000020850.V301109.R01.S.doc 01/11/06 18. YA37 9 15/08/06 19. YA42 18(1)(c) 01/10/06 34 Walsall Street Version 5.2 Page 37 To ensure all frozen foods are stored at correct temperature of –18 oC and replace defective freezer by 8 July 2006. To confirm action taken in writing to the Commission for Social Care Inspection by 11 July 2006. – Immediate Requirement. The Acting Manager is required to ensure the health, safety and welfare of service users and staff in relation to safe working practices, (food hygiene, infection control, fire safety etc), and associated routines in the home, in addition to deficiencies noted about the premises as detailed in the report. 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. 3. Refer to Standard YA3 YA6 YA13 Good Practice Recommendations That a conservatory be built for service users who smoke To consider introducing different person centred planning styles (for example essential life style planning, life story books, MAP and PATH. It is recommended that the home purchase its own transport that meets the needs of the people living at the home To consider strategies for promoting residents’ dignity during meals and mealtimes, for example tablecloths, condiments. To consider producing the complaints procedure in varying formats, such as pictorial and audio. To amend the name and address of the CSCI with up to 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 38 4. 5. YA17 YA22 6. 7. YA23 YA37 date details of the Halesowen Area Office. To ensure that where receipts for purchases are unable to be obtained, that detailed records of items bought are maintained. 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. 34 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 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 Walsall Street DS0000020850.V301109.R01.S.doc Version 5.2 Page 40 - 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!