Inspection on 17/08/07 for 38 Attwood Street

This inspection was carried out on 17th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

38 Attwood Street 19/09/06

38 Attwood Street 21/02/06

38 Attwood Street 04/07/05

38 Attwood Street 10/01/05

38 Attwood Street 13/05/04

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 38 Attwood Street Halesowen Dudley West Midlands B63 3UE Lead Inspector Lesley Webb Key Unannounced Inspection 17th August 2007 03.50p 38 Attwood Street DS0000024950.V345656.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 38 Attwood Street DS0000024950.V345656.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. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 38 Attwood Street Address Halesowen Dudley West Midlands B63 3UE 0121 585 0491 NONE 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 Vic Andrew Jeavons Care Home 5 Category(ies) of Learning disability (5), Physical disability (1), registration, with number Sensory impairment (2) of places 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 5 LD, 1 PD and up to 2 SI. Date of last inspection 19th September 2006 Brief Description of the Service: Attwood Street is a purpose built home providing care and accommodation to five adults with a learning disability, one of who may also have a physical disability and two who may also have a sensory disability. The Home is owned by the Langstone Society who rent the premises from the Churches Housing Association of Dudley District (CHADD) Attwood Street is a bungalow in a quiet residential area. It is close to local facilities and bus routes, allowing easy access to shops and surrounding areas. There is level access to the front and rear of the premises with a secluded garden also at the rear. There is a small car parking area at the front of the building. There are five single bedrooms, a lounge and dining room together with adequate numbers of WCs, bath and shower facilities. The home aims to enable residents to live valued lives, to exercise choice and to learn new skills and to support staff to achieve these aims. A statement of purpose and service user guide are available to inform residents of their entitlements. The charge for accommodation is £946.24 per week. There are additional charges for hairdressing, toiletries and some transport. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this visit over one day from 3.40pm until 8.30pm with the home being given no prior notice. During the visit time was spent talking to staff and examining records before giving feedback about the inspection to the senior person on duty. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking two individuals care provided at the home. For example the people chosen consisted of male and female and have differing communication and care needs. The home is registered to provide long term care for people by the reason of learning and physical disability. Discussions with people living at the home were not appropriate. Therefore observation of behaviours and care practices was undertaken in addition to analysing information supplied by the home prior to the inspection in order to form judgements on service provision. The inspector was shown full assistance during the visit and would like to thank everyone for making her welcome. What the service does well: There is a good assessment process so that new residents can be assured their individual needs will be measured and met. Staff demonstrated understanding of involving residents in decision making despite communication barriers. As one member of staff explained, “it is hard for the clients to verbalise due to lack of speech, they all react differently, gestures, signs, behaviour and moods, its these that staff have a responsibility to understand and act on behalf of resident”. Records viewed during the inspection confirm residents attend a variety of activities including day centres, undertake outings in the local community to the shops, church and other venues and practices observed during the inspection confirm the principles of dignity and respect are promoted. For example staff were seen talking in a friendly yet respectful manor to residents, offering choices at meal times and giving personal care in a discreet and sensitive way. An evening meal was indirectly observed and staff were seen to sit and eat with residents and give assistance where needed in such a way that maintained the resident’s dignity and safety. There was lots of laughter and encouragement given by staff to residents making this an enjoyable and social affair for everyone. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 6 Staff were observed to encourage and support residents to wash their hands before eating and gave another individual privacy when in the bathroom but being mindful of checking on their wellbeing from a distance. There are excellent and well-organised recording and monitoring systems with regard to residents’ health care needs that ensure that any complications are quickly identified. Medication was observed being given, with staff demonstrating good understanding of medication procedures. For example medication was given to individuals from a container to the residents hands with staff observing then take it along with drinks given. Throughout the process staff talked to residents explaining processes and all administration was witnessed by another staff member. All areas of the home are decorated and furnished to a good standard and bedrooms individualised with personal possessions, photographs and stereo equipment ensuring residents live in a comfortable environment. The manager was not present at this unannounced inspection; however there was ample evidence that he communicates a clear sense of direction and leadership that staff can relate to. During discussions with staff they were very positive about the support they received from the manager and records confirm staff receive support in the form of staff meetings and supervision. What has improved since the last inspection? Requirements identified at previous inspections relating to care planning have now been met in full. For example care plans have been expanded and put into place for nutrition; epilepsy and challenging behaviour ensuring needs are managed appropriately. Improvements have been made with regard to managing residents’ finances. For example the home has clarified with the local commissioning department what items are included as part of their basic contract fee, residents have been reimbursed for items purchased from their personal funds and policies and procedures have been reviewed relating to the management of finances in order to offer further safeguards to residents. All requirements identified in the previous inspection relating to medication practices have now been met. For example ‘as directed’ dosages have been clarified with the supplying pharmacist; guidelines have been introduced for ‘as and when required’ medication and all creams are now labelled with date of opening. All of these improvements offer further safeguards to residents. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 7 Also requirements identified at the previous inspection relating to the environment have been met. For example the broken patio slabs have been replaced, a wardrobe has been fixed securely to the bedroom wall in a resident room, torn wallpaper border in a residents room has been replaced and action has been taken to ensure the temperature of hot water in wash hand basins is maintained between 40 oC – 44 oC. Both requirements identified at the previous inspection relating to training are now met, with the majority of staff having received training in infection control and moving and handling ensuring they have the appropriate knowledge to support residents, 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. 38 Attwood Street DS0000024950.V345656.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 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with information regarding the services available. There is a holistic assessment process so that new residents can be assured their individual needs will be measured and met. EVIDENCE: As at the previous inspection there are no vacancies at Attwood Street and the home has remained fully occupied for some time. The last person to be admitted to the home was over twelve months ago and has settled in well, thereby demonstrating that management operate a successful admission procedure. There are assessment tools in place in order for new residents’ needs to be thoroughly assessed prior to admission. All residents’ needs are reviewed six monthly and at least annually with a social worker or a community learning disability nurse to ensure that the home can continue to meet their needs. Copies of review meetings were seen on individual residents’ case files. 38 Attwood Street DS0000024950.V345656.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Where possible residents are involved in decisions about their lives and supported to play an active role in planning the care and support they receive. EVIDENCE: The majority of requirements identified at previous inspections have now been met in full. For example care plans have been expanded and put into place for nutrition, epilepsy and challenging behaviour and the procedures for managing residents monies on their behalf have been greatly improved, ensuring needs are managed appropriately. Care plans contain aims and objectives and are regularly reviewed. It was noted for one individual that they have a care plan for challenging behaviour and also behaviour guidelines completed by an external professional. It is recommended the contents of these two documents be combined in order that staff have access to information in one document, ensuring information is not overlooked and the residents needs are met in full. The home uses a recognised person centred planning approach and care plans 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 11 have been reproduced in formats suitable for service users. When discussing these with the senior person on duty they informed the inspector that they had been advised these documents were no longer needed, but was unable to say who had given this advice. It is recommended person centred plans are reintroduced not only as an aid to communication but to support the principles of choice, involvement and autonomy. Also as at previous inspections case files contained detailed communication packages which have been drawn up with speech and language therapists. Booklets containing important information regarding residents’ likes and dislikes have been established which is an excellent initiative and can be used for example if the resident is admitted to hospital. There is limited family involvement for the majority of residents, however staff are aware of how to access advocacy services as demonstrated at previous inspections. As mentioned previously improvements have been made with regard to managing residents’ finances. For example the home has clarified with the local commissioning department what items are included as part of their basic contract fee, residents have been reimbursed for items purchased from their personal funds and policies and procedures have been reviewed relating to the management of finances in order to offer further safeguards to residents. Care plans have been established with regard to how residents are supported to manage their finances and include some information relating to the level of involvement of staff, for example how seniors balance and check residents finances. However, these would be improved further if they contained greater detail for example the plan for one individual states ‘full assistance with financial matters’ and ‘staff to give full assistance in all financial matters, all transactions to be fully reported, authorised, signed and stored’. If greater detail and breakdowns of tasks, responsibilities, limitations etc were to be included this would offer further safeguards to both residents and staff. Staff demonstrated understanding of involving residents in decision making despite communication barriers. They explained that meetings occur twice a year with residents, parents, community nurses, key workers from the home and daycentre where development is discussed and decisions made jointly for any new areas of development. In addition to this key worker and staff meetings take place where residents needs are discussed. As one member of staff explained, “it is hard for the clients to verbalise due to lack of speech, they all react differently, gestures, signs, behaviour and moods, its these that staff have a responsibility to understand and act on behalf of resident”. There are a range of risk assessments in place covering a selection of activities and these are regularly reviewed. For example, there is a comprehensive assessment regarding the use of bed rails, pressure area care, dignity, falls from chairs and bathing. It is recommended that the home reviews some risk assessments and combine those that that are specific to an area of risk to ensure risk is appropriately managed. For example one resident had several 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 12 risk assessments relating to the use of wheelchair (falling from, staff using appropriately and maintenance). Encouragingly all staff sign and date risk assessments to indicate that that have read and understood them which is a good initiative. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices about their life style. Social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: Information supplied by the home prior to the inspection states ‘service users are encouraged to become part of the local community by weekly attendance at church, regular shopping trips and using the local barbers/hairdressers. No restrictions on visiting for family members. In service users daily lives dignity, respect and confidentiality are maintained. Service users are also offered a healthy balanced diet in a relaxed homely atmosphere’. This information accurately reflects lifestyles and choices given to residents living at the home. For example records viewed during the inspection confirm residents attend a variety of activities including day centres, undertake outings in the local community to the shops, church and other venues and practices observed during the inspection confirm the principles of dignity and respect are 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 14 promoted. For example staff were seen talking in a friendly yet respectful manor to residents, offering choices at meal times and giving personal care in a discreet and sensitive way. Throughout the inspection residents appeared happy in their surroundings and interactions between staff and residents appropriate, with lots of laughter and talking between everyone. The Registered Provider funds a seven-day annual holiday for residents. There were written procedures in place to demonstrate how holidays were chosen and planned on behalf of residents. As at previous inspections staff support residents to maintain important links with families and friends. For example one resident regularly visits her family home at weekends. Other residents do not have active family involvement. As observed daily routines are flexible and are tailored to residents’ needs and preferences. All bedroom doors and bathroom doors are fitted with appropriate privacy locks. Any limitations residents’ choices are risk assessed. Residents are encouraged where possible to undertake independent living skills tasks. For example, residents were observed to be encouraged by staff to take their own cups and plates to the kitchen after the evening meal. Through out the day staff were observed interacting positively with residents and did not talk exclusively amongst each other. An evening meal was indirectly observed and staff were seen to sit and eat with residents and give assistance where needed in such a way that maintained the resident’s dignity and safety. There was lots of laughter and encouragement given by staff to residents making this an enjoyable and social affair for everyone. Three tables were set with residents indicating preference where to sit. Staff were heard offering choices of items of food and drink and specialised equipment was provided to those who required it. One resident chose to have their evening meal in his bedroom and staff enabled this. Staff were heard encouraging residents to eat and witnessed using a hand over hand technique to support an individual. Meals appeared appetising. Menus are planned by senior staff around their knowledge of residents’ likes and dislikes. There are records maintained of residents’ food intake. Detailed records are maintained for breakfast choices and alternative choices from the main meals are also recorded. There is usually one choice for the main meal in the evening although the menu does identify what alternatives residents can have if they wish. Meals are balanced and varied. Fridges, freezers and cupboards contained a range of good quality food produce and there were supplies of fresh salad, vegetables and fruit. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: As at previous inspections residents receive personal support in the way they prefer and require as evidenced through observations during the inspection, discussions with staff and examination of records. For example, upon arrival at 4.00pm. Residents were relaxing in various areas of the home, with one person just leaving to attend an appointment with a general practitioner. Staff were observed to encourage and support residents to wash their hands before eating and gave another individual privacy when in the bathroom but being mindful of checking on their wellbeing from a distance. Daily reports completed by staff demonstrate that residents go to bed at varying times. The home employs male and female staff which reflects the gender composition of the service user group. Care plans contain residents’ preferences with regard to whether they prefer male or female staff to support them in personal care 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 16 tasks. There is a designated key worker system to promote continuity of care and support for residents. There are excellent and well-organised recording and monitoring systems with regard to residents’ health care needs which ensure that any complications are quickly identified. Staff complete detailed records sheets for outcomes of all appointments with health practitioners. Examination of these demonstrate that residents receive regular appointments with doctors, opticians, dentists and chiropodists. Residents are supported by staff to attend annual health checks with their doctor and well person checks. There are also care plans and charts in place with regard to monitoring complications from breast or testicular cancer. It was encouraging to see that some staff have also received training in this aspect of health monitoring. There are also separate monitoring sheets in care plans for health care appointments and Priority for Health Care Screening booklets have been completed for residents by staff, the community learning disability nurse and primary care team. Residents are weighed on a monthly basis and there are regular medication reviews. Two requirements were identified at the last inspection with regard to health care both of which are now met. On examination there are good systems in place for the control and administration of medication. For example, case files contained medication profiles detailing residents’ medication regimes, there is an up to date staff initial and signature sheet, keys to medication cupboards are not held together with any other master keys and there is a key handover policy in place. There are good records with regard to receipt and disposal of medication. All requirements identified in the previous inspection relating to medication practices have now been met. For example ‘as directed’ dosages have been clarified with the supplying pharmacist; guidelines have been introduced for ‘as and when required’ medication and all creams are now labelled with date of opening. All of these improvements offer further safeguards to residents. On examination of medication administration record (MAR) sheets one medication was found not to have been recorded when entering the home, with the senior on duty stating this was an error on their part. All other records were found to be accurate. The medication cabinet is located in the office. The home currently does not monitor the temperature within the cabinet. This is recommended to ensure medication is being stored at appropriate temperatures and to enhance systems further. All staff that administers medication have undertaken training. It is recommended the home introduce written competency assessments as per guidance on the CSCI professional website to ensure knowledge gained through training is reflected in practices. Medication was observed being given, with staff demonstrating good understanding of medication procedures. For example medication was given to individuals from a container to the residents hands with staff observing then take it along with drinks given. Throughout the process staff talked to residents explaining processes and all administration was witnessed by another staff member. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 17 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to raise concerns and have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: As seen previously, there is a comprehensive complaints procedure that is included in the statement of purpose. There is also a complaints procedure in individual case files that has been verbalized to the resident. The Home has also produced a pictorial complaints procedure that is included in the service user guide and in a booklet regarding choices. The Home is to be commended for also producing the complaints procedure in audio and this is also contained within the service user guide. Since the last inspection there has been one complaint that resulted in an adult protection referral being made. All appropriate parties have been involved and the home has fulfilled its obligations in this area, ensuring residents can be confident concerns are listened to and acted upon. There are good systems in place to protect residents from abuse. A range of policies and procedures are available for staff to refer to if necessary, and there is also a copy of the Local Authority multi-agency vulnerable adult abuse procedures on the premises. Ten of the seventeen staff employed at the home have undertaken adult protection training and thirteen challenging behaviour in order that they have the appropriate knowledge to protect residents. As mentioned earlier in this report improvements have been made with regard to 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 19 the management of residents finances, offering further safeguards and protection. Records of financial activity are robust with receipts kept, and assessment showed balances to tally with cash in hand held on the premises. Senior staff carry out daily balance checks and audits of finances at handover meetings to ensure that they are correct. When examining the inventories of two residents the inspector found that one included an armchair and headboard. The inspector questioned staff regarding this who said that these items would not have been purchased from the individuals’ own personal finances. The home should review residents’ personal inventories in order that they only contain items purchased from their personal finances to ensure accurate information is maintained and to ensure there can be no disputes relating to ownership, offering further safeguards to residents. As mentioned later in this report the home must review its systems for accessing recruitment documentation in order to demonstrate practices do not place residents at harm. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: All requirements identified at the previous inspection relating to the environment have been met. For example the broken patio slabs have been replaced, a wardrobe has been fixed securely to the bedroom wall in a resident room, torn wallpaper border in a residents room has been replaced and action has been taken to ensure the temperature of hot water in wash hand basins is maintained between 40 oC – 44 oC. A tour of the premises was undertaken including the viewing of residents’ bedrooms with their consent. All areas of the home are decorated and furnished to a good standard and bedrooms individualised with personal possessions, photographs and stereo equipment. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 21 Communal areas are seen to be bright and airy. equipment to aid mobility. Bathrooms have specialist As at previous inspections all areas of the premises were seen to be exceptionally clean including the kitchen and laundry area. There were no offensive odours. There are good systems in place with regard to management of clinical waste. On the whole there were also good systems in place with regard to the management of infection control for example staff were seen to be wearing personal protective clothing when carrying out personal care tasks, there was a supply of paper towels and liquid soap in the kitchen, laundry, toilets and individual residents’ bedrooms. It is recommended that the home obtain the recently updated guidance ‘Infection Control Guidance in Care Homes’ to ensure its systems for the management of infection protect residents. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained and given support in order to meet the needs of residents. Recruitment records were not accessible and therefore the home could not demonstrate its practices safeguard residents. EVIDENCE: There are currently seventeen staff including the manager working at the home. Nine of the staff have an NVQ level 2 and seven of these also have a level 3 qualification. Other specialist training undertaken by staff includes epilepsy awareness, dementia awareness, skin care, breast and testicular cancer awareness. The inspector spoke to the newest member of staff to work at the home. This person praised the training and support given stating, “this is the most rewarding job I have ever had”. The staff member confirmed they received a full induction and that they have completed the NVQ level 2 along with other mandatory training. The inspector was unable to access if the homes recruitment practices safeguard residents due to being unable to access any recruitment documentation. The inspector arrived at the home at 4pm and asked to view 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 23 this documentation at 7pm. The senior on duty explained that recruitment records are not stored at the home but are maintained at the organisations head office that is open 9am to 5pm, Monday to Friday. The first page of the enhanced CRB disclosures was seen to be maintained with staff supervision records but this in itself does not demonstrate residents are protected by the homes recruitment practices. The inspector explained that either records must be accessible at all times or a proforma introduced that details all required information, that is agreed with the CSCI, in order that the home can demonstrate it is safeguarding residents. The home is making progress with regard to providing induction and foundation training for staff by an approved learning disability awards framework provider. There were excellent and well-organised training records which allow for easy auditing and monitoring and which upon sampling, correlated with training certificates for individual staff. There is active supervision of staff by management; in addition staff receive an annual appraisal. From records sampled it was seen that staff were receiving regular supervision on an individual basis as well as group supervision in the form of staff meetings. It was noted that the inspector was unable to access any senior staff supervision records with the senior on duty explaining that access is restricted to the manager for these. It is recommended the home review its system for accessing records in order that it can demonstrate all staff regardless of their position receive support to fulfil their roles. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, with effective quality assurance systems that allow the home to measure if it is meeting its aims and objectives. EVIDENCE: The manager was not present at this unannounced inspection; however there was ample evidence that Mr. Jeavons communicates a clear sense of direction and leadership that staff can relate to. During discussions with staff they were very positive about the support they received from the manager and records confirm staff receive support in the form of staff meetings and supervision. There was lots of helpful information and guidelines displayed in the manager’s office for the benefit of staff. As at the previous inspection it was a credit to 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 25 both staff and the manager that the inspection process was made so smooth and unproblematic in his absence. Quality monitoring systems appear good at this home. Feedback is sought from all stakeholders in the community and a range of audits take place within the home. The senior on duty was unsure if an annual development plan is in place and was not able to locate such a document. It is recommended that a development plan be devised incorporating all elements of the various quality assurance systems in place, reflecting upon aims and outcomes for service users and that the contents of this be made know to staff in order to further enhance the good monitoring systems already in place at the home. In addition some thought needs to be given as to how to actively engage residents in the quality assurance mechanism in order to seek their views about the service. The home has a range of policies and procedures as required by regulation to ensure residents’ needs are met. It was noted that the home does not have a continence policy with the senior on duty not able to explain the reason for this. As some residents have specific needs in this area it is strongly recommended the home introduce a policy relating to this in order that residents needs are appropriately managed. Generally as mentioned throughout this report record keeping in the home is good, offering safeguards to residents. As already mentioned the inspector was unable to look at the recruitment records of staff due to the inspection being undertaken at evening. This deficit must be explored by the home with a system introduced that allows for pertinent information relating to recruitment and selection being maintained within the home and accessible at all times. It is also recommended that email/web access be provided within the home to support management practices and to improve access to information. Information supplied by the home prior to the inspection states that electrical circuits, equipment, fire detection and emergency call equipment have all been serviced. A sample of maintenance and service records were examined with this information found to be correct. Upon inspection there was good practice relating to food hygiene. For example fridge, freezer and cooked food temperatures are consistently checked and recorded. Foods were seen to be labelled and stored correctly. As at previous inspections there is a strong emphasis on mandatory training for staff. All staff have completed food hygiene, moving and handling, health and safety and fire safety training. All but one person has received first aid. Both requirements identified at the previous inspection relating to training are now met, with the majority of staff having received training in infection control and moving and handling. 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 26 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 3 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 3 X 3 3 2 3 X 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 28 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 YA20 Regulation 13(2) Requirement (Previous timescale of 1/1/04 is not met). Timescale for action 17/09/07 2 YA34 19 01/11/07 3 YA41 17(2) 01/11/07 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations That the contents of the care plan for a resident with challenging behaviour and the behaviour guidelines drawn up by an external professional be combined in order that staff have access to information in one document, ensuring information is not overlooked and the residents needs are met in full That person centred plans are re-introduced not only as an aid to communication but to support the principles of choice, involvement and autonomy. That financial care plans be expanded to include breakdowns of tasks, responsibilities, limitations etc to offer further safeguards to both residents and staff. That the home reviews some risk assessments and combine those that that are specific to an area of risk to ensure risk is appropriately managed. That the home monitors the temperature within the medication cabinet to ensure medication is being stored at appropriate temperatures at all times. That the home introduce written competency assessments as per guidance on the CSCI professional website to ensure knowledge gained through training is reflected in practices. That the home review residents’ personal inventories in order that they only contain items purchased from their personal finances to ensure accurate information is maintained and to ensure there can be no disputes relating to ownership, offering further safeguards to residents. That the home obtain the recently updated guidance ‘Infection Control Guidance in Care Homes’ to ensure its systems for the management of infection protect residents. That the home review its system for accessing senior staffs supervision records in order that it can demonstrate all staff regardless of their position receive support to fulfil their roles. That a development plan be devised incorporating all elements of the various quality assurance systems in place, reflecting upon aims and outcomes for service users DS0000024950.V345656.R01.S.doc Version 5.2 Page 30 2 3 4 5 YA7 YA7 YA9 YA20 6 YA23 7 YA30 8 YA36 9 YA39 38 Attwood Street and that the contents of this be made know to staff in order to further enhance the good monitoring systems already in place at the home. That consideration is given as to how to actively engage residents in the quality assurance mechanism in order to seek their views about the service. That the home introduce a continence policy in order that residents needs are appropriately managed That email/web access is provided within the home to support management practices and to improve access to information. 10 11 YA40 YA41 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 31 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: 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 38 Attwood Street DS0000024950.V345656.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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