Inspection on 19/09/06 for 38 Attwood Street

This inspection was carried out on 19th September 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

38 Attwood Street 17/08/07

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 Jayne Fisher Unannounced Inspection 19th September 2006 08:30 38 Attwood Street DS0000024950.V309425.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.V309425.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.V309425.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.V309425.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 21 February 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, this information was obtained from the pre inspection questionnaire completed by the home’s manager on 7 August 2006. There are additional charges for hairdressing, toiletries and transport (plus bedroom furniture – see comments in standard 7). 38 Attwood Street DS0000024950.V309425.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 between 08:30 a.m. and 16:30 p.m. The purpose of the inspection was to assess progress towards meeting the key 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 3 senior staff and four support workers. Five relatives and visitors completed comment cards. There are currently five residents living at Attwood Street and all were seen during the inspection. Formal interviews were not appropriate therefore the inspector relied upon observations of body language, eye contact, gestures, responses and other observations of interaction between staff and residents. Five comment cards were received from residents; however staff had completed these on behalf of residents, and it was not possible to determine whether or not they were a true reflection of residents’ views. Therefore they were not used to determine judgements. A number of records and documents were examined, a tour of the building was undertaken and all residents’ care was case tracked through interviews with staff and examination of relevant documents. Other information was gathered prior to the inspection from reports of visits undertaken by the owner’s representative and a pre-inspection questionnaire. As this was an unannounced inspection the manager was not able to be present, however it is a credit to both the manager and staff that the inspection went smoothly and documentation was up to date and readily available. What the service does well: Through observations made during the visit, interviews with staff, feedback from visitors and examination of documentation, it was possible to confirm that residents continue to receive a high quality service with positive outcomes for their health and wellbeing. The atmosphere through out the visit was warm and friendly. Staff should be congratulated for their efforts to ensure positive relationships are maintained between themselves and the people living at the home despite service users having a range of communication difficulties. Throughout the visit the inspector witnessed staff making eye contact, looking at facial gestures and body language in order that service users wishes could be obtained. Daily routines are flexible and geared towards residents’ individual wishes and needs. Residents are supported to enjoy a range of stimulating activities and are able to access the local community on a regular basis. Meal times are relaxed and unhurried with staff mindful of residents’ dignity when needing assistance with eating. There was lots of laughter and smiles making the meal 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 6 time a pleasurable and enjoyable event for residents. Residents’ health is closely monitored by staff who ensure prompt access to medical advice and treatment is obtained when necessary. The environment is exceptionally clean, comfortably furnished, and homely through out. Residents’ bedrooms contained lots of personal possessions and are decorated and furnished to reflect residents’ individual personalities. There is a trained, competent and stable staff team who are dedicated and caring in their approach to residents. There are good systems in place to promote health and safety for both residents and staff. Residents benefit from a well managed home. What has improved since the last inspection? What they could do better: Residents are still being charged for items which are normally included as part of their basic contract fee (such as bedroom furniture and furnishings). The lack of progress with regard to this issue has now resulted in the subject being raised as a serious concern with the Registered Provider. Risk assessments need improvement in some areas in order to ensure that control measures which are in place to minimize risks to residents are fully recorded. There were two serious concerns identified at this visit. The first issue was with regard to non trained staff involved in moving and handling 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 7 (including hoist transfers) of service users. Two of these staff had received An Immediate slight injuries from failing to follow correct procedures. Requirement notice was issued to address this problem. Hot water temperatures were found to be too low; this had been previously identified by the manager nearly six months earlier but the landlord had failed to take appropriate action. Both items received prompt attention by senior staff and the manager within 24 hours of the inspection. 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. 38 Attwood Street DS0000024950.V309425.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.V309425.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): 2 The overall outcome for this group of standards is judged to be good. Residents are provided with information regarding the services available. There is an holistic assessment process so that new residents can be assured their individual needs will be measured and met. EVIDENCE: 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.V309425.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 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. All residents have a range of care plans and risk assessments in place, however some of these require review and expansion in order to ensure all information is up to date and reflect residents’ changing needs and support mechanisms. Staff are continuing to make financial decisions on behalf of service users however records and procedures do not demonstrate how this is done or why this is necessary which is restricting service users’ rights. EVIDENCE: A sample of residents’ care plans were examined. A new care planning system has recently been introduced and it was pleasing to note that during interviews key workers and other staff were familiar with the content of care plans. There are some elements of the care planning system which are excellent in providing detailed guidelines for staff in supporting residents. However, some care plans need further detail in order to reflect the high level of support and care which residents receive from staff. For example, there was no care plan in place regarding one resident’s epilepsy although there was a care plan with regard to administration of Midazolam. Ideally a care plan should be established which includes all aspects of how the resident’s epilepsy is 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 11 managed including staff training. One resident is eating erratically according to staff and upon examination of minutes from staff meetings. Staff explained how they are monitoring this together with day centre staff, however the care plan makes no mention of this (or his nutritional status), and only includes guidelines how food should be cut up to maintain independence. One resident has challenging behaviour which includes placing themselves on the floor and grabbing at staff (as observed during the inspection). There was no care plan in place to give guidelines to staff how to manage this behaviour (although as observed, staff manage the behaviour competently). Another resident is not always sleeping in his bedroom at night, and sometimes sleeps in an armchair in the lounge. Staff have sought the opinion of the psychiatrist. However there is no care plan in place as to how staff manage this behaviour. As already stated other elements of care planning are very good, there is a wide range of topics and care plans are regularly reviewed. The home uses a recognised person centred planning approach and care plans have been reproduced in formats suitable for service users. Case files contain 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. The Registered Provider continues to act as appointee for residents’ finances. Whilst it is pleasing to see that a financial policy now includes a statement that an independent auditor will annually examine residents’ financial accounts and give feedback about improving financial controls, there was no evidence that this had taken place. In addition, it is also suggested that greater control measures should be in place with regard to protecting residents from financial abuse. For example, personal identification numbers (P.I.N.) to which senior staff have access should be changed upon staff leaving employment. Concerns were identified at the last inspection with regard to how residents are supported to manage their finances mainly with regard to the issue of incurring charges for items which are normally included as part of their basic contract fee. For example, residents have paid to replace worn bedroom furniture, worn bedding and towels. A requirement was made to liaise with the Commissioning Authority to establish guidelines for staff as to what is included by residents’ fees. This has not taken place. It was also required that service users’ be reimbursed for items which should have been paid for by the Registered Provider. Staff reported that this has occurred for one resident but unfortunately could not provide evidence of this on the day of the inspection visit. Personal inventories for residents still contain a number of items normally included as part of the basic fee including bed linen, beds, wardrobes, chest of drawers and bedside lamp. Examination of residents’ financial records 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 12 revealed that recently one resident had purchased her own bedroom carpet costing £398.32, which staff stated had become worn. Due to the fact that little progress has been made towards addressing this issue, this has now been raised as a serious concern with the Registered Provider together with urgent timescales for competing outstanding requirements. Care plans have been established with regard to how residents are supported to manage their finances. However, these are brief in content and do not include all measures which are in place. For example, there are no details of how senior staff balance and check residents’ finances on a daily basis at handover meetings. There are no details as to what benefits residents receive and what money is entered into bank accounts etc. 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. Some risk assessments need further development as they do not contain all the control measures in place. For example, one resident uses the bath hoist but there is no mention of how many staff are involved in assisting with transfers. Wheelchair risk assessments have been established but these do not include health and safety checks undertaken by staff, servicing of the equipment, use of foot plates and how staff use the equipment safely in the community with regard to ramps and dropped kerbs etc. The bathroom was in the process of being refurbished but there was no risk assessment which ensured that residents’ safety is maintained whilst building work is undertaken, and alternative arrangements. Staff had supported one resident to take a bath in the staff sleeping-in bathroom. No risk assessment had been carried out. There was no risk assessment in place regarding challenging behaviour. It was pleasing to see that new transport with different lifting equipment has been purchased in order to aid residents’ mobility. However there are no risk assessments in place with regard to the new transport and the different moving and handling techniques now in place. 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.V309425.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 good. Staff support service users to achieve fulfilling lifestyles through a variety of stimulating activities and community outings. The meals provided to residents are well balanced offering both choice and variety. EVIDENCE: There was ample evidence from staff interviews, observations and examination of documentation to confirm that residents are supported to lead stimulating lives and participate in their preferred hobbies and leisure activities. All service users attend external day care provision on varying days during the week. One resident also has a weekly hydrotherapy session and another participates in a drama group. There are individual activity planners and staff also complete an activity record sheet to demonstrate what community based outings have taken place. On examination during a one month period, one resident had gone on a shopping trip to Merry Hill, visited Canon Hill Park, visited the cinema, and been on four pub meals in the community. Another 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 14 resident’s activity record sheet was examined but did not include as many community activities, other going to church or attending a coffee morning held at the church. Senior staff stated that he regularly goes for walks with staff but this had not always been recorded. At the previous announced inspection in July 2005 the inspector was concerned that there were some limitations on residents’ opportunities to enjoy outings in the community. However, it is reassuring to find that this situation has improved and in particular there are extra staff on duty to facilitate outings and trips. During the morning residents looked happy to be going to their day centres. One resident indicated that he liked to go to his day centre because he liked singing. All residents (with one exception) have been on an annual holiday and this is now funded by the Registered Provider. There were written procedures in place to demonstrate how holidays were chosen and planned on behalf of residents. One resident is going to have a number of day trips as opposed to a holiday, as this is more suited to his needs and preferences, as stated by staff. Staff support residents to maintain important links with families and friends. For example one resident regularly visits her family home at weekends. Other service users do not have active family involvement. All visitors who completed feedback questionnaires stated that they could see their friend or relative in private if they wished, and were made to feel welcome by staff. 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. For example, not all residents have sufficient bedroom space for two armchairs. Residents are encouraged where possible to undertake independent living skills tasks. For example, one resident’s care plan stated that he was to be encouraged to make drinks and snacks. Staff reported that they help him to do so with structured supervision. Through out the day staff were observed interacting positively with residents and did not talk exclusively amongst each other. Mealtimes are relaxed and unhurried. A lunch time meal was 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 residents. There is a pictorial/photographic menu so that where possible residents can be encouraged to make choices. It was also pleasing to see that staff offered choices of meals to residents and observed body language to determine which food option the resident preferred. For example, two types of cereal were shown to one resident at breakfast time. Menus are planned by senior staff around their knowledge of residents’ likes and dislikes. It is recommended that care plans contain details of 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 15 residents repertoire of likes and dislikes with regard to food and drinks. 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.V309425.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 good. The personal care and health needs of service users are well met and careful monitoring helps identify any potential complications at an early stage ensuring service users’ receive the treatment they require. There are safe systems for the residents in the control and administration of medication, only a couple of minor improvements are required. EVIDENCE: Residents receive personal support in the way they prefer and require as evidenced through observations during the inspection, interviews with staff, examination and records and feedback from visitors and relatives. For example, upon arrival at 8.30 a.m. not all residents were up and dressed. Residents arose at varying times and entered the dining room when they felt ready for breakfast. There was no prompting or coercion by staff to eat their breakfast or get dressed by a specific time which is commendable. Daily reports completed by staff demonstrated 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 tasks. There is a designated key worker system to promote continuity of care and support for residents. 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 17 All relative and visitors who completed comment cards stated that they were satisfied with the overall care provided by staff. Comments included “we are happy with the love and care ‘X’ gets, ‘X’ is very happy at the home”. Relatives and friends stated that they were consulted about care and kept informed of important matters by staff. 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 demonstrated 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. Only a couple of minor improvements are necessary. At one resident’s mental health assessment on 11 May 2006, the psychologist had recommended that the resident receive a hearing test as poor hearing may have impacted upon his ability to complete the assessment. Although it was noted by the inspector that the resident had received a hearing check previously by his doctor earlier in the year, there was no evidence that this recommendation by the psychologist was followed up, and staff were unsure as to what action had been undertaken. As previously requested, the practice of residents receiving two hourly checks during the night time has been reviewed and in some cases has ceased. However two residents are still receiving two hourly night checks and as before there is no care plan in place to demonstrate why this level of monitoring is necessary, and whether or not it has been agreed within a multi-disciplinary team. One member of night staff stated that it was their understanding that they were supposed to wait outside one resident’s bedroom door and only enter if they heard noise. However, night time record sheets completed by other night staff indicated that they were not following this procedure but were entering the resident’s bedroom to check if she was asleep. As previously discussed with staff and management, night checks should only be undertaken if there is a health or behavioural need and therefore the compromise to residents’ dignity and privacy (including the possibility of interrupted sleep), can be justified through risk assessment. 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 18 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. Two residents receive medication for status epilepticus which is administered by invasive techniques. Management have followed good practice in ensuring that this procedure has been ratified by a multi-disciplinary team, care plans and protocols have been established and named staff have received training. The drugs cupboard was clean and there was no overstocking of medication. On examination medication administration record (MAR) sheets are accurately completed by staff with only a couple of discrepancies which may be due to the fact that a total of three staff are involved in the administration of medication. It is recommended that this practice be reviewed. It was pleasing to see that where handwritten instructions were entered onto MAR sheets by staff, that there were two staff initials to demonstrate that this had been witnessed and verified by two staff members. There were detailed guidelines in place for administration of ‘as and when’ (PRN) medications, however there were a couple of exceptions mainly with regard to PRN pain relief which needed to be added to the guidelines. One resident’s PRN guidelines also made reference to a phosphate enema, however staff confirmed that this is only administered by district nurses (this should therefore be removed or made clear in the PRN guidelines list). All staff who administer medication have received accredited training. It is recommended that all staff involved in any part of the medication process including acting as witnesses should receive training. 38 Attwood Street DS0000024950.V309425.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 good. There is a comprehensive complaints system which ensures that users’ views are listened to and acted upon. There are procedures in place to safeguard service users from abuse. EVIDENCE: There have been no complaints received about the service by the Commission for Social Care Inspection, neither has the home received any complaints during the past twelve months. As seen previously, there is a comprehensive complaints procedure which is included in the statement of purpose. There is also a complaints procedure in individual case files which has been verbalized to the resident. The Home has also produced a pictorial complaints procedure which 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. All five visitors/relatives who completed comment cards stated that they are aware of the home’s complaint procedure and confirmed that they have never had to make a complaint. During interview a key worker demonstrated good knowledge regarding how to support a resident in making a complaint and would pass this on to the manager as is good practice. 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. During interviews staff gave good examples of how they would deal with any potential incidents of abuse and understood the principles of whistle blowing. Only seven of the existing sixteen staff team 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 20 have received training in vulnerable adult abuse awareness. However it was pleasing to see written confirmation that that the manager has secured places on forthcoming courses for staff (and it is acknowledged that only a small number of places are allocated to individual care homes at each training session by the Local Authority). There is an outstanding requirement to ensure that all staff receive training in managing challenging behaviour and progress is on-going with eleven staff currently having received this training. The home does not use physical restraint in managing challenging behaviour. As already stated in this report care plans and risk assessments need to be established for one resident who can exhibit behaviours that are challenging from time to time. On the whole there are good procedures in place with regard to managing service users’ finances in terms of protecting them from financial abuse. 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. However, as already stated in this report, the main concern relates to the charging of service users for items normally covered as part of the basic contract fee (see comments in standard 7). 38 Attwood Street DS0000024950.V309425.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 good. The standard of the environment within parts of this home are good providing service users with an attractive and homely place to live. Improvements are needed with regard to hygiene as water temperatures are not reaching sufficient hot temperatures to control infection. EVIDENCE: A tour of the premises was undertaken and a written maintenance and refurbishment programme was examined which demonstrated on-going redecoration of the premises. At the time of the visit the bathroom was undergoing refurbishment. A new specialist bath is to be installed which staff reported would be easier to access for residents with mobility problems which is commendable. All bedrooms were viewed and are decorated and furnished to a good standard being individualised with personal possessions, photographs and stereo equipment. Communal areas are seen to be bright and airy. Carpets in these areas however were stained and the settee and armchairs in the lounge looked faded and worn. Staff were able to provide evidence that these were going to be replaced in the near future. 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 22 There is a sheltered garden to the rear of the premises. Since the last announced inspection, two new bungalows have been built by the landlord in close proximity to the home. A small piece of land at the side of the house has been commandeered as part of grounds for the new bungalows, however this area was previously used by the home for storage and has not impacted upon the communal space in the garden area utilized by residents. The slabbed pathway in this area however now needs to be made level and any cracked paving slabs in the patio need to be replaced. 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. There was however a major concern identified however with the water system. During a tour of the premises it was found that hot water from wash hand basins in a number of residents’ bedrooms, toilets, and the kitchen area were not reaching the required temperature (between 40 oC – 44 oC). Staff were able to provide documented evidence that this issue had been raised by the manager with the landlord in April 2006 and again in June 2006, however no works or repairs had been undertaken. The last water temperatures checks recorded by staff demonstrated that water from some wash hand basins was unacceptably low at 22 oC. Suitably hot water is required to provide safeguards against infection including Legionella. An Immediate Requirement notice was issued to address this problem within forty eight hours of the inspection. The senior member of staff reacted immediately and contacted the landlord who sent in contractors who were examining the problem on the same day of this inspection. Any other items discussed during inspection of these standards are included in the Requirements section of this report. 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 23 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 good. Residents are supported by a stable, experienced and well supervised staff team who know their preferred likes and dislikes. Recruitment and selection procedures are robust and offer protection to residents. Vocational and specialist training for staff is on-going. EVIDENCE: Training is give a high priority. Eight of the sixteen staff team have an NVQ II or above which meets the National Minimum Standards that 50 of the staff team are qualified by 2005. Other specialist training undertaken by staff includes epilepsy awareness, dementia awareness, skin care, breast and testicular cancer awareness. On examination of the duty rota there are three or four staff on duty per shift and there is limited use of agency staff which was a concern at the last announced inspection. There is a stable staff team with the majority of staff having worked at the home for at least five years. Two of these staff have supported residents for twelve years. On examination of staff personnel files, recruitment and selection is a thorough process. All the required pre-employment checks had been undertaken and there had been active supervision of a new member of staff. It was noted that the last member of staff to be recruited did not give a written explanation for the reason why they were leaving their last employer however there were two 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 24 positive references from this employer. Ideally, even if the applicant is still in employment, a reason should be obtained as to why they wish to leave this employment which can then be verified if necessary with the referee. The home is finally making progress with regard to providing induction and foundation training for staff by an approved learning disability awards framework provider. However, staff are not completing this training within the first six weeks, and first six months of employment, (although it was noted that other training was taking place during this period). Not all staff have yet received training in equal opportunities and disability equality. 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, for example one staff member had received three supervision sessions and one appraisal during the last six month period. 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 25 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 good. Residents continue to benefit from a well run home with the manager and staff demonstrating an awareness of their roles and responsibilities. The manager ensures so far as is reasonably practicable the health, safety and welfare of residents and staff with one area of exception, which has received immediate attention. EVIDENCE: Since the last announced inspection the manager has now successfully completed his Registered Manager’s award. Although, the manager was not able to be present at the inspection, there was ample evidence that Mr. Jeavons communicates a clear sense of direction and leadership which staff can relate to. During interviews staff were very positive about the support they received from the manager, one member of staff stating that he was the ‘best’ manager who had worked at the home. There are regular staff meetings and separate key worker meetings which are focused on service users’ health and wellbeing which is commendable. There was lots of helpful information 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 26 and guidelines displayed in the manager’s office for the benefit of staff. It was a credit to both staff and the manager that the inspection process was made so smooth and unproblematic in his absence. Management and staff have strived to introduce a comprehensive quality assurance system. In addition the organisation has engaged in a professional quality award system – ‘PACE’ (practical award in community excellence). The home is now at level 2 with a further level to complete. This is an organisational type quality system although there is some focus on service users. Since the last announced inspection the manager has written to gather feedback from all stakeholders in the community and will be undertaking a further consultation process later in the year. As discussed with staff (and the manager on the following day of the inspection), this is a very good achievement, with only slight improvement necessary. An annual development plan needs to be devised incorporating all elements of the various quality assurance systems in place, reflecting upon aims and outcomes for service users. 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. As discussed observational tools may be beneficial. A sample of maintenance and service records were examined and found to be to be up to date. For example, a new fire safety risk assessment has recently been completed, and as a result more procedures have been introduced for fire safety which staff are diligently applying. There is a recent comprehensive Legionella risk assessment and evidence that works identified at the assessment stage have been undertaken including chlorination of the water system. There is weekly testing and recording of water temperatures. There is good accident reporting systems and monthly analysis undertaken by the manager. 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. Staff demonstrated a good knowledge of food hygiene practice during interview. There is a strong emphasis on mandatory training for staff. The majority of the staff team have completed training in fire safety, health and safety, first aid awareness and food hygiene. Half of the staff team have completed training in infection control. There was one serious concern identified during the inspection in respect of moving and handling of service users. The home currently employs sixteen support staff and one manager. Only 9 staff have received accredited (certificated) training in moving and handling (including hoist transfers). It was noted in the accident book that in March 2006 a staff member had twisted her back whilst trying to assist a service user with moving and handling. The member of staff in question has not received training. In September 2006 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 27 another member of staff ‘hurt’ her back whilst attempting to lift a service user from the floor without any assistance from other staff. This member of staff has also received no training (although this was due to take place in the near future as evidenced through interview and documentation). However it is not acceptable for any staff who have not been trained to undertake any moving and handling or hoist transfers due to the potential of harm to residents and staff themselves. An Immediate Requirement notice was issued to address this concern. Any other items discussed during this inspection as requiring action are contained within the Requirements section of this report. 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 28 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 4 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X 2 2 X 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15(1) Requirement Timescale for action 01/02/07 2. YA7 20 To review and expand care plans to ensure that they reflect the level of support provided to residents, for example with regard to night time routines and management, nutrition, epilepsy and challenging behaviour. 01/11/06 To improve the management of service users finances by: 1) To ensure that if the Registered Provider wishes to remain as an appointee, that written application is to be made to the NCSC together with established policies and procedures relating to the management of service users’ finances including arrangements for an independent audit. (Previous timescale of 1/3/04 is not fully met). 2) To establish a written procedure for staff making financial decisions on behalf of service users in the absence of family or advocates. This must be ratified by a multi-disciplinary team for example the community 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 30 learning disability nurse, commissioning authorities, management committees of the service provider. (Previous timescale of 1/9/05 is not fully met). 3) To undertake a documented liaison with the Local Authority Commissioning Department to establish the exact nature of what the basic contract fee covers in terms of service users expenditure. To fully reimburse service users for any items for which they have been inadvertently charged. (Previous timescale of 1/9/05 is not met – this has now been addressed as a serious concern to the Registered Provider with a timescale for completion of 19 October 2006). 4) To cease charging service users for items such as replacement of worn bedding and furniture, car parking fees on shopping trips undertaken by staff until a meeting with the Commissioning Authority has taken place. (Previous timescale of 1/9/05 is not met – this has now been addressed as a serious concern to the Registered Provider with a timescale for completion of 19 October 2006). 5) Following the introduction of the above items - care plans must be established which identify the exact level of support and assistance service users require in managing their finances. (Previous timescale 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 31 of 1/9/05 is not fully met). 6) A record of the care home’s charges to service users, including any extra amounts payable for additional services not covered by those charges, and the amounts paid by or in respect of the service user must be established following consultation with the Commissioning Authorities. (and must be included in the service user guide). 3. YA9 13(4)(c) To review and expand risk assessments to ensure that there are written risk assessments established for all aspects of service users lives which pose a risk, and to include all control measures which are in place. For example with regard to challenging behaviour, mobility (including moving and handling, transfers and wheelchair use). To review the practice of two hourly checks during the night for all service users unless there is a demonstrable health care or behavioural need (if this level of monitoring is required it must be discused and agreed with a multi-disciplinary team and a care plan must be established). (Previous timescale of 1/9/05 is not fully met). To pursue a hearing test for the identified service user whose psychologist recommended that this be carried out following an assessment on 11 May 2006, with written records maintained of what action has been taken. 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 32 01/12/06 4. YA19 12(1)(a) 01/11/06 5. YA20 13(2) To undertake the following improvements to the control and administration of medication: 1) To ensure that the actual member of staff responsible for administering medication to the service user signs the MAR sheet. 2) To clarify with the prescriber any ‘as directed’ dosages and ensure that MAR sheets are updated accordingly by the supplying pharmacist. 01/11/06 6. YA23 13(6) 3) To ensure that guidelines are introduced regarding all drugs which are administered ‘as and when required’ (PRN) , including maximum dosage, triggers for administration, and when to seek further advice from the G.P. 4) To ensure that all creams are labelled with the date of opening. Current training in the 01/02/07 management of challenging behaviour must be provided for all staff. (Previous timescale of 1/3/04 is not fully met). To continue to pursue plans to ensure that all staff receive training in vulnerable adult abuse awareness. To undertake the following improvements to the premises: 1) To ensure that all broken patio slabs are replaced and all areas of the patio are made level. 2) To ensure the wardrobe is fixed securely to the bedroom wall in the service user’s bedroom identified during this 7. YA24 23 (2)(b) 01/11/06 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 33 inspection. 3) To repair torn wallpaper border in service user’s bedroom identified during this inspection. 8. YA30 13(3) 13(4)(c) To carry out works to 21/09/06 thermostatic safety control valves (or the boiler system) to ensure that the temperature of hot water in wash hand basins in toilets, kitchen, and service users’ bedrooms is increased and reaches between 40 oC – 44 oC. IMMEDIATE REQUIREMENT – WITH IN 48 HOURS OF THE INSPECTION. To confirm in writing to CSCI what action has been taken to undertake repairs to the water system by 25 September 2006. All staff must receive structured induction (within six weeks) and foundation training (within six months) to Sector Skills Council specification and provided by a LDAF (Learning Disability Award Framework) accredited trainer. (Previous timescale of 1/2/04 is not fully met). To provide staff with training in equal opportunities and disability equality. (Previous timescale of 1/7/04 is not met). 10. YA39 24.(1)(3) To continue to expand the 01/02/07 existing quality assurance system - to produce an annual development plan based on a systematic cycle of planningaction-review, reflectng aims and outcomes for service users and to explore methods for obtaining feedback from service users. DS0000024950.V309425.R01.S.doc Version 5.2 Page 34 9. YA35 18(1)(c) 01/02/07 38 Attwood Street 11 YA41 17(2) To obtain and hold information and documents on the premises in respect of persons carrying on, managing or working at a care home as listed in Schedule 4 of the Care homes Regulations 2001. (Previous timescale of 1/1/04 is not met). To provide all staff with manadatory training in: 1) infection control. (Previous timescale of 1/7/04 is partly met). 2) To ensure that all staff who have received no certificated training in moving and handling (including hoist transfers) cease assisting or carrying out any moving and handling or transfers of service users. IMMEDIATE REQUIREMENT BY 19/09/06. 3) To forward written proposals to CSCI with regard to securing training for a total of 7 staff who have not received moving and handling (including hoist transfers) training by 3 October 2006. 01/02/07 12. YA42 18(1)(c) 01/02/07 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 YA17 Good Practice Recommendations To ensure that care plans with regard to nutrition include a list of residents’ likes and dislikes. DS0000024950.V309425.R01.S.doc Version 5.2 Page 35 38 Attwood Street 2. YA20 To ascertain whether the pharmacist has a contract to provide the Home with a service including quarterly visits. To consider pursuing accredited training for all staff in the safe handling of medication including support workers who act as witnesses for administration (or who do administer whilst being witnessed by senior staff). To review the current system of whereby a total of 3 staff are involved in the administration of medication process which has the potential for risk. To keep records of when the food probe is calibrated. 3. YA42 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 36 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 38 Attwood Street DS0000024950.V309425.R01.S.doc Version 5.2 Page 37 - 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. 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