Inspection on 04/07/05 for 38 Attwood Street

This inspection was carried out on 4th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

38 Attwood Street 17/08/07

38 Attwood Street 19/09/06

38 Attwood Street 21/02/06

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 Announced 4 July 2005 th 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 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 Stationary 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 E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 38 Attwood Street Address Halesowen, Dudley, West Midlands, B63 3UE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 585 0491 None Langstone Society Vic Jeavons (Acting) Care Home 5 Category(ies) of Learning disability (5), Physical disability (1), registration, with number Sensory impairment (2) of places 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10th January 2005 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 WC’s, 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. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted between the hours of 9.30 a.m. and 5.00 p.m. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits. A range of inspection methods were used to make judgements and obtain evidence which included: formal interviews with the manager, and three members of staff. There was also a brief tour of the premises. There are five residents currently living at Safe Harbour. The home is registered to provide care for adults with learning disabilities, one of whom may also have a physical disability and two who have sensory impairment as well as other complex needs. All residents were at home for varying parts of the inspection. Formal interviews were not possible therefore the inspector relied upon body language and observations of interactions between staff and residents. A number of records and documents were examined. Other information was gathered prior to the inspection which included the preinspection questionnaire, feedback from a relative one general practitioner and a social worker. What the service does well: The home has a stable and qualified staff team who are committed to providing high quality care. During interviews they demonstrated a caring approach and in depth knowledge regarding residents’ needs, likes and dislikes. When asked about what were the positive benefits for residents living at Attwood Street their comments included: “this is a homely environment, I can’t imagine leaving here and not seeing the residents again”. “We ensure individual needs are met of each resident”. “We are able to give residents lots of one to one attention because the home is small”. There was lots of positive interaction between residents and staff observed through out the day. For example staff were spending time talking to residents and engaging them in activities. Residents were well groomed and dressed in appropriate clothing that reflected their individual personalities. They looked happy and contented and were enthusiastic on returning home from their day centres being greeted warmly by staff. The atmosphere was relaxed and friendly through out the day. Feedback from a relative was extremely complementary and included: “although there is a staff shortage, the residents always seem to get excellent care”. A General Practitioner commented: “I find the care at the home very caring and excellent”. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 6 There is an excellent care planning system in place with comprehensive guidelines for staff in how to meet the individual needs of residents. Any health care issues are quickly identified and acted upon. Every effort is made to include residents in decision making using creative communication methods and formats. All residents attend day centres, colleges or church clubs and enjoy a range of in-house activities. There is good training for staff and the majority of staff have a vocational qualification. All staff have undergone appropriate criminal record bureau disclosure checks which ensure residents are protected from abuse. During interviews they stated that management listened to their views and were very supportive. There is an excellent complaints procedure which has been provided in audio and pictorial formats. There are also documents in place so that residents are aware of what services they should be receiving. Management and staff are very welcoming and co-operative. They strive to meet any requirements made during inspections. Some of the outstanding items need a corporate response from the service provider. What has improved since the last inspection? New formats have been introduced for example there is now a photographic menu. There is good communication between staff and record books have been introduced for this purpose. Residents have photographic books which show their likes and dislikes and gives important information about their needs. All residents have received an annual review of their medication and weight checks are now carried out for residents who use wheelchairs. Training has been given to staff in respect of vulnerable adult abuse awareness. Information relating to staff training is up to date. Since the last inspection staff have managed to secure an extra placement for one service user at their day centre. There are good health and safety checks. For example, the fire alarm system is checked on a weekly basis. The laundry area has been refurbished and an assessment of the premises has been undertaken by professional staff to ensure that it meets the needs of residents who have a sensory impairment. There are now thorough records kept with regard to choices made by residents from the daily menu. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 7 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. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, and 5 The homes Statement of Purpose and Service User Guide are very good providing service users and prospective service users with details of the services the home provides enabling an informed decision about admission to be made. EVIDENCE: The home has produced a comprehensive statement of purpose and service user guide. It is acknowledged that it would not be possible to include service users’ views about the service within the service user guide. The home has admitted one new service user since the last inspection. It was pleasing to see that a thorough assessment process had taken place and there were numerous visits undertaken by the new resident prior to their admission with detailed records maintained. The home had also obtained a copy of the placing officer’s assessment and care plan as required by the Care Homes Regulations 14. However, the manager had failed to write to the prospective service user confirming that Attwood Street could meet assessed needs as required by the same Regulations. The home does not have an assessment tool which covers all of the subjects contained within the National Minimum Standards 2.3. As discussed, this would be useful in establishing in order to undertake periodic re-assessments 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 10 of existing service users’ needs in order to measure progress or deterioration and help ensure care plans are up to date. Staff ensure that service users have access to specialists such as speech and language therapists who are developing comprehensive communication passports. The home is currently in the process of developing contacts/terms and conditions of occupancy (Licence Agreements). All details required by the National Minimum Standards 5.2. must be included. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, and 9 The home has a comprehensive care planning system so that service users know their assessed and changing needs and personal goals are reflected in their individual plan. Service users are supported to make decisions through person centred planning and excellent communication passports. Staff are making 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 care plans were examined which confirmed that the home continues to provide a high standard of care planning with good guidelines for staff to follow. For example, there are detailed care plans regarding how service users are supported in various aspects of their personal care needs. Care plans are reviewed on at least a six monthly basis and there is regular monitoring and updating. The community learning disability nurse participates in review meetings. The home uses a recognised person centred planning approach and care plans have been reproduced in formats suitable for service users. In the past the home has attempted an essential life style planning approach but according to the manager this system unfortunately was not 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 12 successful due to the lack of a circle of friends. This is an acceptable explanation but should be kept under review should circumstances change. The home’s risk assessment and management approach is very good. On examination risk assessments are now more simplified and are up to date and cover a wide selection of topics. Only slight expansion is necessary with regard to wheel chair users and information was given regarding recent notices issued by the Medicines and Healthcare products Regulatory Agency. The majority of service users do not have any active involvement with families despite efforts made by staff. In addition although advocacy services have been approached they will only act in ‘crisis’ situations. As a result the service provider is still acting as an appointee for service users’ finances. There is an outstanding requirement with regard to this aspect which disappointingly has not received any attention. For example a written policy regarding financial management has not been established neither has an independent audit of records and service users’ monies. As a result this had led to confusing procedures and a compromise of service users’ rights. (See further comments in standard 23). Since the last inspection further guidance has been issued by the Commission for Social Care Inspection with regard to corporate appointees and therefore the requirement to identify an independent appointee such as the Local Authority has been withdrawn. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 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 standard(s) 12, 13, 14 and 15 Staff support service users with social activities in-house which enriches their lives. Social inclusion has been restricted due to staffing shortages and as a result service users are not able to enjoy social stimulation and follow their own hobbies and interests. EVIDENCE: Interviews with staff, examination of records and observations made during the inspection confirm that a range of activities are provided at the home to simulate residents. For example, there is evidence of one to one intensive interaction and residents were enjoying a game of playing catch during the inspection as well as watching television and staff engaging positively with service users. All residents attend some form of external day care provision which includes attendance at specialist day centres, college courses, hydrotherapy and a church club. Although there are wall planners identifying which day care provision residents attend on a daily basis, the home no longer has individual activity programmes thereby there is no formal structure to leisure and social activities when residents are not in attendance at their day centres during the 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 14 week and at week ends. These need to be re-established and indicate leisure, independent living skills and community activities. Unfortunately, the home is once more experiencing staffing shortages and as a result this has once again impacted upon social inclusion. (See further comment in standard 33). For example, during a fourteen day period three service users’ community activities were case tracked. Only one service user had enjoyed a community based outing which consisted of a ride out on the mini-bus. Other than attending their day centres service users had not been able to participate in any community based activities. Service users are still funding the cost of their own holidays and in some cases this also includes staffing costs. The manager states that he is attempting to partly address this issue by using a budget of £150.00 per person which is allocated by the service provider on an annual basis for ‘additional costs’. In the interim until this situation is resolved a written policy needs to be introduced in relation to what exactly service users are to pay for in order to ensure consistently and in addition how holidays are chosen. This must be ratified by a multi-disciplinary team for example a family member (where possible), community learning disability nurse, commissioning authorities and management committees. There is only one service user who is able to maintain links with their family which is actively encouraged by staff. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The health care needs of service users are well met with evidence of good multi-disciplinary working taking place only slight improvements are necessary to ensure all the health care needs of residents are met in full. EVIDENCE: 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 16 Interviews with staff, feed back from a General Practitioner and examination of records reveal that the home is proactive towards identifying and addressing the health care needs of residents. For example, one resident was recently observed to have a skin complaint, the doctor was called out on the same day and again a couple of days later with good records maintained. The home uses the a ‘priority screening for healthcare’ booklet for all service users. This is an assessment and planning tool specifically designed to meet the needs of people who have a learning disability. It is a tool which has been designed by the Health Improvement Team and Dudley South Primary Care Trust. The document is jointly completed by the Home, learning disability nurses and the primary care team. It is a comprehensive document which covers all aspects of health care, details of appointments and outcomes, staff training and guidance on consent to treatment. There was evidence that service users receive regular chiropody appointments and eye tests. Hearing tests are carried out at annual health care reviews and there is also an annual review of medication. There are detailed records with regard to various aspects of health care monitoring for example with regard to pressure area care and staff have received training. There are only a couple of minor improvements needed. For example, although service users attend well person clinics and staff have either received, or are about to receive, training in awareness with regard to breast and testicular cancer, formal care plans need to be established with regard to screening and monitoring through physical observations whilst carrying out personal care tasks. Service users are not always receiving a six monthly dental check up. In two cases service users had not received a check up since August 2003. The manager reports that there is a waiting list however this must be actively pursued with written records maintained. It was established that the home has introduced a new procedure which consists of two hourly night checks on all residents. Unfortunately, there was a sudden death of one of the residents at the home last year. Although the home could have in no way prevented this tragedy, staff are understandably anxious and hence the new protocol. Whilst this is commendable, it can compromise residents’ dignity and affect their sleeping patterns unless there is a specific health care or behavioural need. This needs to be reviewed in consultation with staff. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 17 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 standard(s) 22 and 23 The home has a satisfactory complaints systems so that users’ views are listened to and acted upon. Financial procedures and arrangements are not robust and thereby could place service users at risk of possible abuse. EVIDENCE: The home has an excellent complaints system and procedure which commendably has been reproduced in pictorial and audio formats. Since the last inspection the home has obtained copies of the Local Authority vulnerable adult abuse procedures and Protection of Vulnerable Adults (POVA) guidelines as requested. The home’s own policy on vulnerable adult abuse still needs expansion to include reference to Local Authority guidelines and the new POVA scheme. Staff have received in-house training from the service provider regarding vulnerable adult abuse awareness. During interviews staff competently responded to how they would deal with any allegations of abuse and were knowledgeable in their understanding of the principles of Whistle Blowing. As already mentioned the service provider acts as an appointee for the management of service users’ finances. All residents have their own bank accounts but are unable to withdraw their own money which is carried out by staff on their behalf using their personal identification numbers (PIN). On examination there are detailed records of financial transactions with regard to personal allowances and benefits with double signatures of staff obtained. In addition the home also keeps separate detailed records of withdrawals and incoming payments in respect of bank accounts. On examination a sample of records balanced with monies held. Records also balanced accurately with 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 18 copies of bank statements held by the home. Whilst there are no concerns relating to this practice, the home still needs to establish written protocols regarding this procedure in order to protect both service users and staff and ensuring consistency. Once again due to the lack of written protocols and procedures confusion has arisen with regard to what costs are incurred by service users. For example at the last announced inspection in May 2004 it was found that service users had been charged for the cost of redecoration of their bedrooms (these had not been decorated for some time and therefore needed ‘freshening up’). At the request of the Commission for Social Care Inspection, residents were reimbursed. Inspection of personal records once more identify that service users are being charged for items which should normally be included as part of the basic contract fee. For example, one service user had bought their own chest of drawers as the previous ‘work type surface’ was old an inadequate according to staff. In addition the same resident was charged for replacement of worn bedding and towels. 2 service users had also paid for their own protective bed covers. On once occasion on 1 June 2005 a member of staff had gone shopping for a resident’s toiletries using her own car and had charged the cost of car parking fees to the resident! It was also found that 2 service users had paid for their own lunches when out in the community which was a replacement meal and therefore effectively should be paid for by the service provider. Or alternatively, if service users are expected to make contributions towards meals when out in the community this must be a formal agreement approved by a multidisciplinary team and with contributions also made by the service provider. The home is required to undertake a documented liaison with the Commissioning Authority to clarify exactly what is included as part of the basic contract fee. Service users must be re-imbursed for any items which they have been inadvertently charged. Written policies and procedures must devised and care plans following this meeting regarding how the home manages service users finances and ratified by a multi-disciplinary team. This is particularly important as staff are invariably involved in making financial decisions on behalf of service users’ due to their lack of capacity to consent, and the lack of family and advocate involvement. Robust procedures must be implemented in order to protect both service users and staff. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 19 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 standard(s) No standards were assessed at this inspection. EVIDENCE: A brief tour of the building was undertaken as part of the inspection and in order to determine progress towards outstanding requirements and the laundry area. All requirements have been met including an assessment undertaken by the visual impairment team. The premises were exceptionally clean and tidy. During discussions with management regard the practice of service users’ purchasing some of their own bedroom furniture it was established that the home does not have a written maintenance and renewal programme for the fabric and decoration of the premises. This exercise needs to be undertaken and would be of benefit in determining forthcoming expenditure and investments required particularly since Attwood Street is rented from a separate organisation. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36 There is a competent and well trained staff group who understand the complex needs of the service users. However, staffing shortages have impacted upon the quality of life for service users. EVIDENCE: Training is given a high priority; eleven of the fifteen staff team have completed an NVQ II or above. There is a stable staff group. Three of the staff team have worked at the home since 1994. Ten staff have worked at the home for more than four years. Unfortunately, the home is experiencing staffing shortages due to staff who have either retired, left to pursue other employment or are on maternity leave. The home is still managing to meet staffing levels of three care staff per day time shift but a high proportion of agency staff are used and existing staff are supplementing shortfalls by working over time. The manager is not at present supernumerary and whilst it is acceptable that he should work some shifts on the floor given the size of the home, it is unacceptable that there should be no allocation of supernumerary hours. Written proposals must be forwarded to the Commission For Social Care Inspection with regard to the total number of supernumerary hours to be worked by the manager. Due to the lack of permanent staff and qualified drivers of the mini-bus, service users’ outings 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 21 have become restricted. The manager is hopeful the situation will improve as recruitment is on-going. On examination of staff personnel files recruitment and selection is a thorough process. However, there is one area for improvement with regard to retaining two written references for new staff. It was stated that two references had been obtained for a new member of staff but only one could be located on the personnel file. The home still needs to make progress with regard to providing induction and foundation training for staff by an approved learning disability awards framework provider within the required timescales. Since the last inspection improvements have been made with regard to ensuring there are separate individual staff training profiles and a central staff training development programme. On examination there is regular and structured supervision sessions for staff by management. A wide selection of topics are discussed. There are also annual appraisals. Any additional items discussed during this inspection are contained within the Requirements section of this report. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41, 42 and 43 The manager is supported well by his senior staff in providing clear leadership through out the home with all staff demonstrating an awareness of their roles and responsibilities and thereby providing a good quality service. The health, safety and welfare of service users is given high priority by staff and management. EVIDENCE: There is a new manager in post who took over in October 2004 and was formerly the deputy manager. During interviews staff were complimentary about the management style employed, felt listened to and valued. They felt empowered by being given new responsibilities and challenges. Staff personnel files are not held on the premises. These are still retained at the service provider’s head office which does not comply with the Care Homes Regulations 17(2). Files were available for inspection and all staff have up to date criminal record disclosure bureau checks on examination. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 23 The majority of mandatory training has been undertaken. Some training is still on-going and certificates are awaited for other training such as fire safety training. All maintenance and service checks were examined and found to be up to date. It was pleasing to see the emphasis placed upon health and safety. For example, even the shower chair receives regular, recorded visual safety checks which is excellent practice. There is good accident reporting and as well as accident reports there is also a summary book introduced so that the manager can monitor all accidents and identify any patterns. There are regular checks of bedrails which are fully recorded. Wheelchairs are regularly serviced and this needs to be supplemented by visual checks as previously recommended. There is up to date insurance and certificates include the name and address of the home. Budgetary details were available and there is a business plan but this requires updating as it has not been reviewed since 2001. There are regular visits by the Chief Executive of the Langstone Society but copies of the monthly reports are not always sent to the Commission For Social Care Inspection. For example only 2 reports have been received this year. Any additional items discussed during this inspection are contained within the Requirements or Recommendations section of this report. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 3 3 2 Standard No 22 23 ENVIRONMENT Score 4 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 1 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 2 1 2 3 x x Standard No 31 32 33 34 35 36 Score x 4 1 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 38 Attwood Street Score x 2 x 2 Standard No 37 38 39 40 41 42 43 Score 2 x 2 x 1 2 2 E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 25 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 2 Regulation 14(1)(d) 14 Requirement To ensure that confirmation is sent in writing to new service users that having regard to the assessment the home can meet their needs. To ensure a system of periodic reassessment is implemented for existing service users, using a recognised/formal assessment tool, which meets the requirements of standard 2.3 of the National Minimum Standards for Younger Adults. To ensure that each service user has a Contract of occupancy/statement of terms and conditions which includes all elements of the NMS 5.2 including additional charges. (Previous timescale of 1/2/04 is partly met). 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 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 26 Timescale for action 1/9/05 2. 5 5(1)(b) 1/11/05 3. 7, 23 20 1/9/05 procedures relating to the management of service users’ finances including arrangements for an independent audit. (Previous timescale of 1/3/04 is not 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 learning disability nurse, commissioning authorities, management committees of the service provider. 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. 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. 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. 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 27 4. 9 13(4)(c) 5. 12 12(1)(a) 6. 13 16(2)(m) 7. 14 16(2)(n) To review and expand risk assessments for wheelchair users identifying risk associated with using posture belts, and manufacturers specifications with regard to maintenance checks and servicing as detailed in recent Medical Device Alert notices. To re-establish individualised activity programes to identify independent living skills, social and leisure activities based on service users preferences and needs. To provide more opportunities for service users to undertake community based activities on an individual and group basis based on their individual preferences and needs. Service users should be given the option of a minimum seven day annual holiday outside of the home as part of the basic contract price. Service users should not be expected to pay towards staff expenses incurred during activities, outings, day trips, holidays etc. (Previous timescale of 1/2/04 is partly met). To establish a written procedure regarding holidays. This must include details as to how they are chosen, funding and charges during the holiday. This must be ratified by a multi-discipinary team. To improve the health care assessment and monitoring by: To introduce a procedure for the monitoring of service users’ health with regard to potential complications such as breast and testicular cancer screening. 1/9/05 1/11/05 1/9/05 1/9/05 8. 19 12(1)(a) 1/9/05 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 28 (Previous timescale of 1/3/04 is partly met). 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. To develop continenence management care plans for all service users with incontinence. To improve monitoring of dental appointments and to pursue appointments for service users who have not received a dental check up since 2003 and who are on a waiting list awaiting appointments with written records maintained. 9. 21 12(2) To establish a written policy 1/11/05 regarding ageing, terminal care and death. (Previous timescale of 1/3/04 is not met). 1/10/05 A policy and robust procedures concerning Adult Protection should be put in place, which has been referenced to the Department of Health guidance “No Secrets” and include details (or reference) Local Authority procedures for the Protection of Vulnerable Adults. (Previous timescale of 1/3/04 is not met). Current training in the management of challenging behaviour must be provided for all staff. (Previous timescale of is 1/3/04 not met). To review and update the adult proctection policy to include the new Protection of Vulnerable Adult (POVA) scheme. (Previous 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 29 10. 23 13(6) timescale of 1/4/05 is not met). To ensure there is written evidence maintained to confirm that individual agency staff have undergone a POVA/criminal record bureau disclosure check within the last twelve months as required by the new DOH POVA guidance. (Previous timescaleo of 1/4/05 is not met). To establish a written maintenance and renewal programme for the fabric and decoration of the premises. To continue to pursue the recruitment of new permanent staff in order to reduce high levels of agency staff. 11. 24 23(2)(b) 1/11/05 12. 33 18(1)(a) 1/9/05 13. 34 19(1)(b) 14. 35 18(1)(c) To ensure that the Manager is allocated specific supernumerary hours and to forward written proposals to the Commission for Social Care Inspection. To ensure that two written 1/9/05 references are obtained prior to the appointment of new staff and to retain copies on individual staff personnel files. All staff must receive structured 1/10/05 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 met). To provide staff with training in equal opportunities and disability equality. (Previous timescale of 1/7/04 is not met). To ensure that the Manager is supported to completed an NVQ IV in management by 2005. The home must develop an 15. 16. 37 39 18(1)(c) 24 1/1/06 1/11/05 Page 30 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 17. 41 17(2) effective (and professionally recognised) quality assurance and monitoring system to measure success in achieving the aims and objectives and statement of purpose of the home. This must include feedback from families, stakeholders in the community etc. (Previous timescale of 1/7/04 is not met). 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 cease using correctional fluid on records such as duty rotas and menu choices. To provide all staff with manadatory training in: 1) infection control. (Previous timescale of 1/7/04 is partly met). 1/11/05 18. 42 18(1)(c) 1/11/05 19. 43 25, 26 2) First aid awareness. To provide a business and financial plan which must be available for inspection. (Previous timescale of 1/7/04 is partly met). Copies of the monthly reports made on the conduct of the home by a representative of the company, must be forwarded to the Commission for Social Care Inspection on a more regular basis. 1/9/05 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 42 42 Good Practice Recommendations To carry out chlorination and bacteriological testing of the water system. To consider introducing a procedure for regular health and safety checks of wheelchairs. (Visual). 38 Attwood Street E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 32 Commission for Social Care Inspection Mucklow Office Park West Point, Mucklow Hill Halesowen 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 E55 S24950 Attwood Street V231896 040705 Stg4.doc Version 1.40 Page 33 - 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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