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Inspection on 01/07/08 for 38 Dagger Lane

Also see our care home review for 38 Dagger Lane for more information

This inspection was carried out on 1st July 2008.

CSCI found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

New residents have their needs assessed before they move into the home. This means the home can be confident of meeting their needs. Staff gave good explanations as to how they support residents to make choices and involve in decision-making. As one person explained, "residents` sit with us when we do monthly service user reports and we talk to them and go through what we are arranging and writing about them. They can say if don`t agree although some cant talk we look for other ways of communicating. Choices and independence is promoted". Care planning continues to ensure residents` needs are met. Staff understand their responsiblities as key workers. As one member of staff explained, "promoting independence, buying presents, taking with to pick, making sure everything up to date in monthly service user reports".Residents have a choice in activities they can do. Records we viewed confirm activities undertaken include attendance at college, picnics, visits to the barber, bowling, day trips, sensory sessions, in house games and tranquillity sessions at a local centre. The health and personal care that residents receive is based on their individual needs. As at previous inspections medication systems were examined and found to be robust and safe. All staff that were spoken to demonstrated excellent understanding of supporting people to raise concerns. For example one person explained, "we can tell by reactions, behaviour, different noises they make, changes in appetite" and another "I report to the nurse in charge straight away if I thing someone is unhappy". All 4 residents surveys sent to the CSCI confirm people know who to talk to if unhappy. For example one states `I don`t know the actual person. If I am unhappy I will let you know by saying no or I will scream and bang objects badly. People will then ask me what is wrong and I can tell them` and another `If I am unhappy I talk to staff or I tell my mum or sisters`. The home is of a generous size. It is well maintained, comfortable and safe. Bedrooms were viewed. All were clean and well equipped with modern style furniture and contained personal effects making them homely and individualised. As at previous inspections the staff team on duty at the time of the visit were impressive. It was clear that they all had a positive relationship with the residents in their care. They were patient and respectful, there was good eye contact with the residents and they were attentive. It is clear that the manger offers direction and leadership to her staff and demonstrates an ability to run the home effectively. Throughout the inspection the registered manager demonstrated knowledge, competency and commitment to her role. Regular staff meetings are held to share information and give staff a chance to air their views and regular maintenance and health and safety audits are undertaken.

What has improved since the last inspection?

Care plans for social stimulation have been introduced and monthly key worker meetings with residents expanded to enhance person centred approaches to care.Risk assessments have been reviewed and completed based in individuals` needs and capabilities to promote person centred approaches to care. The home has made excellent progress to ensure decisions made by others on behalf of residents comply with The Mental Capacity Act and promote good practice. All 4 residents surveys that we received state residents can make decisions about what they do. A form has been devised `mental capacity act best interest decision protocol for administration and storage of medication`. The form is reviewed monthly and takes into consideration residents` needs and abilities. We have received evidence that adult protection referrals are made as and when required to safeguard residents and the practice of residents purchasing bedding and towels has been reviewed with the home now contributing to these on an annual basis. A previous requirement instructing that the home must be able to evidence that authorised persons have verified CRB disclosures before they are destroyed is now met. We sampled staff recruitment records and found them to be in good order and contain all the required information to protect residents. Since the last inspection regular monitoring visits in line with Regulation 26 of the Care Home Regulations have been undertaken with reports available in the home. We were shown a new format for obtaining residents views called `what do you think`. This is an excellent initiative as it includes the use of colour pictures and large print. The use of colour is an additional aid to communication for residents.

What the care home could do better:

CARE HOME ADULTS 18-65 38 Dagger Lane West Bromwich West Midlands B71 4BE Lead Inspector Lesley Webb Unannounced Inspection 1st July 2008 09:00 38 Dagger Lane DS0000004770.V367342.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 Dagger Lane DS0000004770.V367342.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 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 38 Dagger Lane Address West Bromwich West Midlands B71 4BE 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) 0121 580 0666 0121 580 0752 enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Samantha Ganderton Care Home 8 Category(ies) of Learning disability (6), Physical disability (8) registration, with number of places 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One service user (female) accommodated at the home may be in the category DE. This will remain until such time that the service users placement is terminated. One service user (male) accommodated at the home may be in the category DE(E). This will remain until such time that the service users placement is terminated. 3rd September 2007 Date of last inspection Brief Description of the Service: 38 Dagger Lane is an eight bedded nursing home for people with learning/physical disabilities, shares are owned by Care Tech. The service also provides care and support to two existing residents who have Dementia related needs. The property is situated near to West Bromwich, and has local shops and amenities close by. The home is accessible by public transport and offers on road parking to the front and side and limited off road parking. Accommodation consists of eight single occupancy rooms and communal areas. The home offers shared bathing/toilet facilities, as none of the bedrooms are en-suite. Aids and adaptations are provided which meet the assessed needs of the service users. There is a passenger lift available. The home provides a range of in house and community accessed activities, plus a healthcare programme, which utilises various healthcare resources within the local area. The registered manager at the time of inspection states that fees charged for living at the home range from £ 1,152.00 to 1647.21. It should be noted that any fee information included in this report applied at the time of inspection and that people may wish to obtain more up to date information from the care home. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this visit over one day with the home being given no prior notice. During the visit time was spent talking to staff, the registered manager and area manager, examining records and observing care practices before giving feedback about the inspection to the senior on duty. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking two individuals care provided at the home. For example the people chosen have differing communication and care needs. 4 residents’ surveys were completed and returned to the Commission for Social Care Inspection (CSCI). The home also completed its Annual Quality Assurance Assessment and sent this to us prior to the inspection, the contents of which was also used when forming judgements on standards of service provided and outcomes for residents. The inspector was shown full assistance during the visit and would like to thank everyone for making her welcome. The quality ranting for this service is 3 Star. This means the people who use this service experience excellent quality outcomes. What the service does well: New residents have their needs assessed before they move into the home. This means the home can be confident of meeting their needs. Staff gave good explanations as to how they support residents to make choices and involve in decision-making. As one person explained, “residents’ sit with us when we do monthly service user reports and we talk to them and go through what we are arranging and writing about them. They can say if don’t agree although some cant talk we look for other ways of communicating. Choices and independence is promoted”. Care planning continues to ensure residents’ needs are met. Staff understand their responsiblities as key workers. As one member of staff explained, “promoting independence, buying presents, taking with to pick, making sure everything up to date in monthly service user reports”. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 6 Residents have a choice in activities they can do. Records we viewed confirm activities undertaken include attendance at college, picnics, visits to the barber, bowling, day trips, sensory sessions, in house games and tranquillity sessions at a local centre. The health and personal care that residents receive is based on their individual needs. As at previous inspections medication systems were examined and found to be robust and safe. All staff that were spoken to demonstrated excellent understanding of supporting people to raise concerns. For example one person explained, “we can tell by reactions, behaviour, different noises they make, changes in appetite” and another “I report to the nurse in charge straight away if I thing someone is unhappy”. All 4 residents surveys sent to the CSCI confirm people know who to talk to if unhappy. For example one states ‘I don’t know the actual person. If I am unhappy I will let you know by saying no or I will scream and bang objects badly. People will then ask me what is wrong and I can tell them’ and another ‘If I am unhappy I talk to staff or I tell my mum or sisters’. The home is of a generous size. It is well maintained, comfortable and safe. Bedrooms were viewed. All were clean and well equipped with modern style furniture and contained personal effects making them homely and individualised. As at previous inspections the staff team on duty at the time of the visit were impressive. It was clear that they all had a positive relationship with the residents in their care. They were patient and respectful, there was good eye contact with the residents and they were attentive. It is clear that the manger offers direction and leadership to her staff and demonstrates an ability to run the home effectively. Throughout the inspection the registered manager demonstrated knowledge, competency and commitment to her role. Regular staff meetings are held to share information and give staff a chance to air their views and regular maintenance and health and safety audits are undertaken. What has improved since the last inspection? Care plans for social stimulation have been introduced and monthly key worker meetings with residents expanded to enhance person centred approaches to care. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 7 Risk assessments have been reviewed and completed based in individuals’ needs and capabilities to promote person centred approaches to care. The home has made excellent progress to ensure decisions made by others on behalf of residents comply with The Mental Capacity Act and promote good practice. All 4 residents surveys that we received state residents can make decisions about what they do. A form has been devised ‘mental capacity act best interest decision protocol for administration and storage of medication’. The form is reviewed monthly and takes into consideration residents’ needs and abilities. We have received evidence that adult protection referrals are made as and when required to safeguard residents and the practice of residents purchasing bedding and towels has been reviewed with the home now contributing to these on an annual basis. A previous requirement instructing that the home must be able to evidence that authorised persons have verified CRB disclosures before they are destroyed is now met. We sampled staff recruitment records and found them to be in good order and contain all the required information to protect residents. Since the last inspection regular monitoring visits in line with Regulation 26 of the Care Home Regulations have been undertaken with reports available in the home. We were shown a new format for obtaining residents views called ‘what do you think’. This is an excellent initiative as it includes the use of colour pictures and large print. The use of colour is an additional aid to communication for residents. What they could do better: An area where we advised greater care is assistance with personal care. We witnessed a resident using the ground floor toilet with assistance from a member of staff. The toilet door was left open impacting on the privacy and dignity of the individual. We also noted that one resident care documentation states staff must us an electric shaver each day as the resident cannot do this themselves. At lunchtime we saw that the resident had not been shaved and was taken out into the community. Again this does not promote the residents dignity. Some people who live at the home have behavioural needs. We examined the care plan for one person for managing behaviour. It states that ‘staff should engage in a process of elimination’ – it does not state what these are. The plan also does not make reference to the use of medication to modify behaviour despite this being administered. We informed the registered 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 8 manager that the care plan must be expanded and include information about medication to ensure this is not used as a chemical restraint. A recommendation was made at the last inspection that new garden furniture is purchased. It was disappointing to find this has not happened despite the registered manager putting a request in to head office for funds. The furniture is now dangerous as parts of the wooden seating and table are broken and splintered. The registered manager agreed to have it removed during our visit. There is no outside furniture for residents to use on sunny days. This is not acceptable and suitable outside furniture must be provided A list of recommendations is sited at the back of this report for interested parties. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 9 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 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to decide if the home will meet their needs. They have their needs assessed and a contract that clearly tells them about the service they will receive. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) sent to us prior to the inspection states ‘All potential service users are invited and supported to make visits to Dagger Lane. Usually this will be an afternoon visit with a drink and a snack provided, this will then progress onto a day stay then finally an overnight stay, all this occurs prior to a decision being made with regards to the placement and the amount of visits will depend on the prospective service users health condition and their ability to comprehend the process. Staff are there to make the prospective service user feel welcome and relaxed. Prior visits are extremely important as they allow us to assess the persons suitability and compatibility to the home. It also allows the prospective service user, staff and existing service users to get to know one another prior to any resettlement, thus making the transition period less daunting. The prospective service user and their family will also be presented with Dagger Lanes Statement of Purpose and Peoples Guide (pictorial) which provide full details of the home and its ethos. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 11 A written assessment is completed by the Home Manager alongside a member of the MDT (management development team) with regards to the persons needs, in order to establish a holistic approach to suitability. Following comprehensive, thorough assessments a decision will be made by the Home Manager with regards to the placement. If it is deemed an appropriate placement, the Home Manager will put their decision in writing to the prospective service user and their Care Manager. The Care Costs (fees) and Terms and Conditions of the placement are made available to the service user and appropriate professionals. Current service users are offered the opportunity to discuss any issues/concerns with regards to the service they are receiving during their monthly 1:1 Service User meetings or through completing 6 monthly Satisfaction surveys. We also operate an open door policy and encourage/support the service users to express their feelings as they feel they need to, this is not restricted to set times of the month’. We examined the records of the newest person to move into the home, observed practices and talked to staff and the registered manager and found in the main the information contained in the AQAA to accurately reflect admissions practices in the home. For example assessments of need were completed prior to the new resident moving to the home, records evidence the person visited the home with their relative and participated in a meal with residents and information on the new residents file includes a copy of the homes Statement of Purpose that was reviewed May 2008. We did note that only one visit was made to the home. We were informed that this was due to the new resident being admitted to hospital due to a fall at their previous home. The registered manager assured us that normally any prospective resident would be given the opportunity to undertake a range of visits, including an overnight staff. By operating a thorough pre- admission procedure the home can be confident of meeting new residents needs. We received 4 residents’ surveys prior to the inspection. All state that they were asked if they wanted to move into the home and that they received enough information about the home in order that they could decide if it was they right place for them to live. Additional comments were made such as ‘I came a few times before I moved in’. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Where possible residents are involved in decisions about their lives and the care and support they receive. Care planning continues to ensure residents’ needs are met. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) sent to us prior to the inspection states ‘An overview of each service users likes and dislikes can be found in each persons Essential Lifestyle Plan. These Person Centred Plans were developed with the input of the service users, relatives, key workers, named nurses, Home Manager, college tutors etc. Each service user also has a Life book which is updated at least twice a year by the individual and their key worker, with written and pictorial details of their life events during the previous months, what activities/events they have participated in, birthdays, Christmas, holidays etc. This document reflects the persons individuality, needs and choices. Monthly service user meetings held with the 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 13 key workers, offer the opportunity for individuals to express choices and preferences that they would like to carry out, such as a choice of leisure pursuit. Individually tailored care plans and risk assessments highlight that service users are able to make their own choices and guidance is given to staff on how to recognise these choices. Care plans are reviewed on a monthly basis, whereas risk assessments are evaluated 6 monthly. Each service user is encouraged and supported to make choices on a daily basis in all areas of their lives. If there is a choice to be made that the individual may not fully understand (Mental Capacity Act), assessments would be carried out and referrals would be made to the appropriate agencies. There is also evidence within the service users daily notes and activity plans with regards to choice and decision-making. One female service user used to attend the local toning tables regularly. After a while this lady became tearful when undertaking this activity. As a result her key worker was able to encourage the service user to express her feelings and the activity stopped immediately and was replaced with another activity of the persons choice. Annual Care Reviews are carried out at the home to determine if the service is continuing to meet the needs of the service users’. We examined the records of two residents, observed practices and talked to staff and the registered manager and found the information contained in the AQAA to accurately reflect practices in the home. For example files sampled contained comprehensive care plans for a range of needs identified from the assessment of need process, examples being; the risk of choking, mobility, transfers and smoking. It was positive to see that these care plans are being regularly reviewed. Both recommendations made at the last inspection have now been met. Care plans for social stimulation have been introduced and monthly key worker meetings with residents expanded to enhance person centred approaches to care. Residents are allocated key workers. All staff that were interviewed demonstrated good knowledge of this role and the responsibilities it entails. As one member of staff explained, “promoting independence, buying presents, taking with to pick, making sure everything up to date in monthly service user reports”. The people who live at this home have a range of needs that have the potential to impact on them being involved in decision making. Observations during the inspection confirmed however that residents are encouraged to make decisions that they can, about their lives on a day-to-day basis. Staff were observed continually giving choices, for example about what they would like to eat at meal times, what they would like to wear and what they would like to do that day. The home has made excellent progress to ensure decisions made by others on behalf of residents comply with The Mental Capacity Act and promote good practice. All 4 residents surveys that we received state residents can make decisions about what they do. Additional comments include ‘If I don’t want to do something I will say no or sit on the 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 14 floor’ and ‘I am always asked if I want to take part in the activities down on my sheet, if I don’t want to do them I say no, I might do something else instead’. Staff that were spoken to gave very good explanations as to how they support residents to make choices and involve in decision-making. As one person explained, “residents’ sit with us when we do monthly service user reports and we talk to them and go through what we are arranging and writing about them. They can say if don’t agree although some cant talk we look for other ways of communicating. Choices and independence is promoted”. As at previous inspections risk assessments were seen to be in place covering a range of personal risk issues for each resident, examples being; kitchen safety, smoking and daily routines. A previous recommendation to ensure these are reviewed and completed based in individuals needs and capabilities to promote person centred approaches to care is now met. We did note that in some instances care plans have been implemented to meet identified needs but risk assessments were not in place to compliment the contents of care plans. As we explained to the registered manager risk assessments should be completed for any identified need to promote holistic approaches to care management. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices about their life style. Generally social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) sent to us prior to the inspection states ‘The majority our service users lead an active life, incorporating a variety of social activities and new experiences into their daily lives. Monthly activity plans are compiled with the service users involvement if they have the capacity to do so. However, for those people who cannot communicate their preferences, staff who know them best are asked to provide information with regards to activities they have enjoyed in the past. Activities are regularly assessed and observed so we can ensure that the service user is benefiting from and enjoying it. Chosen activities and lifestyles 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 16 are different for each service user, this can be evidenced in their life books, person centred plans, personal files, and by talking to the service users and staff. 3 of the service users regularly attend college during the week, they have settled in extremely well and the feedback is very positive. Some of the service users are encouraged and supported to be involved in the household tasks. This includes them bringing down their own laundry, making their beds, vacuuming, polishing etc. Again this is encouraged on an individual basis as each service user has a different level of ability and some may not even want to participate in household duties. Family and friend contact is also encouraged. One male service user goes home every other weekend to stay with his sister. He benefits from these visits and looks forward to them. Another female service user goes home 2-3 times each week for her tea and spends Christmas and New year with her family. Other service users relatives visit them at Dagger Lane and are made welcome by the staff team. A private area is provided for them if they request it. Mealtimes are flexible at Dagger Lane. Service users are given a variety of options to choose from for each meal. We use 4 rotational menus at Dagger Lane, all of which were compiled with the involvement of the service users and a Nutritionalist. A pictorial food file is utilised at times to assist people in making a choice. Special diets are also catered for at the home. For example, we have a Sikh lady who eats no beef and another person on a healthy eating programme, these are reflected on the rotational menus. Specialist cutlery and crockery is also utilised to meet individual needs and to promote independence’. We examined the records of two residents, observed practices and talked to staff and the registered manager and found the information contained in the AQAA to accurately reflect practices in the home. For example some residents were observed being supported to go out into the community and others were attending day services. Records that we viewed confirm activities undertaken include attendance at college, picnics, visits to the barber, bowling, day trips, sensory sessions, in house games and tranquillity sessions at a local facility. Lunch was indirectly observed. A member of staff was seen assisting a resident, offering encouragement and support. The staff member gave lots of time to the resident, sitting next to and maintaining eye contact. It was particularly pleasing to note the staff member apologised to the resident after another member of staff started talking, interrupting the resident’s meal. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. In the main principles of respect, dignity and privacy are put into practice. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) sent to us prior to the inspection states ‘At Dagger Lane each service user has an individual Health Action plan, which provides details of their health needs. This document accompanies them to healthcare appointments as it enables external professionals to understand their needs. All service users are registered with a local GP. Service users access dental and chiropody services regularly. Eye tests are carried out locally and retests are performed bi-yearly. Medication reviews are undertaken regularly by the GP. Each service user has a pictorial Medical Checklist for easy reference of their last healthcare appointments. This enables us to see when we need to make the next appointment. Service users weight is monitored monthly and records are 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 18 maintained. Each service user is given an annual medical at the GP surgery to ensure health and well-being. Care plans and risk assessments are in place regarding needs and support requirements with regards to health and personal care. Daily records are completed to evidence support provided with regards to health and personal care needs. Staff allocations on a daily basis ensure all personal care needs are met throughout the day. All personal and healthcare support is provided with privacy and dignity. Service users are encouraged to be as independent as possible; any support given is based on individual need. Only qualified nurses are permitted to administer prescribed medication to the service users. Individual communication methods are understood so that staff are able to recognise ill-health. If a service user is admitted to hospital for whatever reason, they are supported by staff from Dagger Lane’. By observing practices, examining documentation and talking to staff we are able to confirm that in the main the above information is correct. An area where we advised greater care is assistance with personal care. We witnessed a resident using the ground floor toilet with assistance from a member of staff. The toilet door was left open impacting on the privacy and dignity of the individual. We also noted that one resident care documentation states staff must us an electric shaver each day as the resident cannot do this themselves. At lunchtime we saw that the resident had not been shaved and was taken out into the community. Again this does not promote the residents dignity. The same residents care documentation also has a bowel-monitoring chart with no care plan identifying a need for this to be monitored. As we explained to the registered manager this could be viewed as an invasion of privacy and must cease. As at previous inspections medication systems were examined and found to be robust and safe. The home is registered to provide nursing care, with only registered nurses administering medications. The home has a medication policy, which gives instruction on medication ordering, receipt and administration. There were no gaps on medication records meaning that they are being completed properly. Medication totals are carried over to ensure audits can take place. The home should be congratulated for the efforts it has made with regard to consent from residents for staff to administer medication. A form has been devised ‘mental capacity act best interest decision protocol for administration and storage of medication’. The form is reviewed monthly and takes into consideration residents’ needs and abilities. We noted that some prescribed creams state ‘apply when required’. We advised the registered manager to seek advice from the GP, requesting that specific instructions on where creams should be applied to reduce the risk of missadministration. 38 Dagger Lane DS0000004770.V367342.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of supporting residents to raise concerns, with an effective complaints procedure in place to support individuals. Residents are protected in full and have their rights upheld. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) sent to us prior to the inspection states ‘A copy of the organisations complaints policy is displayed in the hallway at Dagger Lane, this ensures easy access for relatives and visitors to the home. A pictorial complaints procedure is also displayed for the benefit of our service users. We have a complaints book at Dagger Lane, where we would log any complaints received’. We found this information to be correct. All staff that were spoken to demonstrated excellent understanding of supporting people to raise concerns. For example one person explained, “we can tell by reactions, behaviour, different noises they make, changes in appetite” and another “I report to the nurse in charge straight away if I thing someone is unhappy”. All 4 residents surveys sent to the CSCI confirm people know who to talk to if unhappy. For example one states ‘I don’t know the actual person. If I am unhappy I will let you know by saying no or I will scream and bang objects badly. People will then ask me what is wrong and I can tell them’ and another ‘If I am unhappy I talk to staff or I tell my mum or sisters’. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 20 Policies and procedures are in place for the protection of vulnerable adults. Both requirements made at the last inspection are now met. We have received evidence that adult protection referrals are made as and when required to safeguard residents and the practice of residents purchasing bedding and towels has been reviewed with the home now contributing to these on an annual basis. Evidence was seen during the visit that staff are regularly reminded of the whistle blowing policy. For example this information was on display in the home and sited in the minutes of staff meetings. In addition to this the majority of staff have received training in vulnerable adults and non-violent crisis intervention. We asked staff what they would do if they thought a member of staff was abusing a resident. One said that they would report it straight away and the other that they would monitor. We explained that any concerns must be reported straight away to ensure residents are protected. We advised the registered manager to continue reinforcing staffs responsiblities to report concerns of abuse to ensure residents are safeguarded in full. We sampled the financial records and personal monies of two residents and found both to be in good order and up to date Some people who live at the home have behavioural needs. Staff that were spoken to demonstrated good understanding of behaviours, triggers and affects. We examined the care plan for one person for managing behaviour. This contains short and long term goals, behaviours and triggers. It states that ‘staff should engage in a process of elimination’ – it does not state what these are. The plan also does not make reference to the use of medication to modify behaviour despite this being administered. We informed the registered manager that the care plan must be expanded and include information about medication to ensure this is not used as a chemical restraint. The registered manager agreed this would be given priority. 38 Dagger Lane DS0000004770.V367342.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment that encourages independence. EVIDENCE: The home is situated in a residential area close to West Bromwich town centre and Sandwell Valley Park and farm. The home is of a generous size. It is well maintained, comfortable and safe. The home’s fixtures and fittings are domestic in style creating a homely feel. Shared space comprises of a large room made up of three different areas, two dining areas and a lounge area. These are all tastefully furnished and nicely decorated. The home also has a separate lounge. We noted that one of the radiator covers and part of the window frame in one of the lounges needs attention, as this appears damaged by water. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 22 Externally, the home has a good size garden. A recommendation was made at the last inspection that new garden furniture is purchased. It was disappointing to find this has not happened despite the registered manager putting a request in to head office for funds. The furniture is now dangerous as parts of the wooden seating and table are broken and splintered. The registered manager agreed to have it removed during our visit. There is no outside furniture for residents to use on sunny days. This is not acceptable and suitable outside furniture must be provided. When looking around the garden we also noticed a number of used disposable gloves on the ground. We advised the registered manager that these should be removed and greater attention paid to the garden as some areas appear neglected. It was also noted that parts of the driveway at the front of the home need attention as this is damaged and poses trip hazards. Bedrooms were viewed. All were clean and well equipped with modern style furniture and contained personal effects making them homely and individualised. There are a number of toilet and bathing facilities sited on both floors of the home. These have a range of equipment such as overhead tracking in one bathroom and grab rails in toilets. We noted that the ground floor toilet needs attention as the radiator cover appears warped and stains were sighted at the back of the toilet and on the skirting board. We saw that a jug is used in the first floor bathroom for residents to wash their hair. We advised that a shower attachment be obtained in order that residents have access to clean running water. It is also recommended that windows be double glazed in the bathrooms to ensure consistent room temperatures are maintained. As at previous inspections the home was found to be clean and no offensive odours were detected. Since the last inspection the carpets have been deep cleaned and a contract agreed for this to be undertaken on a regular basis. It is positive that all questionnaires completed by residents confirmed that the home is always clean and fresh. The home has a small laundry with all appropriate equipment in place. Since the last inspection a written policy for the sanitizing and storing of mop heads has been introduced and the home has obtained guidance ‘Infection Control Guidance in Care Homes’ to ensure its systems for the management of infection protect residents. We advised the registered manager that the laundry should be deep cleaned as there is a build up of dust and cobwebs around the walls and ceiling. 38 Dagger Lane DS0000004770.V367342.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support residents living there. Increased staffing levels will improve the opportunities residents have to undertake external activities. Some records need further expansion to demonstrate residents are protected in full by the homes recruitment practices. EVIDENCE: As at previous inspections the staff team on duty at the time of the visit were impressive. It was clear that they all had a positive relationship with the residents in their care. They were patient and respectful, there was good eye contact with the residents and they were attentive. Staff spoken to were knowledgeable about the residents needs. They all were clearly interested in their work. All questionnaires completed by residents confirm that the staff treat them well and that staff listen and act on what they say. Additional comments include ‘They Try to help me by asking me if I want to do things or help me find my away around the building’ and ‘They Make sure I look nice, I like it when they do my hair and make up’. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 24 The homes Annual Quality Assurance Assessment (AQAA) sent to us prior to the inspection states ‘All staff at the home have received an induction that is relevant to the home and the organisation. Staff have either completed a induction pack or a Skills For Care induction pack. New staff will complete a LDQ (Learning Disability Framework) pack within the first 12 weeks of their employment, which will provide them with an insight into the service we provide. The home uses a comprehensive training matrix, which details what training each staff has received and when the updates are due for renewal. All support workers have obtained a LDAF (Learning Disability Accredited Framework) Foundation qualification and almost all of them have recently obtained a LDAF Epilepsy and Dementia qualification which is not only relevant to the needs of some service users, but has benefited us as a team as we now have a better level of understanding. All staff are provided with monthly 1:1 supervision meetings with a line manager. During this meeting staff have the opportunity to discuss any issues or concerns they may have about their role, their colleagues, the service users, the service we deliver etc. Staff and the person supervising will also discuss areas such as, performance, training needs, attitude and sickness levels. Annually, staff undergo a performance appraisal with a line manager. Monthly staff meetings are also undertaken at Dagger Lane. This allows the team to discuss any issues or concerns with regards to the service and service users. During this meeting we will also discuss positive events that have occurred throughout the month and ways in which we can improve the service. Minutes of each meeting are read and signed by all staff’. By observing practices, examining documentation and talking to staff we are able to confirm that the above information is correct. A previous requirement instructing that the home must be able to evidence that authorised persons have verified CRB disclosures before they are destroyed is now met. We sampled staff recruitment records and found them to be in good order and contain all the required information to protect residents. When looking at staff rotas we saw that a number of agency workers have undertaken shifts at the home. No recruitment records were in place. The registered manager explained that she thought the agency is responsible for ensuring these are obtained. We explained that it is the homes responsibility to ensure any person undertaking shifts has had the required checks and training. The registered manager immediately contacted the agency who faxed confirmation of workers recruitment records and training to the home. This information included proof of identity, photograph, passport and birth certificate, training and dates achieved, two references, mental declaration, CRB number and date of issue and POVA first and date checked. The registered and area manager agreed that they would introduce a system where this information is obtained prior to any agency worker undertaking shifts at the home. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 25 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. Quality monitoring ensures the home can measure if it is meeting its aims and objectives. Health and safety generally is well managed, ensuring residents live in a safe environment. EVIDENCE: As at the previous inspection the manager is a Registered Nurse specialising in the area of Learning Disability and has achieved her NVQ level 4 in management. It is clear that the manger offers direction and leadership to her staff and demonstrates an ability to run the home effectively. Throughout the inspection the registered manager demonstrated knowledge, competency and commitment to her role for which she should be congratulated. As the 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 27 AQAA states ‘The staff team at Dagger Lane work in partnership with each other, everyones role is multi-tasked which reduces the chance of an us and them divide. All staff are highly valued within the home and their opinions and views are listened to and taken seriously. All staff play a vital role in the smooth running of the service’. This statement was reflected in practices observed throughout the visit. Quality-monitoring processes are good. Regular staff meetings are held to share information and give staff a chance to air their views and regular maintenance and health and safety audits are undertaken. Questionnaires are in place for staff, relatives and residents with an analysis of findings. In addition to this an annual development plan for the home is in place that details aims and objectives. Since the last inspection regular monitoring visits in line with Regulation 26 of the Care Home Regulations have been undertaken with reports available in the home. As mentioned throughout this report the registered manager supplied a detailed and informative AQAA that was accurate and reflective of practices within the home. For this she should be congratulated. We were shown a new format for obtaining residents views called ‘what do you think’. This is an excellent initiative as it includes the use of colour pictures and large print. The use of colour is an additional aid to communication for residents. A quality and performance report dated 22/04/08 was viewed. This covers the National Minimum Standards, requirements and recommendations made by the CSCI and is based on outcomes for residents. Again this is another excellent quality monitoring tool. Health and safety is promoted within the home. A random assessment of service certificates and risk assessments was carried out. These were found to be in order. Risk assessments are in place for safe working practices and the majority of staff have undertaken training in moving and handling, first aid, food safety, health and safety and fire safety. Information in the homes AQAA indicates that the homes emergency call system has not been serviced since February 2002. We explored this during the inspection with the registered manager informing us there has been a change in contract causing this but that weekly checks are undertaken to ensure this is working (records viewed confirm this). A risk assessment has been completed for a member of staff who is pregnant as is good practice. This details a number of tasks and roles that the named person cannot undertake to ensure hers and the unborn child’s safety. We discussed this with the registered manager recommending that additional staff be brought on duty when this person is on shift due to the additional tasks/roles other staff have to undertake. We examined accident records and found these to be completed when required but that further work should be undertaken as a result of some. For example several accident records detail injuries to residents heads as a result of falls etc. None of these resulted in medical advice being sought. We strongly advised that for any injuries to the head medical advice be sought to ensure residents well-being is promoted. The registered manager agreed with this. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 28 We also noted that an analysis of accidents is not undertaken. The registered manager agreed this would be a good idea in order that trends can be identified and remedial action taken. 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 4 4 X 4 X 3 X X 3 X 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 30 1 No. 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 YA23 Regulation 13(4) Requirement Care plans for the management of behaviours must include processes of elimination staff must follow and the procedures for the use of ‘PRN’ medication to ensure residents’ needs are managed safely. Timescale for action 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA9 YA18 Good Practice Recommendations Risk assessments should be completed for any identified need to promote holistic approaches to care management. That the home actively explores ways of recruiting male staff to ensure personal care and support is given in the way a resident has expressed and to promote the good systems already in place. Staff should promote residents privacy and dignity by ensure toilet doors are shut when in use and ensuring assistance with shaving is given as per care plans. Bowel monitoring should not take place unless identified as 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 31 3 4 5 YA20 YA23 YA24 a need in a care plan. To seek advice from the GP, requesting that specific instructions on where creams should be applied to reduce the risk of miss-administration. To continue reinforcing staffs responsiblities to report concerns of abuse to ensure residents are safeguarded in full. Garden furniture must be provided for residents so that they can use the rear garden when they chose. One of the radiator covers and part of the window frame in one of the lounges needs attention, as this appears damaged by water. Attention should be paid to the garden, as some areas appear neglected. Parts of the driveway at the front of the home need attention as this is damaged and poses trip hazards. The ground floor toilet needs attention as the radiator cover appears warped and stains were sighted at the back of the toilet and on the skirting board. A shower attachment should be obtained in order that residents have access to clean running water in the first floor bathroom. That windows be double-glazed in the bathrooms to ensure consistent room temperatures are maintained. The laundry should be deep cleaned as there is a build up of dust and cobwebs around the walls and ceiling. That staff receive training and guidance in the principles of person centred planning and approaches to care to further enhance their knowledge. A system should be introduced to ensure recruitment and training information is obtained prior to any agency worker undertaking shifts at the home. Additional staff should be brought on duty when named pregnant staff person is on shift due to the additional tasks/roles other staff has to undertake. For any injuries to the head medical advice be sought to ensure residents well-being is promoted. An analysis of accidents should be undertaken in order that trends can be identified and remedial action taken. 6 7 8 YA32 YA34 YA42 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 32 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 38 Dagger Lane DS0000004770.V367342.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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