Inspection on 03/09/07 for 38 Dagger Lane

This inspection was carried out on 3rd September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

38 Dagger Lane 01/07/08

38 Dagger Lane 24/11/06

38 Dagger Lane 23/11/05

38 Dagger Lane 29/06/05

38 Dagger Lane 01/03/05

38 Dagger Lane 19/11/04

38 Dagger Lane 01/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 38 Dagger Lane West Bromwich West Midlands B71 4BE Lead Inspector Lesley Webb Key Unannounced Inspection 3rd September 2007 09:00 38 Dagger Lane DS0000004770.V343797.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.V343797.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.V343797.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.V343797.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. 24th November 2006 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.V343797.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 formally interviewing staff, 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 three individuals care provided at the home. For example the people chosen have differing communication and care needs. Because people living at this home have complex needs they were not always able to tell us about their experiences. The inspector used a formal way to observe people in this inspection to help. This is called ‘Sort Observational Framework for Inspection’ (SOFI). This involved observing three people who live at the home for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other residents and the environment. Residents’ surveys were completed and returned to the Commission for Social Care Inspection (CSCI). In addition three relatives and three health care professionals questionnaires were also completed. Information was supplied by the home prior to the inspection, the contents of which was also used when forming judgements on standards of service provided. The inspector was shown full assistance during the visit and would like to thank everyone for making her welcome. What the service does well: Systems are in place that ensure prospective residents would have their needs assessed and be given information regarding services provided by the home, enabling them to decide if the home is suitable for them. Staff demonstrated good knowledge of the key worker role. As one member of staff explained, “key workers have to fill in monthly progress cards, keep appointments up to date, hair dressing and nails, we keep bedrooms clean, making sure toiletries and clothes kept nice. I think its good to have someone responsible, residents can rely on us and it stops staff doing things differently”. Staff were observed giving choices, for example about what residents would like to eat at meal times, what they would like to wear and what they would like to do that day. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 6 Three relatives questionnaires were completed and returned to the CSCI before the inspection. All state that in their opinion the home always gives enough information on which to make decisions, that they are kept up to date with important issues and that their relatives are given the support and care expected. The health and personal care that residents receive is based on their individual needs. Three questionnaires were completed by external health care professionals prior to the inspection and returned to the CSCI. All praise the home and its management of residents health needs. Staff have a good understanding of supporting residents to raise concerns. For example one person explained, “I remind them there are policies you can follow or manager can speak to or can speak to myself, I would try and promote their rights. I would go to manager, deputy or nurse in charge to see if any changes occurred that could make someone unhappy”. 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. All questionnaires completed by residents confirm that the staff treat them well and that staff listen and act on what they say. Supervision and support offered to staff is excellent. Records confirm that regular supervision sessions are taking place and that all staff receive an annual appraisal. In addition to this regular staff meetings take place, that inform and advice staff of issues and events relevant to their roles. Feedback received from staff was extremely positive regarding the management of the Home. For example one member of staff stated, “they try their best to keep everyone happy and sort everything out, the manager is really good at what she does, if anything wrong is willing to come in or can talk on phone, I am comfortable with them and can tell if have any problems”. What has improved since the last inspection? Since the last inspection the service user guide has been reviewed and now includes information regarding fees charged for living at the home in order the prospective residents are fully informed. A previous requirement to ensure care plans are signed and dated wherever possible by the resident or their chosen representative is now met and a new filing system has been introduced, which includes maintaining risk assessments to a good standard, also meeting a previous requirement. A dietician has visited the home and given advice regarding menus and food intake records have been expanded to include all food taken to ensure effective monitoring takes place. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 7 Incontinence assessments have been completed by an external professional and aids provided promoting good heath to residents. Since the last inspection there have been major improvements to training provided by staff ensuring they have the appropriate qualifications to meet the needs of residents. For example numbers of staff either holding or undertaking National Vocational Qualifications (NVQ) have increased and specialist learning disability training is now included at foundation level. Dementia and epilepsy training is also provided; again to ensure staff have the appropriate knowledge to meet specific needs of some residents. What they could do better: The home should explore improving external activities that residents undertake. Of the eight residents questionnaires received by CSCI, three state they would like to go out more. At the previous inspection staffing levels were found to have been reduced from four to three, with concern identified that this has occurred when the needs and numbers of residents have not altered. This appears to have impacted on the amount of external activities that residents participate in. The inspector was concerned to find that an incident had occurred between two residents without the appropriate adult protection referral being made to the local authority. The inspector instructed that one should be done immediately to ensure residents are safeguarded from harm by the homes procedures. An investigation into the practice of residents purchasing bedding and towels must be undertaken to ensure contracts of residency are being complied with and to ensure residents rights are protected. All staff files sampled contained a CRB disclosure number and date of issue but this in itself does not safeguard residents as no evidence is maintained that indicates the original documentation having been seen by an inspector before they were destroyed. The registered manager stated that some documents had been seen previously by a different inspector however records were not in place to demonstrate this. As the inspector explained, it is the homes responsibility to maintain these records as legal responsibility lies with them to ensure residents are safeguarded by the homes record keeping procedures. During the course of the inspection a number of records detailed incidents that required reporting to the Commission for Social Care Inspection (CSCI). Staff confirmed notifications had not been made. Improvements must be made in this area to ensure residents are protected by the homes recording systems. A full list of good practice recommendations are detailed at the back of this report. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 8 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.V343797.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.V343797.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): 1,2,3,4 and 5. 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: Written information supplied by the home prior to the inspection states ‘all prospective new admissions are fully assessed as to their needs and abilities. The existing client group is considered before any decision is made, visits are arranged and carried out before any admissions’. Examination of records and discussions with the registered manager during the unannounced inspection found this information to be accurate. For example there have been no new admissions to the home for over 12 months however policies and procedures are in place that ensure prospective residents would have their needs assessed and be given information regarding services provided by the home, enabling them to decide if the home is suitable for them and the files of two residents currently residing at the home contain full and detailed needs assessments with evidence these were completed with the involvement of residents where possible and or their representatives. All of the questionnaires completed and returned to the Commission for Social Care Inspection (CSCI) by residents state they were asked if they wanted to move to the home with additional 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 11 comments made including ‘I was shown first, I liked it’. Since the last inspection the service user guide has been reviewed and now includes information regarding fees charged for living at the home. The registered manager confirmed she would soon be undertaking a review of the statement of purpose in order that it includes information regarding fees. It is recommended information relating to fees be expanded to give a break down of fees and information regarding nursing care contributions and that this be included in both these documents in order that prospective residents and their representatives are fully informed. 38 Dagger Lane DS0000004770.V343797.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. EVIDENCE: As in previous inspection all residents 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. It is recommended that the format used for reviewing the care needs of residents on a monthly basis be amended to ensure this reflects events, occurrences and changes that have taken place during the month, as currently the format in place does not do this. Improvements in this area would further enhance a person centred approach to care. A previous requirement to ensure care plans are signed and dated wherever possible by the resident or their chosen representative is now met. It is recommended that care plans be introduced 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 13 for social stimulation and person centred plans be developed further as aids to communication and to ensure a holistic approach to care management takes place. 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, “key workers have to fill in monthly progress cards, keep appointments up to date, hair dressing and nails, we keep bedrooms clean, making sure toiletries and clothes kept nice. I think its good to have someone responsible, residents can rely on us and it stops staff doing things differently”. 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. It was noted that on all residents files that the inspector sampled documents have been completed where it has been stated in some instances residents lack capacity to consent. It is recommended that the home seek advice regarding this to ensure decisions made by others on behalf of residents comply with The Mental Capacity Act and promote good practice. Three relatives questionnaires were completed and returned to the CSCI before the inspection. All state that in their opinion the home always gives enough information on which to make decisions, that they are kept up to date with important issues and that their relatives are given the support and care expected. 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. Since the last inspection a new filing system has been introduced, which includes maintaining risk assessments to a good standard, meeting a previous requirement. When sampling risk assessments the inspector found that many of these are generic and not based on individuals differing needs and capabilities. It is strongly recommended that these be reviewed to promote person centred approaches to care and risk management. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is 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: As at previous inspections, observations confirm that routines are based around the needs of the residents. For example individuals were seen getting up at different times during the morning, eating at various locations and given assistance according to needs and wishes. An area that the home should explore improving is external activities that residents undertake. Of the eight residents questionnaires received by CSCI, three state they would like to go out more. Recorded comments include ‘I would like to go out more, they don’t always have a driver on’ and ‘I like college’ and ‘I watch what I want on the telly, I listen to the music I want, I 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 15 would like to go out more’. These comments were explored during the visit with the registered manager and other staff confirming that the number of external activities having reduced due to care staffing being reduced. Previously the home employed a member of staff during the day specifically for activities. This practice has now ceased with no evidence available to demonstrate how this is in the best interests of residents. On the day of inspection one resident was observed having their nails painted, another playing bingo and two others going out in the community separately. Everyone appeared to enjoy these events. The activity records for three residents were sampled, with all containing evidence of a variety of events including beauty sessions, sensory stimulation, board games and baking. Of the three residents sampled the only external events were recorded as walks in the park, visit to the pub and lunch out. This does not demonstrate residents are undertaking a range of external activities on a regular basis. All of the requirements identified at the previous inspection relating to menu planning and the dietary needs of residents are now met. For example a dietician has visited the home and given advice regarding menus and food intake records have been expanded to include all food taken to ensure effective monitoring takes place. Residents were indirectly observed at lunchtime. Residents were given assistance and support as per their needs and it was pleasing to see staff sit and eat their lunch with residents. Adapted cutlery and equipment is provided and the atmosphere was relaxed and welcoming. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Evidence gained through observations, discussions with staff and examination of records confirm the home has excellent systems for the promotion of residents personal and health care, ensuring these are appropriately managed. For example care plans include individual care needs relating to residents based on their individual needs and capabilities, residents were seen wearing age appropriate clothing and their hair was nicely done. Good records are maintained to evidence personal care examples being, hair washes, baths, teeth cleaning etc. The home is registered to provide nursing care therefore; a registered nurse is on duty at all times. Information supplied by the home prior to the inspection states that no male members of staff are currently employed at the home and that for future improvements the recruitment of a male staff member would be pursued when a vacancy arises as a male resident has indicated he would prefer a male to support him. The home should be 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 17 congratulated for recognising this deficit and it is recommended this be actively explored to ensure personal care and support is given in the way a resident has expressed and to further promote the good systems already in place. Records viewed showed that a range of health care services is accessed for the service users including chiropody, dentistry and the optician. Since the last inspection incontinence assessments have been completed by an external professional and aids provided (meeting a previous requirement). Three questionnaires were completed by external health care professionals prior to the inspection and returned to the CSCI. All praise the home and its management of residents health needs. For example one person wrote ‘ the home seeks advice and acts upon it to manage and improve individuals health care needs, always respect individuals privacy and dignity, manage medication correctly, usually supports individuals to live the life they choose. Physical care is excellent, health care needs particularly well met by dagger lane staff’. 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. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. 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. Further work is required to ensure residents are protected in full and have their rights protected. EVIDENCE: As mentioned earlier in this report the people who live at this home have limited verbal communication that has the potential to impact on them expressing concerns or making complaints. Because of this the inspector formally interviewed staff in order to seek assurances that they understand their responsibilities to support residents in this area. All staff that were spoken to demonstrated excellent understanding of supporting people to raise concerns. For example one person explained, “remind them there are policies you can follow or manager can speak to or can speak to myself, I would try and promote their rights. I would go to manager, deputy or nurse in charge to see if any changes occurred that could make someone unhappy”. Of the eight residents questionnaires returned to the CSCI three were not completed in full due to barriers to communication. All others indicated that residents would talk to staff if unhappy. It is recommended that concerns/issues be included as a set item for discussion within staff meetings where staff can raise items on behalf of residents who are unable to do this independently, to further enhance systems already in place. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 19 Policies and procedures are in place for the protection of vulnerable adults. Since the last inspection staff have received further training on abuse procedures and challenging behaviour meeting previous requirements. All staff that were interviewed demonstrated good knowledge of protecting residents from harm. For example one person explained, “by looking for signs, if individual scared to go by certain people, crying all time, looking sad, notice bruises when getting up, check accident forms in case fall previous day. I would speak to manager, if manager not here would talk to deputy and on call manager“. It is recommended that staff be reminded of the whistle blowing policy and its contents to offer further safeguards to residents as some did not appear to be aware of the contents of this. When looking at accident/incident records the inspector was concerned to find that an incident had occurred between two residents without the appropriate adult protection referral being made to the local authority. This was discussed with the senior member of staff on duty who explained that advice had been sought at the time of the incident from a senior member of staff within the organisation who had instructed a referral was not required. The inspector referred to the local authority procedures where it clearly states a referral should be made and instructed that one should be done immediately to ensure residents are safeguarded from harm by the homes procedures. Generally the systems for the management of resident’s monies and valuable are good. There is a thorough recording method of all financial transactions made with double signatures obtained and facilities for the safe keeping of any monies and valuables. The records of three residents were sampled and all found to be accurate. It was however noted that the records for two of these individuals indicate that items of bedding and towels have been purchased from their personal finances. The inspector explained that the home must investigate this situation and that the contents of the contract of residency examined and if this states it is the homes responsibility to purchase these then the named residents must be reimbursed. If the contract states residents can purchase soft furnishings from their personal finances this must only occur after agreement has been sought within a multi disciplinary forum to ensure residents rights are protected and to ensure they are not placed at risk of abuse. This must also be reflected in the statement of purpose and service user guide as neither of these documents currently state bedding and towels are not included in the fees charged for living at the home. Assurances were given to the inspector that this situation would be acted upon immediately. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 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. Externally, the home has a good size garden. It is recommended that new garden furniture be purchased as that currently in place is damaged and worn. Bedrooms were viewed. All were clean and well equipped with modern style furniture and contained personal effects making them homely and individualised. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 21 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, however these have become stained again in some areas. It is strongly recommended that a programme be implemented whereby carpets are routinely deep cleaned to promote good infection control standards. 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. It was noted that there is no written policy for the sanitizing and storing of mop heads, with staff stating mops are cleaned weekly. It is recommended that a system for storage and sanitising of mops be introduced to ensure infection control standards are promoted further. It is also recommended that the home obtain the recently updated guidance ‘Infection Control Guidance in Care Homes’ again to ensure its systems for the management of infection protect residents. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally 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. It was noted when observing interactions; some staff undertook conversations of a personal nature between one another without the involvement or recognition that residents were in their presence. It is recommended that this be raised in the next staff meeting to reinforce clarity of roles and responsibilities. Staff spoken to were knowledgeable about the residents needs. They all were clearly interested in their work. As one staff member said “I enjoy my job, treat everyone as I would want to be treated if I was in a home, my hearts in it, it’s 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 23 not just a job you get paid for”. All questionnaires completed by residents confirm that the staff treat them well and that staff listen and act on what they say. Praise was also given by all relatives who completed questionnaires. For example one person wrote ‘I think that the care given by the staff is of the highest quality’. Since the last inspection there have been major improvements to training provided by staff ensuring they have the appropriate qualifications to meet the needs of residents. For example numbers of staff either holding or undertaking National Vocational Qualifications (NVQ) have increased and specialist learning disability training is now included at foundation level. Dementia and epilepsy training is also provided; again to ensure staff have the appropriate knowledge to meet specific needs of some residents. It is now recommended that staff receive training and guidance in the principles of person centred planning and approaches to care to further enhance their knowledge as none of the staff spoken to were able to explain what this form of care planning is or of the values that it is based on. The manager confirmed that currently only one person has received training in this area. At the previous inspection staffing levels were found to have been reduced from four to three, with concern identified that this has occurred when the needs and numbers of residents have not altered. As already mentioned earlier in this report this appears to have impacted on the amount of external activities that residents participate in. A requirement was made at the previous inspection relating to this. This requirement remains unmet, with the home instructed to ensure that adequate staff are provided at all times to meet all residents’ needs. Generally staff recruitment is of a good standard. Recruitment processes appear robust. Interview questions and answers were available on new staff files as was evidence of residents’ involvement in the interview processes, which is positive. The only are of concern was the lack of verification that the appropriate Criminal Record Bureau (CRB) disclosures having been obtained prior to staff commencing employment. All staff files sampled contained a CRB disclosure number and date of issue but this in itself does not safeguard residents as no evidence is maintained that indicates the original documentation having been seen by an inspector before they were destroyed. The registered manager stated that some documents had been seen previously by a different inspector however records were not in place to demonstrate this. As the inspector explained, it is the homes responsibility to maintain these records as legal responsibility lies with them to ensure residents are safeguarded by the homes record keeping procedures. Supervision and support offered to staff is excellent. Examination of staff records confirms that regular supervision sessions are taking place and that all staff also receives an annual appraisal. In addition to this regular staff 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 24 meetings take place, that inform and advice staff of issues and events relevant to their roles. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. Generally 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. Feedback 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 26 received from staff was extremely positive regarding the management of the Home. For example one member of staff stated, “they try their best to keep everyone happy and sort everything out, the manager is really good at what she does, if anything wrong is willing to come in or can talk on phone, I am comfortable with them and can tell if have any problems. Monthly supervision really helpful as it allows you to get things off chest”. Generally 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 such as the reviewing of care plans, menus and activities. It is recommended that the findings from the questionnaires be cross referenced to the annual development plan in order that the home can evidence action taken to involve residents and their representatives further in quality monitoring processes. A quality network report was completed 2003, with the registered manager explaining that the company that owns the home have recently appointed a new quality assurance manager who will be reinstating these audits. Regulation 26 visits and reports were not available for inspection with the registered manager explaining that visits had taken place April, May and June 2007 but no reports sent to the home. Reports were available for time periods before this. It is recommended that visits occur in line with regulation to further enhance quality-monitoring systems. In the main policies and procedures are in place to promote good practice. It is recommended that the home devise and implement policies and procedures for the management of continence and first aid to enhance systems already in place. The registered manager confirmed these are not currently available. Records required by regulation for the protection of residents are in good order and up to date. The only area where improvements must be made is in submission of notifications in line with Regulation 37 of the Care Home Regulations 2001. During the course of the inspection a number of records detailed incidents that required reporting to the Commission for Social Care Inspection (CSCI). Staff confirmed notifications had not been made. Improvements must be made in this area to ensure residents are protected by the homes recording systems. Health and safety is promoted within the home, random assessment of service certificates and risk assessments was carried out. These were found to be in order. Both requirements identified at the previous inspection have been met with unsecured carpet made safe and a radiator guard repaired. 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. When observing care practices the inspector saw one member of staff using an inappropriate moving and handling technique 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 27 when assisting a resident and another member of staff not using the appropriate personal protective equipment when preparing a meal in the kitchen. The senior on duty was made aware of these issues when given feedback on the inspection findings. It is recommended that moving and handling techniques and the use of personal protective equipment be discussed and reinforced to staff to ensure practices safeguard residents’ health and wellbeing. A health and safety audit has been undertaken by an external agent that identifies some areas for improvement. Evidence was found that the registered manager has made several requests for this to be actioned, however at the time of inspection several areas are outstanding. It is recommended that the organisation that owns this home supports the manager to address works required as detailed in the health and safety audit in order to promote the health and wellbeing of residents. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 X 3 3 3 3 2 3 X 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 29 Yes. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 13(4)(6) Requirement The home must make an adult protection referral for the named resident to ensure the homes practices safeguard residents. The home must investigate the situation of residents purchasing bedding and towels and ensure actions comply with contracts of residency. If contracts of residency state it is the homes responsibility to purchase these then the named residents must be reimbursed. If the contract states residents can purchase soft furnishings from their personal finances this must only occur after agreement has been sought within a multi disciplinary forum to ensure residents rights are protected and to ensure they are not placed at risk of abuse. The home must be able to demonstrate that staffing levels meet all service user needs. (Decreasing staff DS0000004770.V343797.R01.S.doc Timescale for action 08/09/07 2 YA23 13(4)(6) 03/10/07 3 YA33 18(1)(a) 01/11/07 38 Dagger Lane Version 5.2 Page 30 from 4 to 3 is a concern). 4 YA34 19 The home must be able to evidence that CRB disclosures have been verified by authorised persons before they are destroyed. Notifications in line with Regulation 37 of the Care Home Regulations 2001 must be made to ensure residents are protected by the homes recording systems. 01/11/07 5 YA41 37 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations That information relating to fees be expanded to give a break down of fees and information regarding nursing care contributions and that this be included in both the statement of purpose and service user guide in order that prospective residents and their representatives are fully informed. That the format used for reviewing the care needs of residents on a monthly basis be amended to ensure this reflects events, occurrences and changes that have taken place during the month, as currently the format in place does not do this. Improvements in this area would further enhance a person centred approach to care. That care plans be introduced for social stimulation and person centred plans be developed further as aids to communication and to ensure a holistic approach to care management takes place. That the home seek advice regarding residents who they think lack capacity to consent to ensure decisions made by others on behalf of residents comply with The Mental Capacity Act and promote good practice. That residents risk assessments be reviewed and completed based in individuals needs and capabilities to promote person centred approaches to care and risk DS0000004770.V343797.R01.S.doc Version 5.2 Page 31 2 YA6 3 YA6 4 YA7 5 YA9 38 Dagger Lane 6 7 YA14 YA18 8 YA22 9 YA23 10 11 12 13 YA24 YA30 YA30 YA30 14 YA31 15 16 YA32 YA39 17 18 YA39 YA40 management. That the home explores ways of increasing the amount and variety of external activities residents can participate in as per their expressed wishes. 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. That concerns/issues be included as a set item for discussion within staff meetings where staff can raise items on behalf of residents who are unable to do this independently, to further enhance systems already in place. That staff be reminded of the whistle blowing policy and its contents to offer further safeguards to residents as some did not appear to be aware of the contents of this during the inspection. That new garden furniture be purchased as that currently in place is damaged and worn. That a programme be implemented whereby carpets are routinely deep cleaned to promote good infection control standards. That a system for storage and sanitising of mops be introduced to ensure infection control standards are promoted further. That the home obtain the recently updated guidance ‘Infection Control Guidance in Care Homes’ again to ensure its systems for the management of infection protect residents. That the issue of some staff having conversations of a personal nature without the involvement or recognition of residents being present be raised in the next staff meeting to reinforce clarity of roles and responsibilities. That staff receive training and guidance in the principles of person centred planning and approaches to care to further enhance their knowledge. That the findings from the questionnaires be cross referenced to the annual development plan in order that the home can evidence action taken to involve residents and their representatives further in quality monitoring processes. That visits occur in line with regulation 26 of the Care Home Regulations 2001 to further enhance qualitymonitoring systems. That the home devises and implement policies and procedures for the management of continence and first aid to enhance systems already in place. DS0000004770.V343797.R01.S.doc Version 5.2 Page 32 38 Dagger Lane 19 YA42 20 YA42 That moving and handling techniques and the use of personal protective equipment be discussed and reinforced to staff to ensure practices safeguard residents health and wellbeing. That the organisation that owns this home supports the manager to address works required as detailed in the health and safety audit in order to promote the health and wellbeing of residents. 38 Dagger Lane DS0000004770.V343797.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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