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Inspection on 11/02/08 for 48 Burton Road

Also see our care home review for 48 Burton Road for more information

This inspection was carried out on 11th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 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

The staff team have developed close relationships with people who use the service and demonstrated a commitment to providing a good service, often under difficult and complex circumstances. The staff team are aware of thediverse needs of people and how to provide support and manage complex behaviour. Through training and experience the staff team have a balance of skills, knowledge and experience to meet the needs of people who use the service. All staff have received the same training to support people with complex needs, which has resulted in a consistent approach. Staff support people to develop living skills and individuals can participate in daily household tasks, including domestic duties and cooking. Staff give sensitive support where required to assist individual activities. The plans of care are based on the individual needs of people and have been developed in a format that support people who use the service to understand and contribute to the plan. Information includes specific preferences and how people want to be supported. People are able to choose how they plan their day and how they wish to dress. Staff give support to people to express their individual tastes and preferences. There are satisfactory medication systems in place and the staff have a good knowledge of medication and of drug usage. A monthly audit of all medicines is carried out.

What has improved since the last inspection?

The plans of care and assessments of risk have been reviewed and clearly records people`s assessed needs and support required. The plans include pictures and are in large print. People who use the service have been involved in the review. People have access to a wider variety of activities in the community and have been able to have meals out in the community, visit places of interest, and have day trips, including a trip to the coast. Medication systems have been reviewed to ensure that all medicines are recorded correctly and where people need `as required` medication there is a written explanation advising staff when this needs to be given.

What the care home could do better:

The staffing has increased to enable people to have greater access to activities and events. This does not reflect the support people require for each day of the week. On three days, the staffing has resulted in people having poor access to activities in the community. The staffing in the home needs to reflect the identified need of people according to their plan of care and agreed contract. The current staffing has resulted in adequate outcomes for people in relation to Personal Healthcare and Support, Lifestyle, Staffing and Conduct of management, and there were unmet requirements from the previous report. Therefore the home will be subject to a further Management review by us. A management review is a key part of the enforcement process whereby we set out what we will do to get the care provider to improve their service. The action we will take will depend upon what effect this is having on the people using the service and how the care service provider responds.

CARE HOME ADULTS 18-65 48 Burton Road, Branston Burton On Trent Staffordshire DE14 3DN Lead Inspector Mandy Brassington Key Unannounced Inspection 11th February 2008 09:45 48 Burton Road, DS0000004923.V359046.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 48 Burton Road, DS0000004923.V359046.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. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 48 Burton Road, Address Branston Burton On Trent Staffordshire DE14 3DN 01283 545370 01283 545370 48burtonroad@robinia.co.uk 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) Robinia Care Homes (2) Limited vacant post Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2007 Brief Description of the Service: The service is registered to provide 24-hour support and care for four younger adults with a learning disability and complex needs, and may have a diagnosis on the Autistic Spectrum Disorder. The home currently provides accommodation for three male individuals. The property is a period semi-detached house located in the residential area of Branston, on the outskirts of Burton-on-Trent. The home is conveniently situated close to a town, on a bus route and close to shops and amenities. The premises are set back from the main road and have tall metal gates leading to the gravel frontage and drive. The building is on three floors and comprises: four bedrooms, an office/sleep-in room, lounge, dining/activity room, bathroom and toilet facilities, laundry room and additional storage. One of the bedrooms has an en-suite shower and toilet facility. Parking space is adequate and to the rear of the house is a large grassed area and patio. People who use the service have access to some activities in the home and the community, though this can be limited due to staffing levels provided. The Service user Guide recorded that the annual fees for the home are from £96,816 to £135,172. The fee includes a contribution of £500 towards a cost of a holiday and an agreed number of additional one to one support hours 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was an unannounced key inspection and therefore covered all of the core standards. The inspection took place over 7.5 hours by one inspector who used the National Minimum Standards for Younger Adults as the basis for the inspection. A Key Inspection was carried out in July 2007. Prior to the first inspection the manager completed an Annual Quality Assurance Audit (AQAA) for the Commission for Social Care Inspection. Information within this document was reviewed. Due to the complex needs of some people living in the home, we were unable to communicate effectively with all individuals present during the visit. A tour of the home was undertaken. On the day of the inspection, the home was accommodating three people. The inspection included an examination of records, indirect observation, discussion and observation of three people who used the service, and four staff on duty. Three care plans and three staff records were examined and observation of daily events took place. Inspection of the storage system and medication procedures were inspected. Information relating to visits to the home on 15 August 2007 and 5 September 2007 is included within this report. This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means that people who use the service experience adequate quality outcomes. What the service does well: The staff team have developed close relationships with people who use the service and demonstrated a commitment to providing a good service, often under difficult and complex circumstances. The staff team are aware of the 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 6 diverse needs of people and how to provide support and manage complex behaviour. Through training and experience the staff team have a balance of skills, knowledge and experience to meet the needs of people who use the service. All staff have received the same training to support people with complex needs, which has resulted in a consistent approach. Staff support people to develop living skills and individuals can participate in daily household tasks, including domestic duties and cooking. Staff give sensitive support where required to assist individual activities. The plans of care are based on the individual needs of people and have been developed in a format that support people who use the service to understand and contribute to the plan. Information includes specific preferences and how people want to be supported. People are able to choose how they plan their day and how they wish to dress. Staff give support to people to express their individual tastes and preferences. There are satisfactory medication systems in place and the staff have a good knowledge of medication and of drug usage. A monthly audit of all medicines is carried out. What has improved since the last inspection? The plans of care and assessments of risk have been reviewed and clearly records people’s assessed needs and support required. The plans include pictures and are in large print. People who use the service have been involved in the review. People have access to a wider variety of activities in the community and have been able to have meals out in the community, visit places of interest, and have day trips, including a trip to the coast. Medication systems have been reviewed to ensure that all medicines are recorded correctly and where people need ‘as required’ medication there is a written explanation advising staff when this needs to be given. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a Statement of Purpose that is specific to the individual home and the resident group, and people are provided with terms and conditions and a contract. EVIDENCE: The people who used the service have been resident in the home for a number of years and there was one vacancy. Staff reported on the previous visit, that if a person were referred to the service, the manager would carry out an assessment to ensure the home could meet the needs of the individual. Each person had a Service User Guide that had been completed in large print with pictorial symbols, and detailed the fees payable and any additional support that had been agreed. Each person also had an agreement, which recorded how the service was to provide support to each person. One person had a number of two to one hours funded, and the manager reported that the registered person was liaising with the placing contract to determine the number of additional support hours agreed for one other person. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 10 The provision of additional support hours is addressed within the Outcomes for people in relation to Personal Support and lifestyle. The Statement of Purpose had been reviewed and included photographs of the home, rooms and facilities provided. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the individual’s life. EVIDENCE: We examined all three plans of care and found the plan had been specifically designed to support people with a learning disability and/or having needs on the Autistic Spectrum Disorder. The plans were in large print and used pictures to support completion. The plans were written in the first person. The Support Plan included information relating to the person, ‘this is me’. There was a photograph and personal details, information relating to the circle of support, this included staff friends and family. The plan had a large section 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 12 on ‘Things that are important to me’ and included likes and dislikes. Information recorded was very specific to people’s needs, examples of which included, ‘I don’t like to rush’, ‘I like to choose my own clothes’, ‘I only eat salad if it has dressing on it’. A typical ‘good’ and ‘bad’ day had been described to support staff to understand any behaviour. Assessments of risk had been completed for support in the home and the community. The assessments included the level of support from staff and a behaviour support programme had been developed that included comprehensive information regarding any identified behaviour, triggers, reactive and proactive management strategies and possible consequences. People who used the service had limited verbal communication, and also communicated using their own gestures and facial expressions, or through complex behaviour. Staff had supported the individuals to participate in the development of the plans and information. From observation and discussion with staff it was evident that people who used the service were supported to make decisions about their daily routine. During the day, people were observed being able to choose how to spend their time in the home. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community, though staffing in the home and support required means some days this is limited. EVIDENCE: Following the previous visit to the home, staffing has been reviewed to enable people to have access to more opportunities to participate in activities in the community. We examined records and spoke to staff, and found that during the previous weeks, people have been to an Outdoor adventure site, to Wales for the day, swimming, shopping, bowling, local walks, a visit to Lichfield Cathedral and a picnic. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 14 Assessments of risk for two people recorded that for some activities two to one support in the community is required. The staffing had been reviewed but did not reflect the identified support needs within the contract, or with the assessment of risk. This has meant when three staff were on duty, people who used the service had limited opportunities to participate in meaningful community activities; some days people had only been able to have a drive in the car or remain in the home. This is further addressed within the outcomes for Personal and Health Care Support and Staffing. Staff reported that activities are flexible due to the complex needs of people who used the service; people’s behaviour may have an impact on which activity is safe to carry out. On the day of the inspection two people went out to complete shopping on an individual basis. The home had a seven-seated car and assessments of risk have been completed for car journeys. Discussion with staff reported that they feel this has been suitably assessed to ensure people are not placed at risk. Staff reported that people who use the service participate in food shopping. One person had a support plan to plan and goes shopping, chooses ingredients and cooks a meal each week. Meals are chosen according to preference and people chose the food based around the foods that have been purchased. A record of meals served was maintained to evidence a balanced diet. Staff reported one person purchased food relating to his cultural preferences. People are able to maintain and develop relationships with family and friends, and people are able to visit on a flexible basis. One individual was supported to have visits to the family home. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person has appropriate health care treatment and intervention according to their needs. Staffing in the home may have an impact on the delivery of appropriate personal care in line with assessed needs. EVIDENCE: During the previous visit, we identified that the staffing provided had an impact on the delivery of care. Assessments of risk recorded that two individuals need two to one support in the community and one person requires one to one support; all people require one to one support in the home. The Service provider had agreed to review the staffing according to people’s needs and agreed contracts. We inspected the plans of care and assessments of risk, daily records and activities, and discussed these with staff. This showed us that the staffing had 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 16 been increased, but did not reflect the identified support needs of people who used the service. One person had an agreed contract with the placing authority to receive two to one support for twenty-five hours per week. We looked at daily records and activity sheets and found over a four week period the person had only received between four and sixteen hours each week. One person had a plan of care and assessment of risk that identified that two people were to give personal support when in the community. The manager reported that the agreement with the placing authority did not identify additional support, and therefore this was not included within the staffing provided in the home. Where it is has been identified that people require this support, it must be provided to ensure the person’s welfare and safety. The staffing did not reflect the agreed contract or support required in the plans of care. It is a concern to the Commission that the review of staffing had continued to have an impact of the level of service and care provision. People had a Health Action Plan that recorded health needs and a record was maintained of health visits and any outcomes. People who used the service also had access to support from an external Psychology agency. The home operated the Boots Monitored Dosage System (MDS). The staff stated that there were no controlled drugs in use. The home had reviewed the medication system and procedures to a good standard. Observation of administration practices was satisfactory and staff were aware of the usage of the medication administered. Medication records contained required entries, and were signed by a staff. Where people require ‘as required’ (p.r.n.) medication, a protocol for usage is available. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand and is supplied to everyone living at the home. The staff understand the procedures for safeguarding adults and able to take appropriate action to an alert. EVIDENCE: The home has a complaints procedure that is clearly written and easy to understand using a suitable system of pictures. The complaints procedure was displayed around the home and staff reported that a copy is available to all people with a photograph of the responsible person. The policies and procedures for safeguarding adults are available in the home and staff received training during their induction. Staff records demonstrated that people are able to keep updated with their knowledge and attend regular training for Safeguarding adults and awareness of abuse. All staff have received training around dealing with physical and verbal aggression, and staff were confident that they were able to de-escalate behaviour exhibited in the home. The home has an assessment of risk for lone working, and discussion with staff revealed that where possible, no one person 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 18 is left alone in the home as assessments and guidance report that two people may be required to manage any complex behaviour. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is appropriate to the specific needs of the people who live there. It is a pleasant, safe place to live, and the bedrooms and communal rooms have been decorated and personalised to reflect the interest of individuals. EVIDENCE: The home has been decorated to a good standard with modern pictures and fittings. Some furniture has been provided to house electrical appliances, and can be locked due to the risk of items being damaged or used to harm others. The furniture was of a suitable design and not institutional. The home was generally well maintained. Due to the complex needs of individuals there was a continuous programme of refurbishment and renewal 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 20 due to damage. Staff reported that when property is damaged the service provider responds promptly to replace equipment. Individuals had a single room, one of which is en-suite. Individuals were able to personalise their bedrooms according to their interests. The manager reported that due to the complex needs of one person; the en-suite room is to be redesigned. The home is also to be redecorated during spring when all people who use the service have booked to go on holiday. One bedroom was vacant and used for staff to sleep-in. There is a separate laundry room on the first floor with professional equipment with sluicing facility. The previous visit identified that during parts of the washing cycle, the vibrations cause the home to significantly shake, the manager reported this will be addressed when the home is vacant. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 21 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, 34, 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service recognises the importance of training and staff are clear regarding their role and what is expected of them. The home does not always provide a sufficient compliment of staff to meet the health and welfare of people using the service. EVIDENCE: On the day of the inspection, the manager was working in a supernumerary capacity. Support staff on duty consisted of:1 Team Leader working 8.00am – 8.00pm 2 Support workers from 7.30am – 3.00pm 1 Support worker from 9.30am – 5.00pm In the afternoon there was:1 Team Leader working from 2.30pm – 10.00pm 1Support worker from 3.00pm – 10.00pm 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 22 At night 1 Support Worker worked from 9.45pm – 7.45am, and one member of staff completed a sleep in shift. The manager stated this was the usual shift pattern for four days in the week. One day in the week and at weekends there were only three staff on duty on each shift, the additional fourth person working across the shifts was not available. The staffing compliment in the home had been reviewed, but did not reflect the identified needs of people who used the service or agreed contracts with the placing Authority. One person who used the service was awaiting a review of the agreed contract. The plan of care stated that two to one support was required in the community; this was not reflected in the staffing. On three days a week, there were only three staff on duty. Inspection of records and discussion with staff revealed that this has meant that people who used the service did not have opportunities to be involved in meaningful activities in line with their plan of care. It is required that the registered person demonstrates how the home is able to support individuals and is providing additional support hours as agreed within the contract. Staff reported that the service provider supported staff development and there were opportunities to attended training for Health and Safety, Moving and Handling, Safe administration of Medication, Managing Complex Behaviour, Safe guarding Adults, Emergency First Aid and Autism. We examined three staff records, which demonstrated the organisation has robust recruitment practices. All records included a photograph, an application form, two written references, a Protection of Vulnerable Adults check (PoVA First) and details of a Criminal Records Bureau Check (CRB). Staff completed a new CRB every three years, which is good practice and demonstrates the service provider is continuing to review the staff who work in the home, to ensure people are not placed at risk. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 23 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, 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager understands person centred planning and thinking but this cannot always be implemented due to staffing arrangements and resources in the home. EVIDENCE: The manager reported that she is awaiting verification of NVQ 4 and will upon completion, start the registered Managers Award. The manager has completed a Criminal Records Bureau Check with us and must submit an application to begin the Fit Person Process. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 24 It is evident from observation and discussion with staff, that the manager is extremely enthusiastic and committed to promoting people’s rights and providing a quality service. The manager understands the importance of person centred care and effective outcomes for people who use the service. Staff commented they feel valued and part of a supportive team and would have no hesitation approaching the manager. Since the last visit, the manager has reviewed the care planning and documents in the home and along with the team of staff raised the standards for planning care. The service provider needs to ensure staffing is provided in order that plans can be followed and outcomes for people are good. People are supported to manage their own money where possible. Individuals have a bank account and access to funds. A record of personal monies was maintained in the home. Prior to the previous visit the manager completed an Annual Quality Assurance Audit. A sample of records including Fire records were sampled from the data section of the AQAA, and found to be accurately and fully completed. Following the previous visit to the home, the service provider completed an Improvement plan in response to requirements from the visit. The response to review staffing has resulted in adequate outcomes for people in relation to Personal Healthcare and Support, Lifestyle, Staffing and Conduct of management, and there were unmet requirements from the previous report. Therefore the home will be subject to a further Management review by us. A management review is a key part of the enforcement process whereby we set out what we will do to get the care provider to improve their service. The action we will take will depend upon what effect this is having on the people using the service and how the care service provider responds. 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 25 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 X 4 X 5 3 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 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X 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 2 13 2 14 2 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 3 X X 2 X 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA14 Regulation 16 (2)(m)(n) Requirement In consultation with people who use the service, to provide suitable activities for people to engage in social and recreational and educational activities each day, in line with their assessed needs and agreed contract. Appropriate levels of staff must be provided in the home in line with the home’s own protocol, and assessments of risk and plans of care to ensure individuals are not placed at risk. Previous timescale on visit 26/07/07 not met. Timescale for action 11/03/08 2. YA19 18(1) 11/02/08 3 YA33 18 (1) Staffing provided in the home 11/02/08 must be sufficient to meet people’s needs and ensure people are safe. A review of the staffing provided is to be carried out to demonstrate how this is achieved. Previous timescale on visit 02/02/07, 22/08/07, 26/07/07 not met. The manager must submit an DS0000004923.V359046.R01.S.doc 4 YA37 8(1) 11/03/08 Page 27 48 Burton Road, Version 5.2 application to begin the Fit person process following satisfactory CRB Clearance. Previous timescale on visit 26/07/07 not met. 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 YA24 Good Practice Recommendations The washing machine needs to be suitably placed to ensure minimum disruption to others from vibration and noise 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 28 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 48 Burton Road, DS0000004923.V359046.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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