Inspection on 10/09/07 for 52 Russell Terrace

This inspection was carried out on 10th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

52 Russell Terrace 31/07/06

52 Russell Terrace 25/10/05

52 Russell Terrace 07/06/05

52 Russell Terrace 15/02/05

52 Russell Terrace 10/08/04

52 Russell Terrace 19/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 52 Russell Terrace 52 Russell Terrace Leamington Spa Warwickshire CV31 1HE Lead Inspector Martin Brown Key Unannounced Inspection 10th September 2007 10:00 52 Russell Terrace DS0000058003.V345687.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 52 Russell Terrace DS0000058003.V345687.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. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 52 Russell Terrace Address 52 Russell Terrace Leamington Spa Warwickshire CV31 1HE 01926 431471 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) www.turning-point.co.uk Turning Point Miss Tracey Bates Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (4) of places 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range of Service Users. People admitted to the home must be in the age range of 18 to 64 years. 31st July 2006 Date of last inspection Brief Description of the Service: The home is registered for six adults with learning disabilities. It offers a service to people with complex needs and communication difficulties. At present, there are four older people with learning disabilities and some agerelated difficulties, and two residents with profound learning disabilities and high communication needs. Turning Point operates the home; it is a national organisation that provides services to primarily to people with drug and alcohol problems, but also with learning disabilities. The home is a converted Georgian house, which has been extended to provide additional kitchen and bedroom space. Accommodation is on two floors. There is a bathroom on each and a separate WC on the mezzanine level. The ground floor has been adapted to provide level access to, and within, the home for wheelchair users. There are two bedrooms on the ground floor in addition to the lounge and dining/ kitchen area. There is a laundry/conservatory area at the rear of the house. There is a large flat garden that includes a swing, suitable furniture and a sensory area. The manager advised that the current fee is £1,110 per person per week. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 10th September, between 10am and 4.20 pm. All service users were seen over the course of the inspection, as were staff on both the morning and afternoon shifts, as well as the manager, who was working on shift that day. A tour of the premises was made, relevant documentation was looked at, and observations of the interactions between residents, staff and their environment were made. Policies, procedures and care records were examined, and two service users were ‘case tracked’, that is, their experience of the service provided by the home was looked at in detail. Specific elements of two other service users’ care were also looked at in detail. The recently introduced Annual Quality Assurance Assessment was filled in and returned by the management to further inform the inspection, as was accumulated evidence from Regulation 37 notices. The handling of an allegation and a complaint that had arisen since the last inspection was discussed with the manager. Two relatives of residents were contacted following the inspection, to give their views on the service. Despite a variety of communication difficulties, service users were able, where they so wished, to express views, either verbally or non-verbally, to varying degrees. Staff and management were helpful throughout. What the service does well: The home continues to be a well run, well maintained, and above all, friendly home, where the needs of a diverse but small group of people are met in individual ways. In spite of, or perhaps because of, the marked contrast in both age and abilities of the people living in the home, residents are all friendly, tolerant and well disposed towards each others’ particular needs and preferences. Staff continue to show a good knowledge of what the residents want and need and to support them in an easy-going, but respectful manner. Photo albums of recent activities and achievements give an excellent and positive record of what individuals have done. These give pleasure to residents and reassurance to relatives, as well as enabling the home to show what has been achieved. Photos of holidays and other activities showed residents engaging in a wide variety of activities and enjoying themselves. The home and garden is spacious, allowing people with different needs and interests the freedom and space to do as they wished within the home. This was noticeable particularly in bedrooms and in the garden. Residents able to 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 6 clearly understand and answer the question all responded ‘yes’ when asked if they liked living at Russell Terrace. What has improved since the last inspection? 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. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 7 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 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has the mechanisms in place to ensure that it can assess the needs and aspirations of potential residents, with a view to ensuring it can meet them. EVIDENCE: There have been no new admissions to the home for over two years. The standards in this outcome group were satisfactory when previously assessed. Evidence of satisfactory initial assessments of current residents are still in place in individual files. The Annual Quality Assurance Assessment returned by the service details a comprehensive assessment and admission process. A copy of the Service User Guide was seen, which is set out in a clear, straightforward format, with simple text and plenty of photographs. The manager advised it was to be updated. Current fees were not detailed in it. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 9 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. Residents benefit from detailed guidelines and knowledgeable staff to support them in making decisions and take risks. Written risk assessments may be of limited benefit if they are seen by staff as burdensome and unnecessarily duplicating existing information. Photograph books records give an excellent record of individual activities and achievements. Individual choice may sometimes be limited by limitations of staffing and by the environment. EVIDENCE: Care plans continue to give a thorough good reflection of assessed needs, detailing how they are met, with regular evaluation and details of actions and professional contacts in respect of meeting needs. Care plans are kept in the office, and care guidelines are kept in individual bedrooms. The care guidelines provide clear guidance on all aspects of individual needs and how they are met, in straightforward text, and well-illustrated with photographs. These guidelines are supplemented by risk assessments, which often duplicate the same information, but in a way that is not user friendly. The inclusion of these risk assessments in the same folders at least doubles its weight, making it a rather unwieldly item. Several staff commented on the repetitious nature of 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 10 them. Staff also expressed concern at the additional burden of having to evaluate such assessments weekly where the likelihood of change was minimal, and thought that monthly evaluation would be sufficient. One set of guidelines and risk assessments, on the use of a service user’s CD player, ran to eight pages, excluding photographs. By contrast, there were two other very distinctive risks, concerning particular behaviours which, although staff and management were able to knowledgably discuss the nature and management of them, did not appear to have the same level of detail. Individual ‘life histories’, in the form of briefly worded photo albums over specific periods, gave an excellent flavour of the high spots of the lives of individual residents. One resident was keen to show me her most recent albums, covering holidays, outings, and pictures of herself, friends, and staff at events in the past year. Staff advised that relatives of two residents got great pleasure and reassurance from seeing photos of enjoyable events that the individual residents could not otherwise easily communicate. Residents were seen being offered choices in day-to-day decisions, as with food at mealtimes, and in going out. This is limited to some extent by staff availability to support one-to-one activities. On the day of the inspection, two staff supported three residents to go out to the shops, an activity which they all enjoyed, as demonstrated by their lively demeanours on their return. “I enjoyed myself!” was one resident’s comment. This left one staff with the other three residents. Residents had free access to all communal areas, including the garden. Various residents spent time in the garden. Others preferred the lounge, or individual bedrooms. Two older residents, now unable to safely manage the stairs unaccompanied, can only go to their rooms with staff accompaniment. I was advised that one rarely wishes to send time in her room; this was confirmed by observation, while the other sometimes has a rest in her room in the afternoon. The two younger residents both spent time in their rooms, relaxing to music. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Residents continue to be supported in a variety of individual activities that they enjoy and look forward to, although staffing resources may limit one-to–one activities at times. An improvement in communication with relatives is noted, although there may still be room for further improvement. Residents continue to enjoy a healthy diet in convivial surroundings. EVIDENCE: Individual residents’ photo albums of activities over the past year showed a wide variety of activities being enjoyed. One resident happily showed off pictures of an enjoyable day at a friend’s birthday celebration, as well as a recent holiday and other activities. Three residents enjoyed a few hours out shopping, and one was supported with a regular walk outside the building. Each resident has an illustrated timetable on their bedroom wall, indicating what activities are planned, so that each person has a variety of activities that they enjoy and find beneficial throughout the week. The home is situated within reasonable distance of the town and its amenities, including the local park, and the service has a car for trips out and for those 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 12 residents who require transport. The manager advised that the service continues to support residents in contact with relatives and friends, arranging and supporting visits where agreed. This was evident in photographs, care records, and in comments by individual residents and staff. One relative, although agreeing that ‘things had improved’, commented that ‘communication is not their (the service) strong point’, and that sometimes relatives had not been informed of incidents. It was agreed that protocols involving key workers making regular contacts had now improved this. One relative noted a visit where she had introduced herself, but where the staff had not, merely letting her in without letting her know who they were. One relative’s view of the service was that it was ‘satisfactory’ rather than ‘good’. The home has a cat. One resident informed me that the cat was ‘not well’. It was due to go the vet. One resident enjoys dogs. This is catered for, I was told, by one member of staff regularly visiting with her dogs, which the resident enjoys fussing for a while. Several residents had recently enjoyed a holiday abroad. Comments from staff, and photographs seen, showed that they had enjoyed it. Menus showed a variety of healthy food being available. Lunch was taken with residents. Lunchtime was split, as some residents were out and returned later in the afternoon. Some residents require prompting in eating in a manner that will not cause them discomfort; this was given throughout. Pictures were in evidence to support choices. Residents were seen to be offered visible choices, such as different sandwiches, crisps yoghurts being offered to them, and the differences clarified as needed. The Speech and Language team has been involved in supporting individuals in eating. Evidence of their guidance was in the form of picture guidance and special cutlery where relevant. Residents were tolerant of each others’ needs, with one person being noisy, but other residents taking no apparent heed. Staff advised that there were no special diets, other than encouraging healthy eating. The kitchen continues to be wellstocked with a variety of foods. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. Residents continue to receive support in ways that enhance their well-being, independence, and quality of life. The age-related needs of residents would be better served if the stairs were supplemented by a lift. Residents benefit from a good, well organised and clear system for dispensing and recording medication. EVIDENCE: The service continues to provide care for six people with widely varying support needs. Although all residents have learning disabilities, four people also have age-related difficulties, while two much younger residents have profound communication difficulties. Involvement of suitable outside professionals was evidenced in records, plans, and in discussion with staff. Each resident has a ‘key workers’ who takes responsibility in arranging appointments and has the lead role in generally seeing the effective maintenance and development of an individual’s wellbeing. One resident had been to the doctor’s that morning for a check up. One resident shows a mildly challenging and potentially hazardous behaviour. Advice has been sought from outside professionals. At present, no solution for the behaviour has been found, but discussion, observation showed staff 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 14 managing it in a calm and non-judgemental way. There had been concern expressed by a relative that a resident showing challenging behaviour in the past year had been regarded by staff as ‘badly behaved’, but was glad to say that this no longer appeared to be the case. There has been a number of falls recorded in the past year. This has fallen in recent months, with the introduction of protocols and guidelines for the care and support of the most vulnerable residents. Staff advised that one resident who appeared more at ease and involved with her surroundings during the last inspection following the introduction of a specific medication, had become less communicative and responsive since that medication had been withdrawn. Staff advised that they were hoping to get the medication used once more. The person concerned was observed to give very little eye contact, in contrast to that observed at the previous inspection. Staff advised that ‘object recognition’ communication had being used previously, with outside specialist support, but that this was not working at present, after some initial success. It was hoped that this would be revived, once current difficulties were resolved. Medication recording continues to be satisfactory, with no errors noted, other than one reported to Commission for Social Care Inspection two months previously, which had been immediately realised and for which prompt action had been taken. The majority of medication is dispensed from pre-packaged ‘blister’ packs, the rest is stock controlled in a separate book to ensure accuracy is maintained. Individual medication sheets are preceded by a photo of the resident concerned and clear brief details of the medication. Staff advised that individual residents have no specific known allergies. This was not clearly stated on the relevant section of the Medication Administration Record Sheets. Medication records are stored on top of the medication cupboard. One staff commented that she needed to stand on a chair to get these down. there is a radiator below the cupboard. It was not clear if this affected the temperature of the medication, some of which advises temperatures of below 25C. ‘As required’ medication was clearly documented, with a clear protocol. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 15 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. There continues to be an open, friendly atmosphere evident throughout the home. This, combined with a clear lead from management in the form of policies and their implementation gave a confidence that residents’ views are listened to and acted upon, that their best interests are protected, and that they are not denigrated in any way because of particular behaviours. EVIDENCE: There have been two complaints and allegations since the last inspection, which were investigated by the service and upheld, with disciplinary action resulting. The results of investigations into two complaints and allegations in the past year had given rise to concerns about the ethos in the home and of staff awareness of abuse. Staff have all received training in these areas. Staff were observed reacting to potentially challenging issues in a calm and nonjudgemental manner. Staff spoken with concerning whistleblowing, adult protection and abuse issues all showed a good knowledge of policies and procedures. I was advised that there is now an ‘online’ facility for staff to report any issues of concern. Resident and staff interaction observed during the inspection demonstrated an atmosphere of respect, where views were heeded and choices supported. Residents continue to be tolerant of each others’ differing needs and wishes. A relative had expressed concern that a resident’s behaviour had been referred to as ‘naughty’ by staff previously, but felt reassured that this was no longer the case. Residents’ personal monies are looked after and all expenditure recorded by staff. These are checked at the end of every shift, and are subject to random 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 16 checks during regular visits by the provider, as well as peer group inspections, on an approximately annual basis. Most residents have relatives who are able to voice any concerns, and who have done so previously. One does not. The manager advised that she hopes to involve an advocacy service where relevant. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 17 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, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Internally, the home is furnished and decorated in a manner that enhances the residents’ well-being, but this not does address the major short coming that four residents have upstairs bedrooms, when at least two of them need supervision to ensure that they manage the stairs safely. This puts the long–term future of at least some of the residents remaining at the home in doubt. The home remains clean and hygienic. EVIDENCE: The home continues to be homely and comfortable. The lounge in particular is well furnished, and tastefully decorated, including works of art the residents helped to create. Bedrooms are personalised and well-furnished, and two residents in particular were seen to enjoy time spent in them, enjoying music and being comfortable in their individual chairs. One resident was pleased to show me a number of possessions that meant a lot to her. Rooms had plenty of photos and pictures, again, all with particular meanings and relevance to individuals. The roof has been replaced, following problems with leaks. The manager pointed out that the front of the house had not been repainted, although this 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 18 was needed. The front of the house has flaking paintwork and ingrained dirt and grime in places. One window frame is rotting at the bottom. The gate at the side of the house has been replaced. The paint on the conservatory window frames continues to flake, putting these at risk of rotting. The garden is a large, even, safe area, with a variety of chairs and tables, and a swing. The garden was used independently by several residents during the inspection. The house was clean and hygienic throughout. The laundry is still situated in the conservatory area. There is one easy chair in here, and this is still a popular place for residents, with this chair being occupied by three different residents at different times. The home has suitable adaptations in toilets and bathrooms to meet specific needs. The home has two downstairs bedrooms and four upstairs bedrooms. The manager advised that putting in a lift has been considered but rejected as too costly/not feasible. Although physically able still to use the stairs, two residents need escorting guidance to do this safely. There have been a number of recorded falls in the home in the past year, none of them involving the stairs. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the attentions of properly recruited staff who are familiar with them and their needs and with whom they are comfortable. More staff at key periods may assist particular residents in specific activities. EVIDENCE: The rota for the service showed a minimum of three staff on per day shift. The manager advised that the service now had eight full-time day staff, and two night staff. With the addition of some more permanent staff, the service is able to reduce the reliance on agency staff. None were noted on the current rota. Some staff were however working extra hours, particularly in the current week, owing to holidays, sickness, and training. This was not the case for other weeks, where overtime appeared less apparent. Guidance on the rota gave limits to the number of ‘long’ (ie double) shifts. During the inspection, two staff accompanied three residents on a trip out, leaving one staff with the remaining residents. There is a ‘lone working’ policy, and staff were able to explain procedures in the event of an emergency. Staff advised that three staff to six residents did limit, at times, opportunities for residents, particularly for those with higher needs, who could arguably benefit from more individual supervision and activities. Staff interaction with residents was seen to be warm and friendly, and residents were at ease with staff. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 20 There are photographs of all the staff, on the wall, and pictures show which staff are on duty that day and the next. The files of the most recently recruited staff were examined. These demonstrated that proper recruiting procedures took place, with satisfactory Criminal Records Bureau references being obtained, and staff undertaking appropriate induction and having supervision at regular intervals. Staff files looked at evidenced ongoing training in relevant areas. Staff spoken with were able to knowledgeably discuss fire safety, infection control, abuse training, and whistle-blowing. The Annual Quality Assurance Assessment returned by the service showed that over half the staff had either achieved or were undertaking National Vocational Qualification level 2. The majority of staff have almost completed a distance learning course in dementia awareness. The manager advised that she had so far been unsuccessful in obtaining Falls Prevention training for staff, citing the reason as the agencies providing this training not seeing this service as a priority, or not being in the right geographical area. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 21 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, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-run home, with mechanisms in place to ascertain their views and to act upon them. Residents’ health and safety is promoted within the home, although this is still compromised by the need for stairs to be used by four of the residents. EVIDENCE: The manager advised that she now had responsibility purely for the home, as opposed to previously, when she was taking on other responsibilities within the organisation. She advised that she felt happier with this, and was able to concentrate on maintaining and improving the service provided by 52 Russell Terrace. The manager was rostered on a number of shifts. She advised that she still had supernumerary shifts, but felt that day-to-day requirements of residents sometimes conflicted with organisational management demands, and that the direct needs of residents would always come first. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 22 The Annual Quality Assurance Assessment returned by the service detailed appropriate checks and measures for maintaining key areas of safety in the home, such as fire safety, electrical, gas and water checks. No hazards were noted in the home, other than the risks implicit in the use of stairs by some residents and the number of falls noted, which are being managed as previously noted in the report. Noise activated fire safety closures are now on all fire doors that did previously have a closure device. The fire system has just been replaced, following water damage to the previous one. The manager advised that this now works well, after initially being too sensitive, and giving false alarms several times. Regular and thorough Regulation 26 visits take place, records of which highlight the strengths of the service, as well as areas in which it needs to improve. Residents’ meetings and relative forums take place, but staff advised that feedback from both residents and relatives often takes place directly, on an individual basis. Records of residents’ meetings were looked at. In some cases, residents are able to raise issues and discuss matters such as what activities they would like to take part in, in other cases, the home provides activities, and gauges how particular residents, who find it difficult to communicate their wishes, enjoy them. The manager agreed that advocacy support may benefit some residents, and is actively seeking this. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 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 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA9 Good Practice Recommendations Risk assessments should be reviewed, to ensure that they are proportionate, service user focused, and are not the cause of unnecessary duplication, so that they can be seen as a direct aid to individual well-being, rather than as a bureaucratic burden. Staff should always, as a courtesy, let visiting or enquiring relatives or significant others know who they are, in case of future query. The service should ensure that medication is not stored above the recommended temperature, so that residents’ well-being is not compromised. It is advisable that, if a resident has no known allergies, then this is clearly stated on the relevant section of the Medication Administration Record Sheet, to help ensure clarity in respect of individual residents’ welfare. The use of advocates would help guarantee the well-being and best interests of residents, particularly those who have no significant others and/or are unable to readily articulate DS0000058003.V345687.R01.S.doc Version 5.2 Page 25 2. 3. 4. YA15 YA20 YA20 5. YA23 52 Russell Terrace 6. YA24 7. YA29 8. 9. YA33 YA35 their wishes. Repainting the front of the house, and the conservatory, and making good the front window frame that is rotting, would enhance the well being of the residents, as well being likely to save the service money in the long term. The service should continue to seek long term solution to ensure the well-being of all residents, by having an alternative to using the stairs for residents, or by seeking alternative accommodation. The well-being of residents is best served if staff only work beyond their contracted hours in rare circumstances. Falls prevention training is recommended for all staff. 52 Russell Terrace DS0000058003.V345687.R01.S.doc Version 5.2 Page 26 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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