CARE HOME ADULTS 18-65
60 Raddlebarn Road Selly Oak Birmingham West Midlands B29 6HA Lead Inspector
Lesley Webb Key Unannounced Inspection 31st July 2007 08:50 60 Raddlebarn Road DS0000054310.V341570.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 60 Raddlebarn Road DS0000054310.V341570.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. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 60 Raddlebarn Road Address Selly Oak Birmingham West Midlands B29 6HA 0121 472 3896 0121 472 3896 patrichardson@bvt.org.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) Bournville Village Trust Mrs Patricia Susan Richardson Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That Ms Richardson has at least 21 hours per week in a supernumery capacity, that is designated management time, not one of the roistered staff providing hands on care. 23rd August 2006 Date of last inspection Brief Description of the Service: This home was formerly part of a core and cluster registration, but the owners applied to split the registration, and now 60 Raddlebarn Road has its own registered manager and staff team. At 60 Raddlebarn Road there are four places for people who have learning/sensory disabilities and who may also display behaviour, which challenges current service provision. The home has four single bedrooms, and a large staff office/sleep in room. The ground floor has a large kitchen/dining room, and a separate lounge. To the rear of the home is a large garden. The home is situated close to shops and local amenities. Visitors to the home can request to see a copy of CSCI reports from staff as reports are located in the home’s office. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector undertook this visit over one day with the home being given no prior notice. During the visit time was spent talking to staff and examining records before giving feedback about the inspection to the registered manager. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking two individuals care provided at the home. For example the people chosen have differing communication and care needs. The home is registered to provide long term care for people by the reason of learning and sensory disability. Discussions with people living at the home were not appropriate. Therefore observation of behaviours and care practices was undertaken in addition to formally interviewing staff in order to form judgements on service provision. No residents’ surveys were completed and returned to the Commission for Social Care Inspection (CSCI). The manager explained that no one living at the home is able to understand the questions contained within this document. 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. Fees charged for people living at the home ranges from £1,000 to £2,177.88. These cover all aspects of service provided apart from toiletries, hairdressing and any personal affects such as clothing. The inspector was shown full assistance during the visit and would like to thank everyone for making her welcome. What the service does well:
Staff have excellent knowledge and understanding of involving people with communication needs in decision-making processes. For example person explained, “its weird they cant speak, but you don’t notice after working here for so long because they communicate in other ways, some will clap and this means they want a cup of tea or coffee, another will open the cupboard so lets us know he wants a drink or something to eat, if don’t like food will spit it out, another person may be more vocal and the sounds he make differ to mean different things and that’s his way of communication, we still talk to residents even though not expecting a verbal answer back, its our responsibility to look at other forms of communication such as expressions, sounds and body language”.
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 6 The home provides a good range of activities that meet residents’ needs. For example residents were observed leaving the home to attend differing day care centres and staff informed the inspector of activities that residents have undertaken such as personal shopping, preparing packed lunches, visiting a public house, aromatherapy and walks in the local community. Records and discussions with staff also confirm that arrangements have been made for all residents to go on individual holidays later this year to Minehead, Stratford Upon Avon and Centre Parks. The health and personal care that residents receive is based on their individual needs. Residents were seen to be well dressed and their clothes were appropriate to their age, gender, culture, the weather and the activities that they were doing. Records and discussions with staff confirm that people have access to health care professionals such as opticians, chiropodists, general practitioners and district nurses. All staff demonstrated excellent understanding of supporting people to raise concerns. For example one person explained, “Each have own traits, can be quiet vocal if unhappy. I try and spend time with clients, reassuring them, then note in care plan, try and find out why unhappy through observation and make sure other staff are aware, we all have a responsibility to find out what may be wrong”. Also staff demonstrated excellent knowledge and understanding of their roles and responsibilities relating to protection. For example one person explained, “everyone has to be vigilant, record anything out of the ordinary, one resident scratches himself so we record this, when we see any changes in a person we monitor, we are good at this, look at how other staff are with residents. I would report even if not sure, only way to be sure would be to investigate, everyone here understands that, we are all aware, we know consequences and it’s the right thing to do”. Residents live in a safe, well-maintained and comfortable environment, which encourages independence. Bedrooms are freshly decorated and furnished to a good standard. They are individualised with personal possessions, sensory items, photographs, televisions and stereo equipment. The communal areas are bright and airy with comfortable and homely furnishings. As in previous inspections staff at 60 Raddlebarn Road present as interested in their jobs, motivated and committed to the welfare of the people living there. Staffs spoken to were aware of residents’ individual needs and had a grasp of knowledge of disabilities and conditions of individuals in general. Throughout the inspection the registered manager demonstrated knowledge, competency and commitment to her role for which she should be congratulated. Feedback received from staff was extremely positive regarding the management of the Home. For example one member of staff stated, “the home is run quiet well, I personally know the manager is there if I need advice, if have any problems can see her. Its come on in leaps and bounds
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 7 over the years” and another “the manager is very supportive, really nice. She helps you when you really need it and easy to talk to”. What has improved since the last inspection? What they could do better:
Improvements must be undertaken to ensure risk assessments as completed for all identified needs as identified in residents care plans. Improvements in this area will ensure the needs are appropriately managed by the home. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 8 Also improvements in the recording of information relating to the dietary needs, actions required by staff and monitoring of progress for a named resident must take place to ensure this persons needs are met in full. The home must investigate the instances when a named resident has purchased items of furniture from their personal finances and reimburse if not compliant with the contents of the contract of residency. If the contract states residents can purchase items of furniture 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. 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. 60 Raddlebarn Road DS0000054310.V341570.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 60 Raddlebarn Road DS0000054310.V341570.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 people considering this service and their representatives have the information needed to decide if it will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: Information supplied by the home prior to the inspection states that ‘we have clear guidelines detailing the procedure for assessing a prospective resident and for introducing them to the home. This includes consultation with the prospective resident, their family, carers, health professionals and any other relevant people. We undertake our own comprehensive assessment, regardless of any other assessments available through other care providers. This includes considering the needs of existing residents’. Examination of records and discussions with the manager and staff confirm this information to be accurate. For example the records of the newest person to move to the home contained a pre-admissions assessment that contained all required information as detailed in the National Minimum Standards for Younger Adults, evidence of trial visits to the home and meetings with next of kin in order that their views and opinions could be gained. The homes admissions policies 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 11 ensure prospective new residents would receive sufficient information on which to base decisions on the homes suitability. 60 Raddlebarn Road DS0000054310.V341570.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. Attempts are made to support residents to make decisions about their lives. Care planning systems are being improved to ensure all staff are provided with all the information they need to satisfactorily meet residents needs within a risk assessment framework. EVIDENCE: Work is progressing to address previous requirements relating to care plans. For example goals and aspirations have now been included in plans for the newest resident to move to the home, with the manager confirming this information is continuing to be included in plans for all other people living at the home. It is recommended that care plans continue to be developed in order that residents’ needs and wishes are acknowledge and acted upon. All files sampled contained care plans for identified needs specific to individuals such as mobility, personal care, communication, health and behaviour. Staff also complete daily records that give brief overviews of residents wellbeing
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 13 each shift and link worker records that review specific areas as detailed in care plans. It is recommended that where an identified action is recorded in care plans or monthly review records a record is maintained of when this action has been achieved to ensure effective monitoring is undertaken and to evidence further that the needs of residents are met. All of the people who live at this home have specific communication needs that impact on them being actively involved in the implementation and reviewing of their care needs. At previous inspections the home as been instructed to explore ways of compensating for these restrictions. The manager explained that the organisation that owns the home is looking to purchase the ‘Picture Bank’ communication tool in order that information can be provided in more accessible formats to aid communication and is looking to develop communication passports appropriate to each resident. Person centred planning was discussed with the manager, including its various formats with the inspector recommending that differing styles of person centred planning should be considered to help in assisting residents to be involved in their care and to further enhance systems already in place. It is also recommended that staff receive training and guidance in person centred planning in order that they have sufficient knowledge in this area as none that were spoken to were able to explain what this is despite many practices observed during the inspection being person centred. As at previous inspections members of staff were observed encouraging residents to make choices about day-to-day matters, such as what meals to have, and what they wanted to do on that day. People’s ability to exercise choice and to make informed decisions is variable, according to their degree of learning disability and communication needs. Some of the residents have contact with family members but this is not the case for all people. The use of advocates was discussed with the manager who confirmed the organisation that owns the home is looking to access external services to support residents. However, as discussed, it is recommended that other types of advocacy which residents may feel more comfortable with, for example, staff who have regular contact with them at the day centres they attend or staff who have worked with them previously and now work in other establishments be explored as aids to communication. All staff that were interviewed demonstrated excellent knowledge and understanding of involving people with communication needs in decision-making processes. For example one member of staff explained, “its weird they cant speak, but you don’t notice after working here for so long because they communicate in other ways, some will clap and this means they want a cup of tea or coffee, another will open the cupboard so lets us know he wants a drink or something to eat, if don’t like food will spit it out, another person may be more vocal and the sounds he make differ to mean different things and that’s his way of communication, we still talk to residents even though not expecting a verbal answer back, its our responsibility to look at other forms of communication such as expressions, sounds and body language”.
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 14 As with care planning, generally risk assessments processes and documentation is good. Some improvements however must be undertaken to ensure risk assessments as completed for all identified needs. For example one person file sampled contained care plans and documentation identifying dietary needs but no corresponding risk assessment and another persons file contained a care plans for continence but again a risk assessment was not in place. It is also recommended that a system be introduced that links care plans, corresponding risk assessments and other documentation in order to ensure a holistic approach to care management occur. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 15 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attempts are made to support residents to make choices about their life styles. Social, educational, cultural and recreational activities meet individuals’ expectations. Minor improvements are required to ensure systems ensure the dietary needs of all residents are managed appropriately. EVIDENCE: Residents living at this home are supported to participate in activities as per their needs and wishes. As at the previous inspection discussions with staff together with observations made during the inspection evidence that residents have lifestyles, which meet their individual preferences and needs. For example residents were observed leaving the home to attend differing day care centres and staff informed the inspector of activities that residents have undertaken such as personal shopping, preparing packed lunches, visiting a public house, aromatherapy and walks in the local community. Both residents’ files that the inspector examined contained activity records detailing one to
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 16 one, group, internal and external activities. Records and discussions with staff also confirm that arrangements have been made for all residents to go on individual holidays later this year to Minehead, Stratford Upon Avon and Centre Parks. Where possible routines within the home are flexible, promoting a person centred approach to care. As already mentioned staff arrange holidays arranged for each individual based on their needs and preferences, there are no set times for rising and retiring to bed and residents have freedom to move around their home at will. As already mentioned earlier in this report some residents have little family contact. Discussion with the manager indicates that staff try and maintain contact by supporting residents to send cards at birthdays and Christmas. Residents also have some contact with people who live in nearby care homes, owned by the Bourneville Village Trust and see friends at day centres. As already recommended work should be undertaken to explore other types of advocacy which residents may feel more comfortable with, for example, staff who have regular contact with them at the day centres they attend or staff who have worked with them previously and now work in other establishments. The home has an eight-week rotating menu, these show that a variety of choices on offer that includes the daily recommended five portions of fruit and vegetables. When looking at the records relating to the management of residents’ dietary needs the inspector found further improvements are required for one individual. This person’s file contained evidence that it has been identified that they have a specific need in this area resulting in consultations with relevant professionals that have recommended a reduced calorie diet. When looking at the individual records of meals taken by this person they do not reflect a reduced calorie diet and in the majority of instances this person appears to have eaten the same meal as other residents. This was discussed with the manger that stated that the portions this person will have eaten would have been different to other residents but conceded records currently do not reflect this. It was also noted that information relating to the management of this persons dietary needs are contained in a variety of documents including a nutritional profile, documentation from the community nurse and information within the homes assessment but that nothing is in place to link these documents. Improvements in the recording of information relating to the dietary needs, actions required by staff and monitoring of progress for the named individual must take place to ensure this persons needs are met in full. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: As at previous inspection residents’ records included detailed manual handling risk assessments. These stated how individuals are to be supported by staff with their mobility and how the risks to residents and staff are to be minimised when doing this. Residents were seen to be well dressed and their clothes were appropriate to their age, gender, culture, the weather and the activities that they were doing. Records sampled show that service users are supported by staff to go to the barbers and also to buy their own toiletries. The management of residents’ health care is good within this home. Records and discussions with staff confirm that people have access to health care professionals such as opticians, chiropodists, general practitioners and district nurses. Case files contain details regarding residents’ likes and dislikes including whether they preferred male or female staff to support them. There
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 18 is very good recording systems of attendance at health care appointments, outcomes and treatments. Work is still being undertaken to complete health action plans for each resident. Medication systems were examined and found to be appropriate. The home uses a monitored dosage system for the management of medication with records of medication entering, being returned to the supplying pharmacist and for the administration of medication to be correct. It was pleasing to find that a photograph of each resident is retained with their records and protocols are in place for ‘as required’ medication. The manager confirmed that all staff that administer medication have undertaken accredited medication training and that she undertakes a visual assessment of staff ordering, recording, administering and disposing of medication and signs a sheet confirming they are competent. It is recommended that the home obtain CSCI guidance ‘medication training for staff in residential homes’ and implement suggested competency assessments to ensure staff’s practices reflects the knowledge gained through training. It is also recommended that information be included on medication administration records instructing on which part of the body creams be applied and that ‘as directed’ instructions are clarified with the general practitioner to reduce the risk of miss-administration. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have excellent knowledge of supporting residents to express their concerns and of protecting residents from abuse. Clarification of a financial practice is required to ensure a resident is not placed at risk. 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, “one person will make a moaning noise this means could want something to eat, another put fingers in ears and that means unhappy with noise, another makes a certain sound if in pain, another brings keys this means unhappy and want to go for a walk, just because they cannot talk doesn’t mean not intelligent, they let you know. Its our job to understand their ways of letting us know they may be unhappy and doing something about it” and another “that comes with getting to know the clients, each have own traits, can be quiet vocal if unhappy. I try and spend time with clients, reassuring them, then note in care plan, try and find out why through observation and make sure everyone else is aware to make sure all staff are taking responsibility to find out what may be wrong”. It is recommended that the format for recording link worker meetings be expanded
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 20 to include any issues staff may have raised in the previous month on behalf of residents in order to further evidence that issues are listened to and acted upon. Information supplied by the home prior to the inspection states ‘we have robust policies and procedures in place, we invest in staff through training, we have a clear whistle blowing policy and ensure staff are aware of their responsibilities regarding this, to ensure the safeguarding and well-being of residents and staff’. Evidence gained during the inspection through sampling records and interviewing staff confirms this information to be accurate. For example the homes policies and procedures in place for the protection of vulnerable adults comply with relevant legislation and all staff that were interviewed demonstrated excellent knowledge and understanding of their roles and responsibilities relating to protection. For example one person explained, “everyone has to be vigilant, record anything out of the ordinary, one resident scratches himself so we record this, when we see any changes in a person we monitor, we are good at this, look at how other staff are with residents. I would report even if not sure, only way to be sure would be to investigate, everyone here understands that, we are all aware, we know consequences and it’s the right thing to do”. 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 and finances of two residents were sampled and all found to be accurate. It was however noted that the records for one of these individuals indicate that items of furniture 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 furniture then the named resident must be reimbursed. If the contract states residents can purchase items of furniture 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. Assurances were given to the inspector that this situation would be acted upon immediately. Both residents’ records that were sampled contained inventories. It is recommended that these be expanded to include documents held by the home on behalf of residents such as passports and birth certificates as a further safeguard to residents. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home makes every effort to ensure residents live in an environment that is furnished and decorated to a very high standard. Information supplied by the manager prior to the inspection states we ensure that we provide a warm, friendly and welcoming environment, bedrooms are personalised according to the wishes of each resident. Improvements this year include a new assisted bath being installed and new sash windows in order to address potential hazards presented by previous windows’. A tour of the premises was undertaken including the viewing of residents’ bedrooms with this information found to be accurate. Bedrooms were freshly decorated and furnished to a good standard. They were individualised with personal possessions, sensory items, photographs, televisions and stereo equipment. The communal areas
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 22 were bright and airy with comfortable and homely furnishings. There is a large, secluded garden to the rear and a new shed has been provided to store items (meeting a previous requirement). During the inspection the manager explained that architects have visited the home to assess the possibility of renovating the house and providing more ground level accommodation. As she explained this is in recognition of the fact that residents’ mobility and capabilities are reducing and therefore the home is attempting look at meeting their longer-term requirements, ensuring it is a home for life. For this the home should be commended. All parts of the home were seen to be clean and hygienic. There is a small domestic laundry that was seen to have a supply of liquid soap and paper towels. It was noted by the inspector that no written procedure for the sanitising of mops and their storage is currently in place. 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. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35 and 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who live there. EVIDENCE: As in previous inspections staff at 60 Raddlebarn Road present as interested in their jobs, motivated and committed to the welfare of the people living there. Staffs spoken to were aware of residents’ individual needs and had a grasp of knowledge of disabilities and conditions of individuals in general. Information supplied by the home prior to the visit states that ‘as an organisation we are now investing more resources into training. This includes an increased training budget, a staff member within the department leading on the co-ordination of training and the development of our own NVQ centre’. This investment in staff training was reinforced by all staff that were interviewed, all of whom praised the amount of training provided. The home should be commended for the numbers of staff holding a National Vocational Qualification, with ten of the eleven staff employed at the home having obtained this.
60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 24 The records of three members of staff were examined to assess if the homes recruitment practices protect residents. All contained an application form, references and enhanced Criminal Records Bureau (CRB) disclosures. Some minor omissions were found. It is recommended that the home maintain all records as listed in Schedule 2 and 4 (6) of the Care Home Regulations 2001 to ensure the homes recruitment practices offer further protection to residents. 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 meetings take place, that inform and advice staff of issues and events relevant to their roles. Since the last inspection the organisation that owns the home has introduced a staff forum with carers from the home participating in this event and a newsletter has also been introduced, again with staff able to make contributions. Staff that the inspector spoke to praised the company for introducing these initiatives, for example one member of staff stated, “everything seems to be going in more positive direction, feel supported and valued, Bourneville Village Trust going in a positive direction”. 60 Raddlebarn Road DS0000054310.V341570.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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. Quality monitoring systems continue to be implemented allowing the home to measure if it is meeting its aims and objectives. EVIDENCE: Throughout the inspection the registered manager demonstrated knowledge, competency and commitment to her role for which she should be congratulated. Feedback received from staff was extremely positive regarding the management of the Home. For example one member of staff stated, “the home is run quiet well, I personally know the manager is there if I need advice, if have any problems can see her. Its come on in leaps and bounds 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 26 over the years” and another “the manager is very supportive, really nice. She helps you when you really need it and easy to talk to”. Good quality assurance systems are in place that allow the home to measure if it is meeting its aims and objectives. These include regular maintenance and health and safety audits, visits undertaken in line with Regulation 26 of the Care Home Regulations and regular staff meetings. When examining the minutes of staff meetings the inspector recommended that these be expanded to include agreed actions and timescales that are then reviewed at the next staff meeting as an additional quality monitoring aid. As mentioned in other parts of this report the residents who live at the home have limited communication that impacts of their views being obtained and recorded. This was discussed with the manager and the implications this has on quality assurance. The recommendations made in relation to person centred planning and the use of advocates also should be applied to quality assurance systems as these would evidence and enable views to be incorporated. Health and safety is well managed promoting the well being of residents. Risk assessments are in place for safe working practices, many staff have undertaken training in moving and handling, first aid, food safety, health and safety and fire safety. Maintenance records for all areas of the building demonstrate that generally repairs are carried out within appropriate timescales and a sample of maintenance and records were examined and found to be up to date. A previous requirement to review the arrangements for on-call advice is now met, with the manager confirming staff have 24-hour access to a central control unit who give advice and access the on-call manager. 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 27 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 4 32 3 33 X 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 4 3 X X 3 X 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 28 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 YA9 Regulation 13(4) Requirement Improvements must be undertaken to ensure risk assessments as completed for all identified needs. Improvements in the recording of information relating to the dietary needs, actions required by staff and monitoring of progress for the named individual must take place to ensure this persons needs are met in full. The home must investigate the instances when a named resident has purchased items of furniture from their personal finances and reimburse if not compliant with the contents of the contract of residency. If the contract states residents can purchase items of furniture 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. Timescale for action 01/10/07 2 YA17 12(1) 01/09/07 3 YA23 13(6) 01/09/07 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA6 Good Practice Recommendations That care plans continue to be developed in order that residents’ needs and wishes are acknowledge and acted upon That where an identified action is recorded in care plans or monthly review records a record is maintained of when this action has been achieved to ensure effective monitoring is undertaken and to evidence further that the needs of residents are met That differing styles of person centred planning should be considered to help in assisting residents to be involved in their care and to further enhance systems already in place. That staff receive training and guidance in person centred planning in order that they have sufficient knowledge in this area. That other types of advocacy which residents may feel more comfortable with, for example, staff who have regular contact with them at the day centres they attend or staff who have worked with them previously and now work in other establishments be explored as aids to communication. That a system be introduced that links care plans, corresponding risk assessments and other documentation in order to ensure a holistic approach to care management occur That the home obtain CSCI guidance ‘medication training for staff in residential homes’ and implement suggested competency assessments to ensure staff’s practices reflects the knowledge gained through training. That information is included on medication administration records instructing on which part of the body creams are applied and that ‘as directed’ instructions are clarified with the general practitioner to reduce the risk of missadministration. That the format for recording link worker meetings be expanded to include any issues staff may have raised in the previous month on behalf of residents in order to further evidence that issues are listened to and acted upon.
DS0000054310.V341570.R01.S.doc Version 5.2 Page 30 3 YA6 4 YA7 5 YA9 6 YA20 7 YA20 8 YA22 60 Raddlebarn Road 9 YA23 10 YA30 That residents inventories be expanded to include documents held by the home on behalf of residents such as passports and birth certificates as a further safeguard to residents 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 home maintains all records as listed in Schedule 2 and 4 (6) of the Care Home Regulations 2001 to ensure the homes recruitment practices offer further protection to residents. That the minutes of staff meetings be expanded to include agreed actions and timescales that are then reviewed at the next staff meeting as an additional quality monitoring aid. 11 YA34 12 YA39 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 60 Raddlebarn Road DS0000054310.V341570.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
