Inspection on 25/09/06 for 66 Dudley Street

This inspection was carried out on 25th September 2006.

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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

66 Dudley Street 03/01/07

66 Dudley Street 03/02/06

66 Dudley Street 04/03/05

66 Dudley Street 17/11/04

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 66 Dudley Street West Bromwich West Midlands B67 9LU Lead Inspector Deborah Sharman Key Unannounced Inspection 25 September 2006 09:30 66 Dudley Street DS0000054828.V303137.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 66 Dudley Street DS0000054828.V303137.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. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 66 Dudley Street Address West Bromwich West Midlands B67 9LU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 525 3900 londonroad@tiscali.co.uk Milbury Care Services Limited Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3rd February 2006 Brief Description of the Service: 66 Dudley Street is a detached property, which has been purpose built to accommodate up to 6 people with Learning Disabilities/Autism. The property provides single occupancy rooms, all of which have en-suite shower, toilet and hand basin and are generous in size. Service users rooms are available on both floors and communal areas include a lounge, dining area, quiet room, and activity room. A domestic size and equipped kitchen is available and an adequate size laundry area. A Jacuzzi/spa bath is provided in the communal bathroom, and there are a further two toilets. The property is situated on a busy main road near to West Bromwich town centre and is easily accessible by public transport. The location enables service users to access local amenities and facilities and also neighbouring towns. There is a small drive to the front of the property and there is parking available on the road. There is good size rear garden, which is well designed and level, and provides extra privacy and space for service users whilst making use of the area. The home offers intensive support to a group of individuals with a range of complex needs and strives to promote ordinary living principles and social inclusion. The service has its own transport. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced meaning that nobody associated with the home received prior notification and were unable to prepare. One Inspector carried out the inspection which began at 9.30am and finished at 8.00pm. This was a key inspection meaning that all key National Standards were assessed as was progress made towards meeting improvements previously identified as required. Since the last inspection the home has notified the Commission for Social Care Inspection of a number of incidents relating to the welfare of service users. These have included injuries, complaints and allegations. This information was used to guide the focus of the inspection and the outcomes of some of the incidents were explored to assess how effectively they had been managed. The Inspector used a range of methods to assess the performance of the home. General documentation was assessed. Care documents were inspected too to sample different aspects of care provided to a range of different service users. Whilst it was not possible due to the nature of service users disabilities to formally interview service users about their experiences within the home the Inspector mixed freely with a number of service users throughout the inspection who presented as happy and settled. The Inspector toured the premises, observed lunch and interviewed three staff members separately. The Acting Manager was on annual leave at the time of inspection therefore the Deputy Manager supported the inspection process throughout the day. The Inspector was welcomed and everybody present cooperated fully and contributed positively to what was a long inspection day and thanks are extended to them all. Weekly Fees: Fees range from £1425.00 to £2841.75 per person per week. What the service does well: The premises are homely and fresh smelling. There is a welcoming happy and calm atmosphere within a home where service users behaviours can challenge. The home works hard to communicate effectively with service users with many documents in pictorial form and some staff being able to communicate in sign language. Recruitment and selection processes are good and protect service users when new staff are appointed. Staff appear to be motivated and interaction with service users is positive and respectful. A staff member when asked what the 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 6 home does well said ‘interaction with service users’. Staff also spoke highly of the Acting Manager describing her as ‘a good manager who is approachable and provides direction, leadership and support. Service users independence is promoted. For example on the day of inspection a service user was being supported to wash up. Service users have free access throughout the premises. There is a friendly and calm atmosphere within the home and service users present as settled. Staff know service users well and demonstrate a good understanding of their needs. Service users receive good levels of health screening. Care plans address most of service users needs but require some updating to ensure accuracy. Service users enjoy their meals but closer attention is required for those service users who may be at nutritional risk. What has improved since the last inspection? What they could do better: All staff spoken to, spoke highly of the Acting Manager. However she is not the Registered Manager and the home has been without a registered manager for some months now. It is important that an application for registration is submitted to CSCI without delay. The internal décor of the premises remains worn and redecoration must be a priority. One service user has been identified as being at nutritional risk and the need for intervention has been identified. There is no evidence that action has been taken to address this and the service user has continued to lose a significant amount of weight. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 7 Changes in health are identified and there is evidence that medical attention has been sought but this is not consistently so. One service user sustained injuries at night and bruising was apparent to night staff. In the Inspectors opinion there was an unnecessary delay in seeking medical attention on this occasion. The home does not have any quality assurance systems to use to measure and improve its own performance. 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. 66 Dudley Street DS0000054828.V303137.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 66 Dudley Street DS0000054828.V303137.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 A judgement about performance cannot be made as there have been no recent admissions to the home. EVIDENCE: The home is fully occupied and there have been no new admissions since the last inspection. Therefore it has not been possible to assess how new service users are selected and supported to settle into the home. However the Service User Guide has been improved and this will provide better information to potential residents of the home. The home has identified long and short-term goals for its current service users and is working to improve its assessment tools. This would reassure new service users that their need and aspirations would be assessed. There are no outstanding requirements in relation to these Standards. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. The performance outcome overall for this group of Standards is adequate. Whilst risk assessment systems are generally good and care plans have improved, few but significant omissions in care planning and decision making processes negatively impact upon outcomes for service users potentially putting them at risk. EVIDENCE: Steps have been taken since the last inspections to improve some information within care plans. Of those sampled, required frequencies have been included to plans for health screening and there is better information available to guide the provision of personal care e.g. shaving has now been included. There is a wealth of written information about service users and it is all useful and valid. However it would now be worth rethinking how this is managed to ensure that the care plans which are held in bulky, overloaded and inaccessible files currently are living and usable documents. For example shaving care plans were not held with other personal care information and an improved behaviour intervention care plan which illustrates acceptable techniques for one service user was not held with other behaviour management information. The most significant omission in care planning is diet / nutrition and this is of concern 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 11 given the level of risk identified for one service user but this will be discussed in more detail under Standard 17. A medication profile sampled was out of date and the information within it did not tally with prescribed medication on the Medication Administration Record. There is more detail in care plans appertaining to contact with families but again information was found to be out of date and the care plan has not been updated to reflect new arrangements. It was pleasing to see that multi disciplinary review meetings are being held to review care provided to individual service users. There are a broad range of risk assessments in place based upon the principal of best interest for individual service users which are linked to plans of care. Service users were observed making day-to-day decisions which were respected by staff throughout the inspection day. Service users have free access to areas of the premises. Some service users who are none vocal can communicate with staff and this was observed to be effective. A well minuted service users meeting has been held recently and was also attended by some relatives where views about the home are expressed. Previous records however show that these meetings have been held annually each August for three years although the intention has been to hold them more regularly. In the absence of any other quality assurance tool currently this would be advisable. Advocacy services have had input previously but are not currently supporting any service users within the home. A service user who has previously rejected a bed and had been sleeping on a mattress on the floor now has a double bed as it was felt that this may better meet his need and may be more acceptable to him. This is the case and he has readily accepted the bed. However he has purchased the bed himself and there is neither evidence of how this decision was made nor guidelines in his plan of care for how financial decision-making is made. The home is obliged to provide a bed that meets his needs and the service user must be reimbursed. A service user was also found to have funded his own lunch out because day activity money provided by the Organisation had run out. He too must be reimbursed. These examples demonstrate disregard for non vocal service users rights, choices and decisions. So whilst day-to-day decisions made by service users were observed to be respected there is the opportunity for improvement in relation to how more difficult and significant decisions are supported. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. The performance outcomes for this group of Standards are generally adequate. Service users preferred activities and meals are known and are mostly provided. Improvements in the assessment of cultural needs are required in order to ensure needs are fully known and met and must be made in response to the assessment of nutritional need. EVIDENCE: Service users preferred activities and routines are known and there are opportunities available for further education in packages designed to specifically meet the complex needs of some service users. Others attend more traditional day centres either full or part time and some service users are reliant upon the home in full for their day activity. There was evidence that the service user case tracked is supported to take part in most but not all of his preferred activities. There wasn’t a lot of evidence of his use of community facilities although he had been on holiday and there was evidence of another service user visiting the pub. The home has had a difficult relationship with a neighbour and complaints have been made. These have been investigated and a response issued. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 13 One service user is under represented amongst peers in terms of ethnic background and another in terms of gender. However the ethnic and gender mix within the staff team reflects that of the local community and the service users. Cultural diversity is included within the care plan sampled but is short on detail. The need to attend church is recognised for example but the service users religion is not included nor his church of choice. Cultural traditions and important dates to celebrate are also not included. A care plan sampled contains full but outdated detail in respect of arrangements for contact with friends and family. It was suggested within the last inspection report that the method of recording family contact is reviewed for ease of monitoring. This has not been done and evidence of contact could not be supplied to the Inspector for the service user case tracked. However, relatives did visit one service user during the day of inspection. Service users daily routines are noted and known by staff. Staff were observed to knock on bedroom doors before entering and left upon the request of service users. Service users are left alone when required but a staff member demonstrated understanding the need for ongoing vigilance for those service users requiring 1:1 support. Some service users have keys to their room and where some don’t this is accounted for in their care plan. Menus are pictorial and were available up until the week prior to inspection. All service users self manage at meal times and some contribute towards meal preparation and serving. No service users are at risk of choking, are diabetic or need to follow a gluten free diet. Concern arose at this inspection about protracted weight loss by one service user whose nutritional risk assessment shows her / him to be at risk with intervention required. A general diet care plan is in place but it is not dated and does not address the needs identified in the nutritional assessment combined with a weight loss of one stone and five pound in just less than 12 months. A body mass index guide is available but has not been used and the healthy weight range for this service user is not known. This was an improvement required at the previous inspection and is therefore judged not to have been met. This affects outcomes for the service user and action must be taken as a priority based upon medical advice. Service users individual food preferences are known and sight of menus shows that three meals are offered daily with at least one being a cooked meal and is based upon the known preferences of the service user sampled. Service users indicated that they enjoy their meals and mealtime was a relaxed occasion. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. The performance outcomes for this group of Standards are good. The provision of personal care is good and in accordance with service users preferences and need. Routine Health screening is very good and changes in health are recognised. To improve the Manager must ensure that medical advice is sought promptly without unnecessary delay on every occasion. The administration of medication and systems to support the management of medication are good which maximise service user’s health and minimise risk of error and harm. EVIDENCE: Care plans now include developed detail to guide the provision of personal care to service users and their preferences are known. All service users present as well groomed with individual personal style. It was pleasing to note the attention to personal detail such as service users being supported to use individual aftershaves for example. Baths and showers are available. All ensuites have showers but a bath has been provided in the ensuite for one service user in accordance with preference. All service users are fully mobile and continent so mobility and continence aids are not required to support personal care. Service users routines and preferred retiring and rising times are known. Routines are flexible with one service users wish from time to time for a lazy morning in pyjamas being respected. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 15 Health needs are assessed and health plans have been improved by including required frequencies of screening. All required outpatient and routine health screening had been provided with sufficient regularity in accordance with the plan of care for the service user case tracked providing the assurance that service users health is maximised with the opportunity for diagnosing potential problems early. This is good practice and is to be commended. There is also recorded evidence that changes to service users health is recognised. Responses to two incidents were assessed. On the one occasion the Doctor was called the same day and there is evidence that subsequent medical direction was adhered to. On another occasion but at night an injury following a fall was recognised by night staff who telephoned the Acting Manager but medical attention was not sought until the following day when the injury was seen by the Acting Manager. Night staff must be supported to understand the importance of seeking medical attention without delay and must be supported to have the confidence to make this decision. X rays the next day showed there was not a fracture but the potential for a neglected fracture was there. The administration of medication was not observed at this inspection as there were no concerns arising from the previous inspection about administration practice. All but one of the previous requirements for improvement issued in respect of medication have been met resulting in safer systems. Training provided to staff in the Safe Handling of Medication is now accredited and copies of prescriptions are being held to evidence medications prescribed. Furthermore a procedure has been put in place to support service users taking medication when out in the community. This procedure is however based upon double dispensing, which is not considered good medication practice. So the Acting Manager is required to seek advice about this from the supplying pharmacist at support visits, which are taking place quarterly with largely positive outcomes. In house systems to assess staff competency to administer medication have not been revised, reviewed or updated with the last one given as evidence being dated 2003. Apart from the need to update the medication care plan and provide directions based upon medical advice for the use of PRN medications (especially those prescribed to modify behaviour) medication administration systems however are generally good with risk limited and good outcomes for service users. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The performance outcomes for this group of standards are good with positive practice outweighing the need for improvement. Relatives feel able to make complaints where necessary and they are positively received and investigated. Recruitment practice, improved staffing levels, broad ranging risk assessments combined with staff who have mostly received and understand abuse and behaviour management issues serves to protect service users. Improvements in financial policies and some aspects of financial practice together with training in protection for all staff will better protect service users interests. EVIDENCE: The home has a complaints procedure and a simplified version is included in the newly revised Service User guide but its suitability is doubtful as it is in the written form. Relatives are offered the opportunity to provide feedback and raise issues about the service provided before they become complaints at service user meetings attended by relatives but in the absence of any other quality assurance system these annual meetings are a little infrequent. The home has had 8 complaints in a 12-month period. Three themes emerge noise, concerns from members of the public who witness non violent crisis intervention to manage service users behaviour and physical marks / scratches to service users one of which went to investigation within the adult protection multi disciplinary arena. Learning has been gained from the complaints about scratches to service users and twice daily monitoring systems have been implemented now. All complaints have been recorded openly but not all outcomes are recorded and dates of resolution are not noted to evidence complaints being addressed within agreed timescales. All agencies have been 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 17 aware of the issues and are now resolved. A complaint sent to the Commission for Social care Inspection about noise and other issues has been investigated by the provider within agreed timescales and a response sent to the complainant. The adult protection policy has not been reviewed as required to ensure that the quick reference flow chart does not contradict the text in relation to advice about the need to gain consent before reporting adult abuse. This provides the potential to mislead staff and compromise the protection of vulnerable adults in the event of an incident. All reported incidents have now been resolved. Behaviour support guidelines are positive and are based upon the best interests of service users but need multi disciplinary agreement. Records and discussion with staff show that physical intervention is minimal and staff demonstrated that they are aware of behaviour triggers to avoid. Medications prescribed to help to manage behaviour are used minimally and service users in receipt of such medications present as alert. Records show these as required medications are infrequently used and control measures are in place where staff have to seek authorisation before administering medication to modify behaviour. Discussion with staff showed a good understanding of abuse and carers role upon becoming aware of abuse. The staff member could recall the detail of the training provided on abuse and protection. Records show that two thirds of the staff team have received adult protection training. Staff spoken to said that they feel that service users are safe. Assessment of recruitment records show that service users are protected by good practice in relation to recruitment and selection practices. Improved staffing levels also better protect service users. The home has improved notifying the Commission for Social Care Inspection of incidents that affect the welfare of service users. Therefore the requirement to inform the Commission for Social Care Inspection of all restraints has been deleted. However the home continues to have a regulatory duty to do this. Financial systems account for expenditure but tighter guidance on financial decision-making will better protect service users from spending money on items, which should be met by the organisation such as the bed, referred to earlier and the meal purchased by another service user. Service users monies sent to the organisation on the service users behalf by the appointee continue to be paid into the Organisations business account, which contravenes the regulations and has not been reviewed as required. Similarly, it is a previous requirement for the Organisation to develop a new policy to clarify responsibilities for holiday expenditure and this has not been met. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 The performance outcomes for this group of Standards is generally poor. The premises are generally safe and meet the needs of the service users. Décor and fittings are shabby however and although the premises are domestic in style this does not provide the impression of a well-maintained and homely living environment in which service users can feel valued. EVIDENCE: The premises are purpose built and are domestic in style, only accommodating a maximum of 6 service users. The premises are safe and clean and are sufficiently heated. The home has recently acquired an aquarium and the Inspector observed service users gaining pleasure from this. Décor and some furnishings and fittings are worn and require replacement. Paintwork in bedrooms is heavily marked with holes in plasterwork observed. The Inspector is concerned that care staff are expecting to paint service users bedrooms as this detracts from care hours provided and is something staff are not trained to do. One bedside cupboard had the drawer door missing, kitchen cupboard doors and drawers continually are in a state of disrepair and a cupboard / sideboard in the dining room is heavily scratched. The home has in its possession a brief memo with a vague statement of intent in terms of some aspects of maintenance but this is not considered to be a sufficiently robust planned maintenance and renewal programme for the fabric and decoration of 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 19 the premises. Given the needs of the service users accommodated, furniture and fittings are going to be subject to heavy wear and tear and a robust renewal schedule is essential to ensure the premises remain (and now become) well maintained and homely. Windows were not clean. With permission two service users bedrooms were inspected. All required furniture is provided as per Standard 26 and bedrooms are clearly individualised reflecting individual preferences and lifestyles. The Manager is advised to seek the advice of the Fire Service about safety in the one bedroom, which as a result of the needs and wishes of the service user is clearly cluttered, with hoards of paper on the floor. Some service users have keys to their rooms, which are also lockable from the inside and overridable with a master key from the outside. The laundry is very small and therefore attention to minimising the risk of cross contamination is essential. Hand washing facilities, personal protective equipment are available and machines are industrial with sluice facilities. Infection control procedures and signs are posted on the laundry wall. Therefore it was disappointing to find unprotected soiled linen including worn underclothes exposed on the laundry floor in a small laundry where clean clothes were hanging. This compromises good infection control practice but also compromises the dignity of the person to whom the clothes belong. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The performance outcome for this group of Standards is adequate. Performance outcomes across the range of Standards are mixed with recruitment and supervision being good, training adequate and staffing levels ranging from poor to adequate in the period of time since the last inspection. To improve omissions in training must be addressed and must be satisfactorily evidenced and the home must become fully staffed. These improvements will ensure that service users are supported by sufficient staff who are well trained to meet their needs. EVIDENCE: Staff spoken to present as motivated and knowledgeable about their role and the needs of service users. The home does not currently employ anybody under the age of 18 or 21. Records indicate that 20 of staff hold an NVQ qualification which is half that found at the previous inspection. A further seven are currently undertaking this award. Staffing levels have been consistently problematic since the last inspection due to a combination of factors including the need to recruit more staff, sickness, unauthorised absence, late arrival of staff for work, compassionate leave and a poor response from the supplying agency. Contingency arrangements have therefore not been effective and the home has on many occasions been left understaffed. Given the high dependency levels of the service users accommodated this has left staff and service users vulnerable. However there 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 21 is evidence that timekeeping has been addressed, four new permanent staff (131 hours new care hours) and three new temporary staff have been recruited and are waiting to start and the number of notifications to CSCI about insufficient staffing have decreased to none since June 2006. Perusal of the rota indicates that staffing ratios are being better managed but the situation will continue to be monitored closely. The rota, which is subject to multiple amendments in small spaces is overwritten and difficult to interpret accurately. It must be reviewed to ensure that it is more clearly maintained. The personnel records for a staff member recently recruited were assessed. All documentation was available and demonstrated that correct procedures had been adhered to in order to protect service users as far as possible. Training records for a staff member employed over 12 months were assessed. S/he was found to have had training in Fire Awareness, Equal Opportunities, Infection Control, Moving and handling, Physical Intervention (NVCI), Adult Protection, Epilepsy Awareness and Communication. Not all certificates were available to evidence attendance at these training courses however. S/he is booked to attend Food Hygiene training and is currently undertaking Accredited Medication training (and does not consequently administer medication not being trained to do so). S/he is also undertaking NVQ training. Discussion with the staff member showed that s/he appreciated the training opportunities but felt that too much is being provided all at once. From assessment of the team training records it is clear that there have been improvements in the number of people who have undertaken Infection control training with 22 having completed and the remaining four staff being enrolled (only 11 certificated were available however as firm evidence of this). Similarly 16 of 26 staff have completed Adult Protection training with one additional place booked and again only 11 certificates were available. Eight staff have undertaken autism training with 10 booked to do but only 3 certificates were available. The booking is the improvement since the last inspection. One staff member is certificated in British Sign Language with others having done the course and are using the techniques without having taken the examination. It is planned for a further staff member to enrol for BSL training in September 2006, this month. Nobody has been provided with training in Nutrition and given the nutritionally related concerns arising from this inspection this is now required. There has been no improvement with induction training. Training Organisation for the Personal Social Services (TOPSS) training is still being provided in the absence of Learning Disability Award Framework (LDAF) training. Supervision records for one staff member were assessed. In 13 months s/he had received five formal well-recorded supervision sessions, which just falls short of the national minimum of 6 required in 12 months. However records indicate that supervisions are effective and cover required subject areas. The 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 22 content of supervision records confirmed staff opinion and evidence from staff meetings that staff performance is addressed. 66 Dudley Street DS0000054828.V303137.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The performance outcomes for this group of Standards are adequate. The Manager is not registered or yet qualified. However, the team is happy and settled, staff performance issues are being addressed where required, some improvements have been made without a registered manager or the aid of regular supervision for the Acting Manager or a quality assurance tool. EVIDENCE: The home does not have a Registered Manager and the Organisation must address this without delay. The Acting Manager has been in post for 6 months and is working towards the required qualifications. The home appears to be happy and settled with staff describing the team as working well together. There is evidence that the Acting Manager has brought about some improvements within the home with some previous requirements having been met and deleted from this report. Others have been partially met. The Organisation had however been required to provide better support to the previous Manager of Dudley Street through evidenced supervision meetings. This Acting Manager has not been provided with the same with their being 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 24 evidence of only one supervision provided in the time she has been Acting Manager (6 months) and with only two supervisions provided in the previous 12 months. This is unsatisfactory and falls short of the National Minimum Standard. However, all staff spoken to spoke highly of the Acting Manager. The Inspector was told that she is efficient, has the service users best interests at heart, provides leadership, support and direction and is quick to both correct and praise staff. Five staff meetings have been held in the last 12 months and are excellently recorded. They evidence as staff have said the provision of direction and the setting of Standards with service users being the focus. There is evidence that the Acting Manager is continuing to undertake training courses to update her knowledge and skills and is currently working towards national qualifications for managing a care home. Registration certificates are displayed and some progress has been made towards meeting previous requirements. No progress has been made with respect to quality assurance and the home remains without a system to assess and respond to its own performance. This is a significant omission and is viewed seriously. Health and Safety within the home is generally well managed with like the outcomes from the last inspection there are some omissions. However good practice is outweighing identified needs for improvement. All service maintenance documents were available and were up to date showing that gas and electric appliances had been serviced minimising risk. Fridge and freezer temperatures are better managed than at the previous inspection with fewer but some occasions still when the freezer was not cold enough with no evidenced action to remedy this. Hot food temperatures are being taken before being served and the temperature gauge is being calibrated. This minimises the risk of ill health to service users from a food related source. A Food Safety inspection was carried out in January 2006 and it appears that 2 of the three legal requirements and both recommendations for improvement have been met. One requirement to carry out HACCP (hazard analysis of critical food points) have not been undertaken. Water outlet temperatures are also safer and reduce the risk of burns and scalds from excessive temperatures but now records indicate occasions when the temperatures were not warm enough e.g. 31 degrees. This is not a comfortable temperature for the service user and does not reduce the risk of legionella in accordance with the homes own and commissioned water risk assessment. However records show that staff are implementing other recommendations from the risk assessment to reduce the risk of legionella. The provision of fire training and fire drills is good. Fire drills are regular and include service users. A fire risk assessment is available. Accident records are maintained with trends analysed monthly, which is good practice. Staff know where the three well stocked first aid boxes are kept and following analysis of a weeks shifts each shift with the exception of one night shift is staffed by at least one staff member with a first aid qualification. It was pleasing to see too that upon arrival Commission for 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 25 Social care Inspection staff were asked to produce identification prior to being invited into the home. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 26 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 X 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 2 ENVIRONMENT Standard No Score 24 1 25 X 26 3 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 1 X X 2 X 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 15 Requirement Care plans must be reviewed to ensure that all information is up to date and reflects service users current needs. New requirement at September 2006. Care plans must establish individualised procedures for service users likely to be aggressive or cause harm or self harm and must describe restrictions on freedom (e.g. restraint techniques) agreed by a multi disciplinary team based upon service users needs, disabilities, physical health gender etc. (This is as opposed to current general guidance which states ‘use team control’) New Requirement at Feb 06. Not met. (At September 06 improved but not agreed by multidisciplinary teams) The Registered person must not pay money belonging to any DS0000054828.V303137.R01.S.doc Timescale for action 31/10/06 2. YA6 13(6) 31/12/06 3. YA7 20(1)(a)(b) 31/12/06 66 Dudley Street Version 5.2 Page 28 service user into a bank account unless the account is in the name of the service user to which the money belongs; and the account is not used by the registered person in connection with the carrying on or management of the care home. Current systems must therefore be reviewed with action taken confirmed in writing to the Commission for Social care Inspection. New Requirement at February 2006. Not met. 4 YA7 13(6) Service users must not fund furniture items that should be funded by the provider to meet need. Service user 1 must be reimbursed for the payment made for the double bed. Service users must not fund the cost of meals and must be refunded where this has been the case New Requirement at September 2006. The provider must ensure that a policy is in place which clarifies responsibilities for holiday expenditure. ‘Staffing’ costs met by the organisation must be defined e.g. who funds staff hourly rates, staff expenses, staff meals, staff accommodation costs arising from the holiday. New Requirement at February 2006. Not met. 31/10/06 5. YA14 13(6) 31/12/06 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 29 6. YA17 13(4) Service users nutritional risk must be assessed using a reliable assessment tool (with action taken where required to meet nutritional need) Sufficient information must be available to ensure that the level of nutritional risk is known to staff. New Requirement at February 2006. Medical advice must be sought for the service user case tracked who has lost a significant amount of weight. All staff must be provided with training in Nutrition Awareness New Requirement at September 2006 31/10/06 7 YA19 12, 13, Medical advice must be sought without delay following accidents. The Acting Manager must review with night staff procedures to follow in the event of an accident. New Requirement at September 2006. To ensure that systems are in place to support service users taking medication at the prescribed time e.g. particularly when going out in to the community. New Requirement at February 2006. (At September 06 procedure completed. The Manager must 31/10/06 8. YA20 13(2) 31/10/06 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 30 obtain the supplying pharmacists advise about double dispensing referred to within procedure) Directions for the administration of PRN medication (particularly in respect of medication prescribed to modify behaviour) must be obtained from the prescriber. New Requirement at September 2006. 9. YA20 13(2) The Manager must update the in house assessments of staff competency to administer medication. New Requirement at February 2006. Not met. 10. YA23 13(6) The home’s Adult Protection policy requires review to ensure it complies with the expectations of Local Authority guidelines. New Requirement at August 2005. Not met. 11. YA24 23(2) A written maintenance and renewal programme must be developed. New Requirement at August 2005. Not met. A full written maintenance and renewal programme must be developed and must be provided to CSCI following a full audit of each room. The schedule must as a minimum include with specific target dates: 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 31 31/10/06 31/12/06 31/12/06 • Replacement of specific items of furniture identified as damaged A date for the decoration of each room A date for the planned refitting of the kitchen. Window cleaning • • • New Requirement at September 2006. 12. YA33 18(1)(a) To notify the Commission for Social Care Inspection as a Regulation 37 notice on any occasion when morning (8a.m. - 10a.m.) staffing levels drop below 5 staff and below 6 staff for the time period 10.00 a.m. 10.00 p.m. - Requirement first made August 2005 - met but ongoing requirement for subsequent occasions for monitoring purposes. 13 YA33 17(2) Sch 4(7) The layout of the duty roster must be reviewed to ensure that amendments can be made clearly to demonstrate whether the roster was actually worked. New Requirement at September 2006. To ensure that all induction (within 6 weeks of commencement) and foundation training (within 6 months of commencement) is delivered, and is in accordance with guidance issued by the Training Organisation Personal Social Services (TOPSS) TOPSS done in house in timescale but not LDAFF at Feb DS0000054828.V303137.R01.S.doc 30/09/06 31/10/06 14. YA35 18 31/12/06 66 Dudley Street Version 5.2 Page 32 06. 2. To identify and access relevant training for staff in the use of British Sign language (BSL). The home should aim for at least one person on duty at all times who have the skills to use BSL (At Sept 06 1 staff certificated) 3. To ensure all staff are provided with awareness training with regards to the Autism and the range of Autistic Spectrum Disorders – At Sept 06 10 staff not done At Aug 05 7 staff not done. At Feb 05 9 out of 24 staff not done. Requirements at Feb 05 – Not met. The registered manager of 66 31/12/06 Dudley St must receive regular, formal, and appropriate supervision meetings with a line manager from `Milbury`. Requirement outstanding since March 2005. Not met. At Feb 06 some progress - two supervisions dated Sept and Oct 2005. Minimum of Six to have been completed by 31.8.06 (At September 2006 insufficient supervisions provided to Acting Manager) 16. YA39 24 The quality assurance tool must be reviewed. New Requirement at August 2005 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 33 15. YA37 18, 24 31/12/06 No evidence at September 2006 of any QA. 17 YA42 13(3) 13(4) Action must be taken and must be evidenced when water outlet temperatures do not meet the recommended range (either too hot or too cold) HACCPS must be carried out as per Food Safety Inspection requirement Jan 06 with further advice sought from Environmental Health Food Safety Department if required. New Requirement at September 2006. The provider must verify with its insurers whether it is acceptable for care staff to undertake decorating and inform the Acting Manager and CSCI of the outcome of this enquiry. New Requirement at September 2006. 31/10/06 18 YA43 25(2)(e) 31/10/06 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 YA15 Good Practice Recommendations The manager should review the way in which contact with friends and families is recorded to facilitate monitoring. Care plans should state the specific arrangements for contact with family and friends i.e. twice per week on Mondays and Fridays as opposed to ‘regular’ At September 2006 improvements made but info was out of date in care plan case tracked. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 34 2. YA41 The manager was advised that due to the volume of information held with regards to the care and risk management strategies in place, all current documentation should be checked, to ensure it is the most up to date and is dated and signed by the staff and where possible the service user or their representative. 66 Dudley Street DS0000054828.V303137.R01.S.doc Version 5.2 Page 35 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: 0845 015 0120 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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