Inspection on 30/04/08 for 68 Bescot Road

This inspection was carried out on 30th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

68 Bescot Road 29/04/09

68 Bescot Road 10/10/07

68 Bescot Road 02/10/06

68 Bescot Road 28/11/05

68 Bescot Road 05/08/05

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 27/09/2008.

CARE HOME ADULTS 18-65 68 Bescot Road 68 Bescot Road Walsall West Midlands WS2 9AE Lead Inspector Peter Dawson Unannounced Inspection 30th April 2008 08:45 68 Bescot Road DS0000062047.V363222.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 68 Bescot Road DS0000062047.V363222.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. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 68 Bescot Road Address 68 Bescot Road Walsall West Midlands WS2 9AE 01922 648758 0121 525 8492 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) enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Jane Anderson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 2007 Brief Description of the Service: 68 Bescot Road is a care home with nursing that is owned and managed by Caretech following the ‘takeover’ of Lonsdale Midlands Ltd in 2006. The home offers nursing care and personal support to up to eight individuals with a learning disability with health and/or complex social care needs, plus degrees of behavioural challenge. The home has two floors which are identical and are staffed separately. A passenger lift is available. The two units have the same layout and comprise of four single occupancy rooms, (some with en suite shower facilities) a shared bathroom and two separate toilets, lounge, dining room, and kitchen. The two units operate independently of each other although staff work between both. The external area of the home comprises of a car park at the front and small rear garden. Entrances and exits are ramped to ensure access by people with mobility difficulties. The home aims to provide its residents with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. This is stated to be achieved through a programme of activities designed to encourage stimulation, self-esteem, and social interaction with other residents and with recognition of core values that are fundamental to the philosophy of the home. The core values being Privacy, Dignity, Rights, Independence, choice, and fulfilment. Information about fees was unavailable at the time of this inspection; the reader may wish to contact the service for the current fee information. People who use the service and their representatives are able to gain information about this home from the Statement of Purpose, Service User Guide and inspection reports produced by Commission for Social Care Inspection. Inspection reports can be obtained direct from the provider or are available on our website at www.csci.org.uk 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out by one inspector on one day from 8.45 a.m. – 5.00 pm. The National Minimum Standards for Younger Adults were used as the basis for assessment of the service. Prior to the inspection the Manager completed and returned and Annual Quality Assurance Assessment (AQAA), some information from that document is included in this report. Five feedback questionnaires completed by/with users of the service were returned to us prior to the inspection, some with relative input - all stating that they were treated well and satisfied with the services provided. All said that they could make decisions/choices about what they wanted to do at all times. A questionnaire from a Care Manager (Social Worker) was received stating that he was satisfied with the arrangements for individual health care, medication and response to individual needs. There were 4 permanent and 3 respite people in residence. Most residents were seen and several spoken with during the inspection. Observations of interactions throughout the day between all staff and residents appeared positive. Staff spoken with had a good knowledge of residents needs and spoke positively about their work and the support they received. The inspection was carried out directly with the Registered Manager and the Area Manager of the service who provided useful information and positive dialogue throughout. The main objective of this inspection was to assess the current level of service following concerns that standards have deteriorated in the service over the past year. Contributory factors included absence of the Registered Manager on maternity leave and the absence of ongoing support for the home from an Area Manager. A key inspection on 10/10/07 made 13 requirements. An improvement plan to address those issues was requested and received from the service in January 2008. A further Random Inspection was made on 5/02/08 to monitor the progress of the improvement plan. It was found that considerable progress had been made in many areas, some requirements met and others still requiring further work. This inspection has shown that virtually all the promised actions in the Improvement Plan have been satisfactorily addressed. Areas still needing 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 6 further action relate to staff recruitment and training and continuing evaluation of the quality of the service. What the service does well: What has improved since the last inspection? New format support/care plans have been reviewed, revised and established for all 4 permanent and 19 respite care users. Health care action plans have been established for all with clearer documentation of needs and actions required to meet those needs. Annual health checks are now scheduled for permanent residents. Risk assessments have been revised for all and present in support plans relevant to the instructions for staff on the level of support needed in the various areas of care. PRN medication is now regularly reviewed with GP/Consultant. This is particularly important with anti-psychotic prescriptions. A new medication procedure has been implemented for all respite care users to improve the safety of medication brought into the home, administered whilst resident and returned to carers following respite periods. This improves the safety of the medication system for those using the service. Discharge letters are sent to carers following respite care to ensure the events and progress of the stay are clear. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 7 1:1 Talk time is made available to all on a monthly basis as a means of assessing satisfaction with the service and defining chosen lifestyles. Refusal of talk time is now recorded. There has been input from the providers Quality & Performance Manager to advise on methods of feedback. Some training has taken place with new Trainers appointed by the providers. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 68 Bescot Road DS0000062047.V363222.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 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Stanadards 1 – 4 were inspected on this visit Quality in this outcome area is adequate. Information about the home should be further checked and updated. Pre-admission assessments and visits ensure assessments are correct and needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a statement of purpose/service users guide available in the home for residents and prospective residents and carers. This is in pictorial form providing clear information. The Manager said the documents had been updated although a review date of 2/11/07 as stated in the last inspection report was still recorded. This will be changed and information checked. It is important that the weekly fees charged are also included in the documents. A person on extended respite care is about to be reviewed for permanent placement. A care plan established from assessed need was in place for this person and also a multi-disciplinary assessment had been carried out prior to the final meeting to confirm permanent placement. Relatives had been closely involved in the discussions and assessment. 68 Bescot Road DS0000062047.V363222.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6 – 9 Quality in this outcome area is adequate. Assessed and changing needs and personal goals are reflected in individual plans. Specific time is allocated to consult residents about their lives. Risk assessments have been extended, improved and now reviewed regularly. Some improvements in the quality of recording should be made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous requirements have been made to develop care and support plans to state the required actions to meet needs. Evidence was also required that people receiving support were involved in planning and decision making. Risk assessments also required further information and regular review. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 11 Progress was made at the time of the last Random Inspection on 5th February 2008 in all these areas. Care and support plans for the 4 permanent residents had been changed to a new format giving more comprehensive and detailed information, but only 3 plans for the 19 people on a rolling respite care programme completed. At the time of this inspection all support plans for the 19 respite care users had also been reformatted and completed. A sample of 4 support plans for both permanent and respite care users were inspected on this visit. Plans contained detailed information about needs and choices and the actions required by staff to meet those needs. There is now a monthly support plan book for each resident, reviewed and reprinted each month to include changes to the plans. At the end of each month a summary review takes place and is recorded. This information is incorporated into changes to the plans and it is recommended that this information is included in the new monthly individual plans to identify those areas that have changed. Risk assessments were found to be in place in the relevant areas of the plans matching the instructions to staff to meet particular areas of need. A risk assessment - questioned at the last inspection – showed that the person requires constant staff support of 2:1 at all times whilst at home and 3:1 at all times outside the home. This person is occasionally subject to physical restraint, PRN medication and physical aggression to staff and other residents – risk assessments were in place to address each of these issues. Measures to reduce or eliminate risk were identified in the relevant part of the support plan and all reviewed on a monthly basis as agreed and required in recent inspections and the homes improvement plan. Plans included good assessments in areas such as behavioural triggers, continence care, nutrition, communication and personal safety - all had matched risk assessments to assessed risk. A risk assessments strategy seen in relation to all respite care users had 12 areas of risk defined including: night care, nutrition, activities, diagnosed conditions, transport etc and there was a programme for ongoing review of all respite support plans on a 3 monthly basis commencing May 2008. Risk assessments have been evaluated on a monthly basis, evidenced through daily recording and become part of the monthly internal review process as stated in the homes improvement plan. Activity plans were in place in records seen. Some plans outlined activities for the week; others had short timescales. A resident unwilling/unable to plan often beyond the present day had a record of activities and choices made. Previous concerns about a lack of resident input into plans was addressed by means of a specific monthly allocated 1:1 Talk Time for each person. This has 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 12 been successful for some but not feasible for all as mentioned above. It nevertheless provides the opportunity for residents to state their likes, dislikes, choices and criticism of the service. Due to the complex and individual needs of some residents 1:1 engagement may be often refused, but other productive means of communication are spasmodically used – this was exampled with a resident with no speech or hearing, using BSL (British Sign Language) with staff who have established a means of communication with the persons own version of BSL. These inputs should be recorded and quantified as an important part of the care process for this person, staff are sometimes reluctant to record this vital input, they do not always consider it is part of the activity programme for the person. The standard of recording of care information showed some shortfalls in quality. The Manager agrees that this must be improved and intents to arrange some staff training with completed examples of recorded information. This is a further task now that support plan information has been changed and completed for all people using the service. Residents are involved in reviews where possible although the home is working towards a more user friendly format for reviews within the Organisation and a local group is being established to forward the option. Keypad risk assessments highlighted in previous reports have been reviewed these include inevitable communal risk assessments for example for kitchen access but also individual use of, for instance – locked wardrobes which have been reviewed on a multi-agency basis with the person and reasons clearly stated in care plans. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11 -16 Quality in this outcome area is good. Residents views of chosen lifestyles and activities are sought and met where possible. Community based activity is identified and used appropriately. Family contacts are maintained and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were no requirements relating to lifestyle at the time of the last Random Inspection 3 months ago. Residents use day service provision as part of their activity week. This applies particularly to respite residents where continuity of routines are important. Some permanent residents use the service also having established relationships over time with people in the day centres. On the day of this inspection 4 people were attending local day centres, this included respite care 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 14 residents. Other people were taken out for a walk, to the shops and this included a resident who required 3:1 staff for all external activity. A permanent resident considers he is too old “retired” and does not want to continue attending day services, his activity programme shows he attends cinema, meals out, walks, shopping and interactions with others. He also likes attending an evening disco. This person has severe mental health needs which sometimes dictate his activity programme. A small group had recently enjoyed a day out in Liverpool (at their request), records showed that recent choices were Safari Park and the seaside. Records showed entries such as “went for drive to Wolverhampton, Dudley & Birmingham. Transport is readily available as needed. The home have a min-bus and private car at their disposal – lack of transport does not restrict activities. Activity programmes and boards are in place which are pictorial ensuring residents are able to identify their programme of activity and external visits. Talk-time 1:1 specifically identifies choices of lifestyle and activity with residents. The home now records when 1:1 time is refused or activities are offered and refused, sometimes on a daily basis depending upon the persons psychological status that day. Individual preferences are sought and accommodated. One person spends time in his bedroom for sexual expression. This is understood by staff who ensure he has the appropriate private time uninterrupted. Efforts have been made to identify educational courses for residents. One now attends literacy group another applied for course, which was over-subscribed and has been offered a summer school placement. Family involvement in all aspects of care are a priority. Three people are currently taken by staff to visit their family on a weekly basis. Others receive either visits or telephone calls from relatives. Some respite care families continue to speak daily to the home, or even visit, others do take advantage of the need for a respite break. All respite carers are given a discharge letter giving an overview of the respite placement. Support plans record food likes/dislikes, although daily menus were not inspected. The records of a resident without speech showed that he makes daily choices, is involved in some food preparation – uses pizza bases, chooses toppings and makes cakes. The kitchen is secured by keypad as mentioned above, which does not restrict its ultimate use by residents. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18 – 20 were inspected on this visit. Quality in this outcome area is adequate. The recording of personal and healthcare needs has improved. Physical and emotional health needs are met. Action is being taken to remedy a poor service from a GP practice. Medication procedures have been strengthened to ensure a safe system is in place. The service meets the health and personal needs of the people using the service and they are kept safe by improved medication procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Outstanding requirements of the Random Inspection on 5/02/08 identified that: - Meeting healthcare needs must be evidenced. Routine screening and monitoring of residents ongoing health needs must take place and ensure all receive annual health checks including well person clinics. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 16 This related mainly to one resident with high dependency needs. The GP practice concerned presents difficulties in the home complying with the requirement. “Well-person clinics” are not provided by the practice – only consultations for specifically identified health care needs. The person in question had a minor accident recently in the home a GP visit was requested to check any injuries. The practice stalled - requested attendance at the surgery, insisted upon a request by 10a.m for a home visit etc. The person concerned requires 3 staff to support external visits and presents severe behavioural difficulties when attending health clinics/hospitals etc. It was impossible for the home to secure an examination for this person and they monitored closely for any injuries. If there had been obvious concerns the A & E facilities would have been used. These matters were documented in detail and evidenced during the inspection. The home are currently trying to contact the Health Facilitator (Learning Disability Service) for alternative GP allocation. It is strongly recommended that the home put the issues in writing to the Health Facilitator as a matter or urgency. It was clear that the home have attempted to resolve these issues to the best of their ability but been unable to do so for the reasons stated. In relation to the same person the last inspection revealed that regular weighing had not taken place on a monthly basis. Records on this visits showed regular recording of weight over the past 4 months. There is a health action plan in place for all permanent residents and the home were able to evidence that appointments had been made for annual checks for all other residents at a GP practice on 9/05/08. A requirement to review a protocol for PRN administration of anti-psychotic medication which had not been reviewed since October 2007 has been actioned. The Consultant Psychiatrist reviewed the protocol on 20/02/08, ongoing reviews will be monitored by the home for all PRN medication. Reviews of other PRN protocols have also taken place including analgesics. PRN medication is signed for on MAR sheets and recorded in daily notes. It is recommended that when PRN medication is given a record of the reasons for its administration and also the outcomes should be recorded on MAR sheets to enable easy monitoring. Support plans and other records evidenced that the ongoing monitoring of health issues are satisfactory. New policies and procedures to increase the safety of medication for respite residents were introduced in January 2008 following a requirement in October 2007. The cooperation of carers and introduction of the new procedures have ensured that the receipt, storage and disposal of medication for respite care users is monitored closely and provides an audit trail in the event of any shortfalls and also ensures a safe system. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were inspected on this visit. Quality in this outcome area is good. Complaints have been received and appropriately actioned. Referrals are made to the local Safeguarding Adults team with excellent cooperation from the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No requirements were made as a result of the last inspection in relation to this outcome group, although practices which were regarded as restrictive were identified and have been addressed by means of risk assessments, multiagency and resident agreement. These include areas such as locking wardrobes and other doors. The complaint procedure is in an easy read format and seen on files and in the reception area of the home. Three complaints seen were appropriately logged and addressed within the required timescales. Not all staff have received training in Safeguarding of Vulnerable Adults and this should be dealt with under a training requirement in Standard 32. A Safeguarding referral was made by the home in January 2008 and a member of staff suspended. The investigation continues. Prior to this inspection the Adult Protection Coordinator (Social Services) stated that the Manager of 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 18 Bescot Road had been totally co-operative, pro-active and been extremely helpful in providing the necessary information for the investigation. Physical restraint is used as a final option only in relation to one person in the home. Documents seen showed detailed protocols in place and clear records showing the necessary details of the actions and outcomes. These records are now countersigned by the Manager and should be reviewed during Regulation 26 visits by the providers representative. A person who self-harms has a risk assessment in place, reviewed on a monthly basis. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 - 30 Quality in this outcome area is good. A homely, comfortable environment, well maintained and safe with good facilities. Bedrooms suit lifestyles and promote independence. Standards of hygiene are high. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated in an area, which is easily accessible to local shops and other community facilities. The building is well presented. All areas are well furnished and provide a pleasant, comfortable homely atmosphere. Unfortunately keypad locks are used throughout the building, risk assessed to ensure the safety of residents. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 20 The building is essentially divided into 2 areas one on each floor which are replicated and each area includes 4 single occupancy rooms, all en-suite, some with showers, a shared bathroom, lounge, dining, kitchen and toilet areas. There is a shaft lift for access to the first floor. The two units operate and are staffed independently, although staff work between the two. The external parts comprise a parking area at the front and small garden area at the rear. Entrances and exits are ramped providing good access for people with mobility needs. High standards of cleanliness and hygiene were present throughout the home. Cleaning is carried out by staff and with input from residents where possible/appropriate. There is a laundry on each floor, resident encouraged to bring their laundry, washed and ironed by staff. Furniture, fittings and equipment are to a good standard and maintenance is generally good. Some areas are furnished comfortably but minimally. Moveable objects is some areas have to be removed to ensure safety for others when challenging behaviours occur. A sample of bedrooms were seen and were well personalised reflecting the individual interests of residents. The building meets required minimum standards and meets the needs of the resident group. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 – 35 were inspected on this visit. Quality in this outcome area is poor. Staff roles are clearly defined and staffing numbers adequate to meet need. There are shortfalls in staff training that must be addressed. Poor documentation of recruitment procedures must be improved to ensure protection of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was staffed at the time of this unannounced inspection with 7 staff. There were 7 people in residence. This is the usual staffing throughout the day and 3 waking night staff are on duty at night. There have been discussions at previous inspections about staffing levels but this number is adequate for the current needs of the resident group. Higher staffing ratios are needed for some residents but several attend day service centres and overall the numbers are adequate. There is a registered nurse on duty at all times. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 22 There were staff shortages at the start of the year but new staff have been appointed and are in place. The files of 2 new staff members were inspected. There were no photographs, no proof of qualification (although the pro-forma stated so), no statement of physical/mental health. It was not possible to ascertain previous employer and whether a reference had been obtained or any gaps in employment identified/pursued. The Area Manager said that we had agreed for personnel records to be held centrally at the Providers regional office and a pro-forma completed on each persons file. It was impossible to check many aspects of recruitment and whether all documents required under Schedule 2 were provided. This must be resolved between the home and HR Manager to ensure that during inspections checks can be made to ensure all checks/references have been obtained as required. The pro-forma said that in both instances CRB checks has been received prior to the start date for each employee and CRB numbers listed on the form. The Manager sees all documents during the recruitment process but she needs to check with HR to ensure they are all present and correct. These shortfalls were identified at the time of the last inspection and must be resolved. Induction records for one member of staff were present, had been completed accurately, discussed and signed by the employee and the trainer. The other induction record was not present the Manager said the carer had the records with her. This reason was given for an induction file not present on the last inspection. A staff training matrix has been established since the last inspection and in line with the homes Improvement Plan identifying areas of training completed and those which need to be met. The Improvement plan stated that staff have been nominated for courses and Bescot Road staff given priority. Shortfalls in training were clear from the matrix in relation to most areas of statutory training and although nominations have been accepted for some courses, there are waiting lists for other. This must be addressed swiftly by the providers. Only 5 staff presently have completed NVQ training, below the recommended 50 of total care staff. A further 6 are to commence NVQ training in the near future. Numbers of NVQ trained staff must be increased. Staff engagement with residents was observed to be excellent. Communication skills were evident - exampled by staff communicating throughout the day with a resident with no verbal communication and no hearing. BSL (British sign language) was used as the main means of communication. Knowledge of the specific needs of residents were also evident from discussions with and observations of staff during the inspection day. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37 - 42. Quality in this outcome area is adequate. Management leadership in the home has improved. The views of people using the service are more actively sought - further progress is needed. Record keeping has improved but quality needs improvement. Health & Safety competence could improve with further training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Management of this home has been poor over the past 12-15 months. The Registered Manager was on maternity leave for 7 months returning in November 2007. Also during that time the Area Manager left and there was no interim support. An Acting Manager was brought into the home at a late stage 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 24 to address the many outstanding issues. By the time the Registered Manager returned in November and new Area Manager appointed late 2007 many aspects of management and care required urgent action. Some requirements identified at the last Key Inspection on 10/10/07 and the subsequent Random Inspection on 5/02/08 had been outstanding from 2006. Since her return in November 2007 the Manager has been urgently addressing serious shortfalls in support plans and risk assessments. All have been reviewed, revised and re-written to provide a comprehensive plan to support all aspects of resident need. This has been a very significant task – originally completed for the 4 permanent residents and latterly completed just prior to this inspection for all 19 respite care users The result has provided a much needed and improved system of planning and support for all using the service. Plans are now person centred. Shortfalls in staffing have resulted in the appointment of new staff. The Registered Manager is a qualified nurse and has obtained the Registered Managers Award. She has considerable experience in this and other services in meeting the needs of people with complex needs and particularly those with behaviours that challenge the service. She is an approved trainer in restraint techniques. There have been shortfalls in areas of statutory and other training for staff. Two new trainers employed by the providers have given preference to Bescot Road staff but there are still shortfalls, although most have planned dates for training. A staff matrix completed following the last inspection report has finally highlighted areas where training has taken place and those where it is needed. The Area Manager who was present throughout this inspection has given support to the Manager in addressing the management shortfalls. The Manager has worked hard to further develop the service as highlighted in the last inspection report. Considerable improvements have been made and need to continue. An improvement plan completed by the Manager in January 2008 identified a 8 requirements which have now been met – these are: Revised Care Plans and risk assessments, regularly reviewed. Individual preferences & choices of residents sought and acted upon with the introduction of 1:1 talk time for all residents. Risk assessments provided relating to key pads. Individual risk assessments related to individual risk and reviewed regularly. Improvements in health action plans and routine screening. Procedures revised to improve safety of medication for respite care users. Staffing levels confirmed and agreed to meet resident needs. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 25 Although the timescales for the above did not meet our required dates, all had been completed at the time of this inspection. Requirements where progress has been made but not finalised satisfactorily are: All aspects of statutory training must be completed for all staff, particularly where this relates to the health & safety of residents. Recruitment documentation still requires urgent action. Further progress on feedback from users of the service. All service users are presently involved in the process of completing quality assurance audits developed by the Quality and Performance Manager who is also developing a monthly audit tool. This will be repeated with relatives/carers, which has happened in the past and also for other stakeholders. Outcomes will inform planning and development of the service. 1:1 talk time introduced for all residents has secured a vital input for people using the service. Regulation 26 visits carried out monthly by the Area Manager were seen and documented the monitoring of progress and shortfalls. The Fire Officer identified shortfalls in fire protection issues in his letter to the service and us dated 13/02/08. The Manager stated that action had been taken and confirmed satisfactory by the Fire Officers visit in April. This was later confirmed in discussions with the Fire Officer. Considerable progress has been made in meeting the requirements following the key inspection on 10/10/07 and since the return of the Registered Manager from leave. This was evident at the Random Inspection on 5/02/08 and confirmed during this inspection. Further action is required in some areas. Sustained improvements will be monitored closely on future inspections. 68 Bescot Road DS0000062047.V363222.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 2 2 2 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 1 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 3 2 2 2 2 x 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 27 No 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 YA32 Regulation 18(1) Requirement All staff must have training appropriate to the work they perform. This will ensure the safety of residents. Recruitment procedures and documentation must evidence that all documents listed in Schedule 2 have been obtained and are satisfactory prior to employment Timescale for action 30/06/08 2 YA34 19 & Schedule 2. 07/05/08 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 YA20 Good Practice Recommendations Continue to improve the standard/quality of recording MAR sheets should record reasons for PRN medication and also outcomes. 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 68 Bescot Road DS0000062047.V363222.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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