Inspection on 22/09/08 for 68 West Park Road

This inspection was carried out on 22nd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

68 West Park Road 24/03/09

Similar services:

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

CARE HOME ADULTS 18-65 68 West Park Road Smethwick Birmingham B67 7JH Lead Inspector Lesley Webb Unannounced Inspection 22nd September 2008 08:45 DS0000071851.V371415.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 DS0000071851.V371415.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. DS0000071851.V371415.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 68 West Park Road Address Smethwick Birmingham B67 7JH 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) 01707 652053 www.caretech-uk.com CareTech Community Services Ltd Miss Marie Fisher Care Home 12 Category(ies) of Learning disability (12) registration, with number of places DS0000071851.V371415.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 12 The maximum number of service users to be accommodated is 12. 2. Date of last inspection None – first inspection. Brief Description of the Service: 68 West Park is located along a residential road in the Smethwick area of Birmingham. It is close to all local amenities and transport links for Birmingham, Dudley and Sandwell. There is sufficient off road parking located through the side entrance. The building is divided into two units each comprising of four residential beds and two self contained flats. The accommodation is located on three floors of which the first is accessible via a lift. Both units have large fully fitted kitchens and separate laundry areas. The building has two large lounges and separate dining areas. There is a large separate room available on the ground floor that has been designated to be used for staff meetings and residents reviews. There is a pleasant garden to the rear of the premises mostly laid to patio. The garden has suitable perimeter fencing to provide privacy and is gated on both sides guaranteeing access and security. Specific information regarding fees charged for living at the home is not included in the homes Statement of Purpose. Interested parties should contact the home for this information. DS0000071851.V371415.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection over a day. The home was not informed that we would be visiting. Time was spent examining records, talking to staff and residents and observing care practices, before giving feed back on our findings to the registered manager and responsible individual for the organisation that owns the home. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI) in the form of its Annual Quality Assurance Assessment (AQAA). Information from this was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking 3 individuals care provided at the home. For example the people chosen consisted of both male and female and have differing communication and care needs. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be implemented for all residents needs to ensure these are managed safely. DS0000071851.V371415.R01.S.doc Version 5.2 Page 6 Risk assessments must be implemented that inform choices and support residents in their daily lives. Improvements to some medication practices must happen to ensure greater protection to residents. Detailed care plans, risk assessments and documentation for the monitoring and management of behaviours must be implemented in order that staff have sufficient information to support residents, whilst reducing where possible the risk of harm and/or injury. Staffing levels must be maintained to the assessed needs of individuals living at the home. This will help meet their needs safely. The home must be able to demonstrate recruitment checks have been completed for anyone who works at the home. This will reduce the risk of harm to residents. Sufficient numbers of staff must have undertaken specialist training in order to meet residents’ individual needs. A list of recommendations is located at the back of this report if people wish to view. 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. DS0000071851.V371415.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000071851.V371415.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information is available to people considering moving into this home. This helps them decide if it can meet their needs. The needs of people are not always assessed before they move into the home. This means people with specialist needs may receive a poor quality of care. EVIDENCE: The home has a statement of purpose and service user guide that set out the aims and objectives of the home. For example they include details with regard to the registered managers experience and qualifications, staff, the environment, rules on smoking, keys to rooms and peoples rights. Efforts are being made to make this information assessable to people who may not understand the written word by using colour pictures as aids to communication. This is the homes first inspection since being registered with us. As part of the registration application we were informed that 2 residents would be admitted upon registration with another 2 people over a six month period due to the complex needs of people who would be living at the home. This phased process would allow the home to not only identify residents’ needs but also ensure these are met and managed safely. Upon arrival to the home we were DS0000071851.V371415.R01.S.doc Version 5.2 Page 9 informed that there are currently 9 residents, 4 of which are planning to be living at the home for 6 months and one who moved into the home as an emergency. Evidence sited throughout this report indicates that the home is not currently meeting all needs of residents safely. We asked the registered manager if the homes statement of purpose informs people that they offer respite services and she did not think it did. The homes statement of purpose states ‘the home does not take service users on a respite basis and any potential service users who may need to be found accommodation urgently will still be carefully assessed to ascertain suitability and compatibility’. Evidence indicates the home is not complying with this statement. We looked at the records for 3 of the newest people to move into the home to see if assessment processes ensure individuals’ needs are identified and managed safely. We found that one person did not have any pre-admission assessment in place and the other 2 only brief assessments that were completed by the funding authorities. The registered manager informed us that one person had moved from another service owned by CareTech and care management documents had transferred from that place of residency when the individual moved into the home, another resident was an emergency admission and the other individual was one of 4 people who moved here on a temporary basis. From examination of records, discussions with staff and management it appears the decision to admit some residents to the home was based on filling beds rather than receiving a thorough assessment of individual need. This has resulted in omissions in care planning, risk management and staff training, all of which impact on the quality of service people receive living at the home. One of the 3 residents who we case tracked visited the home before they moved there in order to decide if it would be suitable for them. The registered manager informed us this was not possible for one person due to being an emergency admission and that for another staff from the home visited them in there previous home as this was thought to be less distressing for the individual. They then visited with a family member for an hour (records viewed confirm this to be accurate). As mentioned above, the home offers a specialised service for people with complex needs. As such it is recommended that a range of visits suitable to the individual be completed in order that the findings of these can be incorporated into the homes pre-admission assessment. This will help ensure staff have sufficient knowledge of the individual so that they can meet their needs. It will also help prospective residents decide if the home is suitable for them. There were no contracts of residency in place at the home for any of the 3 residents we case tracked. Therefore we could not assess if residents legal rights are being protected with regard to terms and conditions of residency. DS0000071851.V371415.R01.S.doc Version 5.2 Page 10 DS0000071851.V371415.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning and risk management is poor and does not ensure individuals’ needs are identified, met and reviewed. Not all individuals are supported to make their own choices and decisions. EVIDENCE: We examined the care records for 3 residents, talked to staff and indirectly observed practices and found that care planning processes do not meet all residents’ needs. When we asked to view the care plans for the 3 residents we were case tracking we were informed these are still being developed. We asked to view the documents that staff currently have access to. These are very basic and do not give information in all areas that the individuals require support. For example one person’s documents identify they require support to manage their finances but no care plan is in place explaining how this support will be provided. The resident confirmed this area of need when we spoke to them. As they explained, “I have a problem with managing money. Need DS0000071851.V371415.R01.S.doc Version 5.2 Page 12 guidance and support, staff to help me”. Another resident with complex behavioural needs has no care plans apart from behaviour guidelines and these do not cover all needs in this particular area (discussed further in the protection section of this report). The third persons records we looked at include an individual support plan. This gives basic information about the person. Daily records are completed for each person living at the home. These give an insight into the person’s routine each day, their state of wellbeing and any appointments they have attended. Additional care should be taken to ensure these are completed for every shift as we found this not to be the case for the 3 residents who we case tracked. We asked the registered manager how residents are supported to make choices and decisions. She informed us that the home has recently implemented monthly co-ordination duties for key workers and ‘talk time’ on a monthly basis where each resident has an individual meeting with their key worker to discuss their support. We found no records to evidence that these meetings are taking place and the registered manager confirmed they may not have started yet. The residents in the home have a range of needs including communication, behaviour and sensory. Some staff were seen to use signing to aid communication. It is recommended other forms of communication be explored such as the use of photographs, pictures and objects of reference in order that all residents can be involved in decision-making processes. When examining the records for one resident we found them to contain this statement of capacity and best interest ‘is able to give basic information regarding what he likes and dislikes but would not be able to provide comprehensive information in order to complete this documentation. This documentation has been devised by the staff, parents and his social worker to meet his needs having his best interest at the centre of the document’. We discussed this with the registered manager who confirmed that a written protocol and procedure had not been used when making this decision. It is recommended action be taken to ensure protocols are introduced when the decision is made that someone lacks capacity. This will help promote their rights and compliance with the Mental Capacity Act. We found no evidence of risk assessments being in place that inform choices and support residents in their daily lives. Improvements must be made in this area to ensure risks to residents are not only identified but also managed safely. We expressed concern to the registered manager with regard to the lack of care planning and risk management documents. Without these, staff have no information on which to support residents in a consistent and safe way. The DS0000071851.V371415.R01.S.doc Version 5.2 Page 13 registered manager acknowledged the shortfalls, explaining due to severe staffing shortages and no deputies she has spent most of her time “on the floor” supporting residents rather than completing paper work. We explained that this could not continue (discussed further in the management section of this report). DS0000071851.V371415.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts are being made to support individuals to develop their life skills and to participate in activities that meet their needs. EVIDENCE: We talked to residents, staff and examined records and found efforts are being made to support people to lead stimulating and interesting lifestyles despite the lack of permanent staff at the home. For example some residents attend day centres, one person is supported to access a college, individuals are encouraged to undertake independent living skills and some opportunities are given for people to access activities in the wider community. Improvements to the choice of activities in the community should be undertaken as records indicate some individuals with complex needs do not have the same opportunities as those requiring less support. For example the daily records for one person with complex needs detail activities as out for rides, shopping and meals. The daily records for a person with less complex needs detail DS0000071851.V371415.R01.S.doc Version 5.2 Page 15 activities as shopping, listening to music, out with visitor, gardening, college, banking, pub, night club and drive outs with another resident. The home has forms for recording activities. These were found to be blank on all 3 of the residents’ files we case tracked. It is recommended these be used for recording and evaluating activities in order that the home can monitor that activities meet individuals’ expectations. An area that the home should consider improving is that of sensory stimulation. There are 2 sensory rooms within the home but neither have a range of equipment that would make them stimulating to the user (this is discussed further in the environment section of this report). The environment has been planned to promote individuals independence. For example an area of the building is divided into self-contained flats, each with its own kitchen. We indirectly observed one resident being supported to prepare a meal and another informed us “I have put on half stone, doing more cooking since been here”. During our inspection we observed that daily routines, where possible are flexible. Staff were seen to spend time with all residents, treating them with respect and courtesy. Meals that residents have are varied and well balanced. We observed the evening meal being prepared. We noted that there appeared to be only one choice and the menu on display in the kitchen confirmed that 2 choices are not offered every day. It is recommended that menus be expanded to offer 2 choices of main meal every day and that menus be reproduced in alternate formats to that of the written word, in order that all residents can be involved in decision making. It is also recommended that nutritional assessments be undertaken for all people living at the home. This will help monitor that the dietary needs of residents are identified and managed safely. Residents that we spoke to confirmed their enjoyment of the meals provided. As one person explained, “for tea think its sausages casserole, the foods lovely here”. DS0000071851.V371415.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the main the health and personal care that people receive is based on their individual needs. Further work is needed with regard to health care monitoring and recording of medication to ensure individuals receive person centred support in a safe way. EVIDENCE: We observed that staff had paid attention to each person’s personal care; people were wearing clothes in good condition suitable to their age and gender. Staff were seen promoting residents privacy and dignity by ensuring personal care is carried out in private and encouraging high standards of personal hygiene. Improvements should be made to ensure health related records are completed in full so that the health needs of residents are managed safely. Each persons’ records that we looked at contained a health action plan but none have been completed in full. Also for two individuals their health action plans identify actions needed by staff but no evidence could be found of these being acted DS0000071851.V371415.R01.S.doc Version 5.2 Page 17 upon. These include the need for staff to arrange an eye examination and for a hearing test. We did find evidence that residents are being supported to attend General Practitioner appointments however these are reactive measures due to feeling unwell or accidents. Systematic health action planning will support a holistic approach to health management. As mentioned earlier in this report care plans and risk management systems must be improved. This also applies to care planning for health needs. None of the 3 residents we case tracked have care plans for specific health needs and therefore staff do not have the information needed to support people safely. For example one person is diabetic with no care plan or risk assessment in place. We asked the registered manager how this is managed. She explained this is controlled with medication and diet and that blood sugar levels are taken daily. We looked at the blood sugar monitoring records for this person and found the frequency of recordings to range from every 2 days to every 2 weeks. We asked a member of staff what the safe levels should be for blood sugars and they stated, “I don’t know would have to check”. The registered manager confirmed staff have not received training in this area. The lack of care planning, monitoring and training in this area is unacceptable as it places the residents at undue risk of harm. Medication systems require some improvements to ensure greater protection to residents. For example written consent with regard to administration of PRN (as and when required) medication must be obtained from the prescriber, a record of stock maintained in the home must be maintained for PRN medication used for managing behaviour and staff must sign medication administration records (MAR) every time they give a resident medication. The drugs cupboard was clean and tidy with no overstocking. The registered manager confirmed staff have received training to administer medication and that competency assessments are currently being introduced. DS0000071851.V371415.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individuals have access to a complaints procedure. The management of behaviours is not safe and places individuals at risk of harm. Some recruitment practices are not safe and do not offer safeguards to individuals. EVIDENCE: There is a pictorial complaints procedure and information regarding complaints is contained with the service user guide and statement of purpose. As yet residents do not have their own copies of the complaints procedure. The registered manager informed us these are currently being worked upon and each person will have a copy kept in their bedrooms. We spoke to 2 residents with regard to raising concerns and making complaints. Both stated they felt comfortable to talk to staff if they were unhappy. As one person explained, “I would talk to my key worker, she has got a lovely face”. We examined 3 residents’ records for monies held on their behalf by the home and found all generally to be in order. As with other areas care plans and risk assessments are not in place that inform staff how to individuals require support to manage their finances. These must be implemented to ensure residents receive consistent support from staff. When examining the financial records of residents we noted that records indicate residents’ pay for meals eaten outside of the home. We discussed this with the registered manager DS0000071851.V371415.R01.S.doc Version 5.2 Page 19 who explained the home contributes £2.00 for each meal and the resident pays the remainder from their personal finances. Contracts of residency were not available in the home and therefore we could not check if this practice is compliant with the terms and conditions stated within. We did examine the homes statement of purpose, recommending this be reviewed and amended. This currently states meals are provided by the home and makes no reference to contributions that have to be made by residents. We examined the behavioural support plan for one resident who needs assistance in this area. The plan is specific to one area of need and does not cover all behaviours displayed by the person. We examined accident, ABC charts and daily records for this person and found records are not being completed to a satisfactory level to ensure this persons needs are managed and met safely. For example one accident and incident record details an incident of self injury resulting in restraint being used and medication administered to manage the behaviour. No care plan or risk assessment is currently in place that explains how, when and why restraint should be used or for the use of PRN (as and when required medication) to manage behaviour. Staff have recorded another incident where PRN was administered for behaviour but no accident record or notification in line with Regulation 37 of the Care Home Regulations has been completed. We also found accident records for incidents of aggression with no ABC incident analysis records and visa a versa. We found body charts completed for some reported injuries and not others. We found MAR charts completed when medication has been administered to manage behaviour and not for others. Of particular concern is an accident record that informs due to displaying behaviour the resident was restrained, resulting in bruises to their body. We were notified of this incident in line with Regulation 37 of the Care Home Regulations 2001 however the notification makes no reference to being restrained or bruising to the body. If the bruising is a result of restraint this is inappropriate and the practice must cease to ensure the persons human rights are not compromised. As we explained to the registered manager care plans and risk assessments must be implimented for all behaviours. These must include instructions on triggers, diversion tactics, forms of behaviour, frequency, use of PRN, associated record keeping and approved physical interventions. In addition to this the registered manager should complete an analysis of incidents in order to inform the reviewing of behaviour guidelines. Guidelines should also be agreed within a multi disciplinary forum. This offers greater protection to the resident. Due to our concerns we issued an immediate requirement form for omissions in care planning, risk management and documentation for the management of DS0000071851.V371415.R01.S.doc Version 5.2 Page 20 behaviours having the potential of placing residents at risk of harm and/or injury. The home was instructed to completed detailed care plans, risk assessment and documentation for the monitoring and management of behaviours in order that staff have sufficient information to support residents, whilst reducing where possible the risk of harm and/or injury. They were instructed to do this within 3 working days. Due to poor records with regard to staff training (discussed further in the staffing section of this report) we could not access if suitable numbers of staff have received training in adult protection and aggression. Recruitment records sampled showed that a robust procedure is not being followed for the protection of people living in the home (detailed further in the staffing section of this report) with regard to agency staff. Improvements must be made in this area to offer further safeguards to residents. DS0000071851.V371415.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals live in a safe, well-maintained and comfortable environment that encourages independence. EVIDENCE: We toured the premises and found it to be decorated and furnished to a good standard. This service was registered with us as new April 2008 and it was assessed as meeting the requirements set out in the Care Homes Regulations and stated in the National Minimum Standards for Care Homes for Adults (18-65). 68 West Park is located along a residential road in the Smethwick area of Birmingham. It is close to all local amenities and transport links for Birmingham, Dudley and Sandwell. The building was previously used as a care home for older people but has undergone extensive renovation. There is sufficient off road parking located through the side entrance. The building is DS0000071851.V371415.R01.S.doc Version 5.2 Page 22 divided into two units each comprising of four residential beds and two self contained flats. The accommodation is located on three floors of which the first is accessible via a lift. Each unit has four single occupancy bedrooms with generously sized en-suite wet room facilities. All bedrooms seen were furnished to the required standard, with good quality furnishings and fittings. There are two self-contained flats in each unit comprising of a lounge/dining area, bedroom and en-suite wet room. The kitchens are fully fitted to a high standard. There are two sensory rooms within the home. When the home was registered with us in April 2008 a catalogue was seen highlighting the sensory equipment that will be purchased. At this inspection it was disappointing to find very little equipment has been purchased. We discussed this with the registered manager who stated, “We are getting to know residents needs before purchasing”. We asked if advice from a relevant professional has been sought and she said no. We advised that this takes place due to the varying needs of people living at the home. We also advised that this be obtained as a priority to increase the opportunities of sensory stimulation for people living at the home. There is a pleasant garden to the rear of the premises mostly laid to patio. There are handrails along the patio area. The garden has suitable perimeter fencing to provide privacy and is gated on both sides guaranteeing access and security. There is a designated smoking area for residents within the garden. A shelter is needed for this facility that is complaint with the Smoke Free Regulations. Both units have large fully fitted kitchens and separate laundry areas. These have the necessary equipment in place to ensure infection control practices are maintained such as additional wash hand basins and dispensers for liquid soap and disposable towels. There are also dispensers for liquid soap and disposable towels in the shared bathing and WC facilities. Due to poor records with regard to staff training (discussed further in the staffing section of this report) we could not access if suitable numbers of staff have received training in infection control. DS0000071851.V371415.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individuals are not supported by sufficient numbers of trained staff. People living at the home do not receive a consistent quality service due to the high level of reliance on agency workers. Some recruitment practices do not offer sufficient safeguards to people living at the home. EVIDENCE: We received a mixed response from residents that we were able to hold a conversation with about staff that support them. One resident said, “staff are ok, sometimes hard, they don’t know my needs, I don’t really talk to them, don’t think they are used to people taking control, apart from that staff are good”. Another resident said, “the staff are much better here than where I lived before”. The lack of care planning documentation (discussed earlier in this report), insufficient training and the high reliance on agency staff (discussed below) maybe the reason some residents feel staff do not meet their needs. There are 14 staff vacancies (out of a possible 24), 2 of which are deputy positions. The registered manager explained that bank staff (CareTech staff DS0000071851.V371415.R01.S.doc Version 5.2 Page 24 from other homes) and agency staff are used to cover these vacancies. She also informed us of the 10 permanent staff employed at the home 3 hold a National Vocational Qualification (NVQ) and 7 are in the process of completing. No information with regards to agency workers and NVQ qualifications is known. Without this information we cannot assess if suitable numbers of people undertaking shifts at the home are suitably qualified to support residents. Staffing levels are not being maintained to the assessed needs of individuals living at the home. This means their needs might not be met safely. We asked the registered manager what staffing ratios should be in place for the 9 residents currently living at the home. We were informed a total of 7.5 care staff are required as one resident requires 2 to 1 staffing and 3 other residents 1 to 1. Before the 12th September the ratios were 6.5 as one of the current residents was not living at the home. During the night there are 2 wake night staff and a sleep-in person. The home does not employ separate ancillary staff and the manager’s hours are supernumerary to care. We were informed that apart from one day when agency staff were not provided staffing levels have been maintained. We viewed the staffing rotas for September. This details 10 permanent staff and 28 agency/bank staff undertaking shifts for the month. From 1st September to the 12th when 6.5 staff should have been on duty from 8am to 10pm the rota details 10 shifts with 5.5, 4 shifts 6.5 and 8 shifts with 4.5 staffing ratio. From the 12th September to the date of inspection the rota details 5 shifts with 5.5, 15 shifts with 6.5 and 2 shifts with 4.5. We discussed the rotas with the registered manager explaining they do not demonstrate staffing ratio being maintained to the assessed levels of residents. She said she thought they were, and was confused with .5 for residents and unsure if assessed levels correct. We advised the registered manager to undertake her own thorough assessments in order that residents can be confident staffing levels meet their individual needs. The registered manager also informed us that from Monday to Friday one resident attends a daycentre from 9-3.45 so staffing could be reduced. We explained that rotas indicate staffing is increased at this time of day using .5 and if fewer residents are in the home it should be the other way around. The registered manager agreed. Some recruitment practices do not offer sufficient safeguards to people living at the home. The organisations human resources (HR) department undertakes recruitment. They undertake a number of checks to make sure that staff are suitable to work with vulnerable people. We examined the recruitment records for 3 permanent members of staff employed at the home. 2 did not contain evidence that an enhanced Criminal Record Bureau (CRB) disclosure was obtained prior to commencing shifts at the home. Evidence of other documentation including 2 references, a POVAfirst and proof of identity was on file. We discussed the absence of enhanced CRB disclosures with the registered manager who confirmed both members of staff had commenced employment without this. She was not aware that in order for this practice to DS0000071851.V371415.R01.S.doc Version 5.2 Page 25 be safe to residents additional safeguards should have been completed as recommended by the Department of Health (e.g. risk assessments and allocated supervisors). We asked the registered manager for the recruitment profiles for the 28 agency staff as detailed on staff rota for September. She was able to produce profiles for 12. These detail dates when a CRB issued, confirm 2 references seen and that staff hold first aid, food hygiene, manual handling, fire, infection control, medication and health and safety training. For many profiles they indicate all training is received on the same day. We questioned how staff could retain information if undertaking so many courses on the same day. An agency worker on shift confirmed they undertook 6 courses on the same day. The registered manager agreed that this is too many courses for staff to retain information that supports them to undertake their duties. We were concerned with the number of agency workers who did not have recruitment profiles in place as this could mean residents are being supported by staff who may not be safe to work at the home. Sufficient numbers of staff have not undertaken specialist training in order to meet residents’ individual needs. The profile provided by the staff agency gives information with regard to first aid, food hygiene, fire, health and safety and moving and handling but does not give information of specific training to meet residents’ needs. Due to the high numbers of agency workers currently undertaking shifts at the home and because the profile does not include this information we have to assume this training is not provided by the agency. This means residents are being supported by staff that may not understand the needs of people living at the home. There is currently no system in place at the home for identifying training permanent staff have undertaken, when this occurred and the numbers of staff who have received this. We discussed this with the registered manager advising that a training matrix be developed in order that the home can monitor that suitable numbers of staff have up to date training to meet residents needs. During our inspection the organisations human resource department was contacted and emailed a copy of staff training details to the home for permanent staff. This gave information for 7 staff 1 who has undertaken communication training, 1 epilepsy, 1 diabetes and 3 non-violent crisis intervention (NVCI). We also looked at the files for 3 permanent staff to see if we could find further evidence of training. 1 did not contain any certificates with the registered manager informing us these were being “chased with HR department and previous home”, another did not contain certificates for any specialist training and the third certificates including those for visual awareness and diabetes. We were shown a record of training booked for October to March that details 5 permanent staff and the registered manager booked to undertake medication, NVCI, risk assessment, manual handling, food hygiene, mental capacity, epilepsy, infection control, food hygiene and LDQ. We explained to the registered manager we are concerned that at present sufficient numbers of staff have not received training to meet the needs of people living at the home. This means staff may not support residents safely. DS0000071851.V371415.R01.S.doc Version 5.2 Page 26 Due to our concerns with regard to 14 staff vacancies out of possible 24 being covered by agency and bank staff and omissions in recruitment and training records we issued an immediate requirement form during the inspection instructing that an action plan must be submitted to us detailing what actions will be taken to minimise risk to residents whilst ensuring their needs are met safely. DS0000071851.V371415.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management of the home is not meeting all the needs of residents safely. EVIDENCE: Ms Fisher became the registered manager of this home in April 2008. She has had almost six years experience working in a social care setting and has had five years relevant management experience. She has been in her current post with CareTech since the 3rd March 2008. Ms Fisher holds a NVQ Level 3 and has undertaken short courses including supervision & Appraisal, sexuality & relationships, adult protection and mental capacity. During the inspection Ms Fisher informed us she should be completing the registered managers award by the end of October and that she has recently signed to start the NVQ level 4 in care. DS0000071851.V371415.R01.S.doc Version 5.2 Page 28 Evidence is sited throughout this report that all the needs of residents’ are not being met and in some instances this is placing residents at risk of harm and/or injury. For example there are major omissions in care planning and risk management, the high number of staff vacancies being covered by agency workers is impacting on consistency of service and the lack of trained staff means residents needs are not always understood. The registered manager acknowledged the shortfalls, explaining due to the severe staffing shortages and having no deputies she has spent most of her time “on the floor” supporting residents rather than completing paper work. As already mentioned in this report we issued an immediate requirement during our visit instructing that an action plan must be submitted detailing what actions will be taken to minimise the risk to residents whilst ensuring their needs are met consistently and safely. During our visit the responsible individual for the home contacted the organisations operations manager who agreed not to admit any more residents at the present time until the current situation improves. This is positive, as it will allow the home to concentrate on making improvements for people already living at the home without increasing risks. The organisations quality monitoring processes are in the process of being implemented. We were informed that the organisations quality assurance officer recently visited the home and completed an audit and that the home is waiting for a copy of the report. The registered manager informed us that she completes random checks in areas including meals and the environment but has not recorded the outcome of these. We advised records are maintained in order that the home can monitor where improvements are needed and when achieved. Prior to this inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. The contents of this were detailed. During our inspection we found that the contents of this do not reflect the current situation at the home. We discussed this with the registered manager, advising greater accuracy when next completed. We did send residents surveys to the home before our visit but did not receive any back. The registered manager informed us this was due to residents not able to understand the questions and staff not having enough knowledge of residents to assist them. This is further evidence that care planning and training is needed in order that staff understands residents’ needs. When the home was registered with us in April 2008 a number of health and safety documents were assessed as part of the application that demonstrate it is complying with relevant legislation. For example completion certificates were viewed confirming that the fire alarm system and emergency lighting had been installed and tested and had been passed as safe. A completion certificate for the electrical hard wiring had also been seen and had been signed off as satisfactory with another test due in five years. There was also a Gas Landlords Safety Certificate on file. A letter was seen from the Fire Safety Officer for West Midlands Fire Service who visited the premises 12 March 2008 and expressed satisfaction with the current arrangements for the prevention of DS0000071851.V371415.R01.S.doc Version 5.2 Page 29 fire. A fire risk assessment was in place. Certification was also seen that a risk assessment had been undertaken for the prevention of Legionella and there was also documentation in place to confirm there was a contract for the lift and it had been serviced 1 January 2008. We viewed accident records (as detailed in the protection section of this report). The registered manager confirmed that as yet no analysis of these is undertaken. It is strongly recommended this takes place and where necessary action taken to reduce risks to people. Records evidence that a fire drill took place June 2008. The records state 5 staff participated in this but does not include the names of individuals. As we explained to the registered manager the home must be able to demonstrate all staff (including agency workers) have participated in a fire drill. Also that for permanent staff that they participate in a fire drill at least every 6 months. This will help reduce the risk of injury to residents in the event of a fire. The registered manager stated that fire evacuation procedures are gone through with agency workers but that this is not recorded. As mentioned in the staffing section of this report systems are not in place that evidence suitable numbers of staff working at the home have received training in all required areas. We examined 3 permanent staff files. The first holds copies of certificate for manual handling and basic first aid. The second certificates for health and safety, first aid and moving and handling. The third contained no certificates. For over half the agency workers who have undertaken shifts at the home during September staff profiles were not in place to evidence training they have undertaken. The home must be able to demonstrate that sufficient numbers of staff (including agency workers) have undertaken food hygiene, first aid, health and safety, fire and moving and handling training. This will help promote the health and wellbeing of residents. DS0000071851.V371415.R01.S.doc Version 5.2 Page 30 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 1 3 2 4 2 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 2 30 2 STAFFING Standard No Score 31 2 32 1 33 1 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 1 X 2 X 1 2 X DS0000071851.V371415.R01.S.doc Version 5.2 Page 31 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 2 Standard YA6 YA9 Regulation 12(1) 13(4)(6) Requirement Care plans must be implemented for all residents needs to ensure these are managed safely. Risk assessments must be implemented that inform choices and support residents in their daily lives. Written consent with regard to administration of PRN (as and when required) medication must be obtained from the prescriber. A record of stock maintained in the home must be put in place for PRN medication used for managing behaviour. Staff must sign medication administration records (MAR) every time they give a resident medication. The above must happen to ensure greater protection to residents. Detailed care plans, risk assessments and documentation for the monitoring and management of behaviours must be implemented in order that DS0000071851.V371415.R01.S.doc Timescale for action 01/11/08 01/11/08 3 YA20 13(2) 01/11/08 4 YA23 13(4)(6) 26/09/08 Version 5.2 Page 32 5 YA33 12(1) 6 YA34 19 7 YA35 18(1) 8 YA42 18(1) staff have sufficient information to support residents, whilst reducing where possible the risk of harm and/or injury – immediate requirement issued. Staffing levels must be maintained to the assessed needs of individuals living at the home. This will help meet their needs safely. The home must be able to demonstrate recruitment checks have been completed for anyone who works at the home. This will reduce the risk of harm to residents. Sufficient numbers of staff must have undertaken specialist training in order to meet residents’ individual needs. This must include – Diabetes, challenging behaviour, epilepsy and communication. The home must be able to demonstrate that sufficient numbers of staff (including agency workers) have undertaken food hygiene, first aid, health and safety, fire and moving and handling training. This will help promote the health and wellbeing of residents. 01/11/08 01/11/08 01/12/08 01/12/08 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 Refer to Standard YA1 Good Practice Recommendations The home should review the statement of purpose to include the practice of offering respite services and contributions that have to be made by residents towards meals. This will ensure people have access to accurate information. DS0000071851.V371415.R01.S.doc Version 5.2 Page 33 2 YA2 3 YA4 4 5 6 7 YA5 YA6 YA7 YA8 Detailed and thorough pre-admission assessments should be completed before people are offered a placement at the home. This will help the home be confident of meeting people’s needs. A range of visits to the home, suitable to the individual, should be completed in order that the findings of these can be incorporated into the homes pre-admission assessment. This will help ensure staff have sufficient knowledge of the individual so that they can meet their needs. It will also help prospective residents decide if the home is suitable for them. Contracts of residency should be maintained in the home in order that the registered manager can monitor if residents rights are being upheld. Additional care should be taken to ensure daily records are completed for every shift. This will help give an insight into the person’s routine each day and state of wellbeing. Systems should be introduced that support residents to make choices and decisions. Other forms of communication should be explored such as the use of photographs, pictures and objects of reference in order that all residents can be involved in decisionmaking processes. Action should be taken to ensure protocols are introduced when the decision is made that someone lacks capacity. This will help promote their rights and compliance with the Mental Capacity Act. Improvements to the choice of activities in the community should be undertaken so that residents with complex needs have the same opportunities as those requiring less support. Systems should be implemented for recording and evaluating activities in order that the home can monitor that activities meet individuals’ expectations. Menus should be expanded to offer 2 choices of main meal every day and be reproduced in alternate formats to that of the written word, in order that all residents can be involved in decision making. Nutritional assessments should be undertaken for all people living at the home. This will help monitor that the dietary needs of residents are identified and managed safely. Health action plans should be completed in full and any agreed actions evidenced. This will support a holistic approach to health management. DS0000071851.V371415.R01.S.doc Version 5.2 Page 34 8 YA14 9 YA17 10 YA19 11 12 13 YA23 YA24 YA29 14 15 16 17 YA30 YA32 YA33 YA34 18 19 YA35 YA39 Suitable numbers of staff should receive training in adult protection and aggression in order to reduce risks to residents. A shelter is needed in the garden for residents who smoke. This is needed to be complaint with the Smoke Free Regulations. Advice from a relevant professional should be for equipment in sensory rooms and this purchased. This should be obtained as a priority to increase the opportunities of sensory stimulation for people living at the home. Suitable numbers of staff should receive training in infection control to promote the wellbeing of residents. Suitable numbers of staff should hold a NVQ qualification in order that they are qualified to support residents. The registered manager should undertake her own thorough assessments in order that residents can be confident staffing levels meet their individual needs. If staff commence work at the home without a full enhanced CRB additional safeguards should be completed as recommended by the Department of Health. This will reduce the risks to residents. A training matrix should be developed in order that the home can monitor that suitable numbers of staff have up to date training to meet residents needs. Quality monitoring processes should continue to be implemented in order that the home can measure if it is achieving its aims and objectives. The Annual Quality Assurance Assessment should be completed with greater accuracy when next requested. And analysis of accident records should be undertaken and where necessary action taken to reduce risks to people. The home should be able to demonstrate all staff (including agency workers) have participated in a fire drill. Also that for permanent staff that they participate in a fire drill at least every 6 months. This will help reduce the risk of injury to residents in the event of a fire. 20 YA42 DS0000071851.V371415.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000071851.V371415.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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