Inspection on 11/04/07 for 7 Wellington Street

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

7 Wellington Street 31/10/05

7 Wellington Street 18/05/05

7 Wellington Street 27/09/04

7 Wellington Street 21/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 7 Wellington Street West Bromwich West Midlands B71 1DR Lead Inspector Jayne Fisher Unannounced Inspection 11th April 2007 08:50 7 Wellington Street DS0000004774.V330078.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 7 Wellington Street DS0000004774.V330078.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. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 7 Wellington Street Address West Bromwich West Midlands B71 1DR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 532 3556 NONE Pioneer Care Limited Ms Sandra Horsley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 service user who may also have a physical disability Date of last inspection 31 October 2005 Brief Description of the Service: 7 Wellington Street is a semi-detached property which is rented from the Local Authority and is located in West Bromwich. The centre of town is within a two mile radius and there are local shops nearby. Public transport is good. The Home currently provides care for two persons with learning disabilities one of whom also has a physical disability. The Home is able to provide care for service users with complex needs and challenging behaviour. The accommodation includes: a dining area, lounge, kitchen, downstairs walk in shower and toilet, three bedrooms on the first floor, a bathroom and toilet, and sleeping in room. There is a Wessex style lift leading from the lounge area directly into one of the service users bedroom who has a physical disability. There is a ramp leading to the front door and back garden. There is off side parking on the road in front of the property. The garden to the rear is has a patio and large lawned area which is secluded. Service users attend either Local Authority run day centres or have an in-house day care provision. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding the fee levels stated in contracts confirms that these are £741.68 per week. There are additional charges for toiletries and hairdressing. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 08.50 a.m. and 5.50 p.m. and was undertaken by one inspector with the home being given no prior notice. We spoke with the acting manager, two staff members and met all three residents who live at the home. Questionnaires were received from two relatives and one visiting professional. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: What has improved since the last inspection? 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 6 Management have acquired extra funding so that residents can have more access to the local community and can choose to go out in groups or as individuals. Better systems are in place regarding recruitment and selection of new staff in order to offer residents more safeguards. Staff are receiving more frequent and formal supervision so that residents benefit from being supported by staff who are aware of their roles and responsibilities. There is on-going training for staff in order to provide them with the skills required to meet the specialist needs of residents. There is improved record keeping with regard to health care appointments which helps staff monitor the needs of residents. 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. 7 Wellington Street DS0000004774.V330078.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 7 Wellington Street DS0000004774.V330078.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 and 5 Quality in this outcome area is adequate. There is an informative statement of purpose and service user guide although both review in order to provide people with more up to date information about the service. There is an holistic assessment process so that new and existing residents can be assured their individual needs will be measured and met. Existing residents’ assessments require review to ensure that they accurately reflect their current needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that the statement of purpose has not been updated since it was originally implemented in 2003 apart from adding new information about bathing facilities. As a result some of the information is now out of date. For example, it gives the name and address of a former senior manager (responsible individual) who is no longer an employee. Staffing details have also changed as have internal management arrangements. We saw that there is a useful pictorial service user guide. However, this also now requires updating. For example, this document also refers to a former 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 9 responsible individual no longer employed and previous manager. The telephone number of the home has also changed. The guide contained some information regarding who is responsible for payment of fees, but did not include any information about additional charges. Both the guide and statement of purpose referred to the National Care Standards Commission which was disbanded in 2004. We also recommended that further information required by the Care Homes Regulations 2001, Regulation 5, to be included in the service user guide, is provided alongside this pictorial guide in a folder, for example: a standard form of contract, a summary of the complaints procedures and a copy of the most recent inspection report. The home is fully occupied and has remained so since the last admission in 2005. There is a comprehensive assessment tool in place which is used for new residents and also to review existing residents’ needs. This is entitled ‘my way’. However, existing people’s needs have not been reviewed using this document since 2005. The acting manager told us that he was shortly going to be introducing a new assessment format. We saw residents’ terms and conditions of occupancy (contracts). These require expanding to include additional charges incurred by residents. For example, hairdressing, chiropody and toiletries. 7 Wellington Street DS0000004774.V330078.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): 6, 7 and 9 Quality in this outcome area is adequate. The home produces wide ranging care and support plans for each individual but these are not clearly linked to assessed need and are not always comprehensively underpinned by up to date risk assessments. Slight expansion is needed to allow service users more opportunities for participation in care planning and thereby giving them chances for identifying their aspirations and wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that care files contained extensive comprehensive information regarding residents’ needs but a simplified style may help staff extract information more easily. For example, there is no separate care plan regarding mobility but details were found in the ‘medical’ care plan. There was no separate care plan regarding how staff support a resident to manage their epilepsy but basic details were located in the ‘medication’ care plan. Food 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 11 preferences were not located in the nutritional care plans but were found within the communication package established by speech and language therapists. During interviews one member of staff was not familiar with the content of the care plan for the resident for whom she was co-worker. She told us that she had not sufficient time to read the care plan. The dates when care plans were implemented or reviewed was not always included, nor the signature of the staff member who had completed the care plan. Some care plans are basic and some were not updated when residents’ needs had changed. For example, one person’s care plan regarding their challenging behaviour stated that they were receiving ‘as and when’ (PRN) medication, yet the acting manager told us this had ceased last year. The care plan states that staff will take the resident to their room if their behaviours continue (the acting manager states that this has been fully agreed within a multi-disciplinary forum). However, there were no details as to how long the resident should be left and interviews with staff confirmed differing views as to the length of time. This must be included in the care plan. There was good information regarding pressure area care in one residents’ care plan but this was generalised ‘good practice’ information and did not contain specific information such as types of pressure relieving equipment in place or skin inspections undertaken by staff. On one occasion staff were seen to stand over a resident when assisting them with drinking; the acting manager told us that this was their preference although this information was not contained within the eating/drinking care plan. Care plans have been reproduced in a pictorial/photographic format for residents through a person centred planning approach. As previously stated, it is recommended that different strategies are explored for helping residents to identify what is important to them due to their complex communication needs for example, essential life style planning. Residents have detailed communication packages in place which have been devised by speech and language therapists. We saw that risk assessments still need to be expanded and developed further. For example, a number of risk assessments did not contain the date that they were implemented or reviewed. There was a risk assessment in place regarding the use of a wheelchair and posture belts but this made no mention of the risk associated with foot plates or control measures such as staff training. The risk assessment regarding the use of bed rails did not contain all of the control measures to minimise the risk of entrapment as identified in Medical Device Alert notices. A risk assessment regarding pressure area care did not contain information regarding pressure relieving equipment which the acting manager told us was in place. There was no separate risk assessment for one resident regarding their mobility although there were details of the use of a hoist when bathing the resident. However, this resident requires a number of different transfers 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 12 using a range of varying equipment including overhead ceiling tracking, portable hoists, adjustable bed and a Wessex style vertical passenger lift. There were no details regarding numbers of staff involved in transfers, training or details of the resident including their communication needs, continence, medication, attachments or details of the environment. One resident had a risk assessment in place regarding their challenging behaviour and refusing meals. This directed staff to try a nutritional supplement although the acting manager told us that this is no longer a strategy which is employed. 7 Wellington Street DS0000004774.V330078.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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. Staff fully encourage residents to maintain and develop social, emotional, communication and independent living skills and as a result they are provided with lots of opportunities for personal development Staff support residents to maintain important links with their families and ensure that residents’ rights are respected with regard to their privacy and dignity. Residents are offered a varied and healthy diet which they help choose and plan. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents were at home during the day and one resident returned from their day centre in the afternoon. We saw staff encouraging residents to 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 14 participate in making their own drinks, helping to do their laundry and watching staff prepare their evening meal. Two residents attend external day centres and a third is funded to have their day care provided by staff at the home. Each resident has a diary in which staff make daily (and very detailed) entries regarding how they have spent their day. Examination of these demonstrated that residents enjoy a wide range of activities in the home and the local community. Since the last inspection visit one resident has received extra funding so that they can enjoy outings as an individual. The acting manager told us that he used these hours flexibly and gave an example of how he planned for four staff to be on duty occasionally at weekends to allow residents a choice of activities. This had recently taken place. There are activity plans in place but the acting manager stated that these are very flexible and only used as a guide for staff. However, these have not been reviewed since 2005. The acting manager told us that these are based on individual preferences of residents as detailed in their assessment tools. The activity planners need to also make reference to this fact and guide staff where to look to find out about residents’ likes and dislikes. A relative who completed a comment card stated: “my sister especially looks forward to activities. Everyone else there also seems happy with the activities they do”. Feedback from a professional who visits the home was very positive regarding this aspect of support. They confirmed that they felt that staff supported people to live the life they choose and gave examples of how staff would make requests if they felt extra help was needed. They commented: “I think the staff deal with some very difficult situations at times. They work very hard with the people they are looking after. There is always a friendly feel to the home when I visit. I will usually plan visits, but not always, yet the atmosphere is always the same. I think they work very hard and are committed to provide as homely an environment as they can”. Two relatives completed feedback questionnaires. They both stated that they felt staff gave the correct amount of support to their relative. One person commented “I have noticed that there always seems to be an interest towards the progression of my relatives quality of life” and “everyone I have seen work where my relative lives, show commitment towards their clients”. Both people felt that staff respected their family member’s dignity and privacy. The home does not operate a set menu plan. Instead, residents are able to choose on a daily basis what they would like to eat. We saw staff showing residents contents from the fridge in order to determine what they would like to eat for their evening meal. During interviews some staff were more knowledgeable than others regarding residents’ individual likes and dislikes or known allergies to certain food types. One co-worker could not locate their 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 15 resident’s care plan regarding her dietary needs upon request. During interviews they gave a different account as to how they managed one resident’s occasional refusal to eat breakfast offering a drink rather than an alternative meal. We discussed this with the acting manager and the need to perhaps simplify care plans as already stated. Staff told us that one resident likes to go food shopping and is offered opportunities to do so, whilst the other two residents do not enjoy this activity. On examination of food records we saw that residents are able to choose different meals to each other and have a varied and balanced diet. There was a wide range of meat, fish, vegetables, rice and potatoes. Residents also have regular ‘take away’ meals such as Chinese food. In the evening we saw residents enjoying their dinner which looked appetizing. Staff were seen to be appropriately assist those residents who needed help with eating their meal. See comment in standard 19 regarding nutritional screening tools. 7 Wellington Street DS0000004774.V330078.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 good. The health needs of residents are well met and close observation helps identify any potential complications at an early stage, ensuring people receive the treatment they require. Only slight improvements are needed to further enhance systems already in place. In general there are good arrangements in place regarding medication; slight attention is needed to ensure there are sufficient safety measures are in place for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff encourage residents to make their own choices with regard to how they receive personal support. For example we saw that one resident had chosen to have a lie in because she did not have to attend her day centre and got up later than the other residents. Daily diaries also contained evidence of residents’ individual preferences. Feedback from a visiting professional confirmed that they feel that the staff can meet the different needs of the residents. Comments included 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 17 “staff are flexible and have an open approach to the care of people living at the home, who all have varying degrees of physical disability, behaviours and complex needs”. It was noted that all residents’ receive regular checks during the night time according to their diaries. There were no care plans or risk assessments in place to demonstrate why residents’ required this support and interviews with staff gave different responses as to the number of checks carried out. We discussed this with the acting manager as night time checks can compromise residents’ dignity in addition to disturbing sleep. There must be a justified medical (or behavioural) reason for this level of monitoring. If this is required, then it must be recorded in a care plan and risk assessment. This must then be discussed and agreed with the resident and within a multi-disciplinary team. We saw that there are good systems in place to promote residents’ health. There is an improved procedure in place to monitor residents’ health care appointments with a checklist and record sheets which staff complete with detailed outcomes of treatments and advice. The acting manager told us that all three residents have had ‘health action plans’ established by the community learning disability nurse although as yet only one had been received and was included in the case file. There are care plans and guidelines in place for screening of breast and testicular cancer as previously required. The recent health check had not included attendance at a well person clinic for one resident with regard to testicular screening and the acting manager agreed that this needed to be followed up. Only a couple of issues require further action. Two residents are not able to be easily weighed and as a compromise at previous inspections it was agreed that observational weight checks were undertaken and recorded (at a frequency determined by the nutritional screening tool and care plan). Information was also provided with regard to using an alternative measurement tool to determine people’s weight. However, these have not been introduced. We discussed this further with the acting manager and also gave further details of using an alternative nutritional screening tool particularly as existing nutritional screening tools have not been reviewed since 2003. In addition, the third resident also needs to have their weight checked and recorded. Some improvements have taken place with regard to medication. The registered manager has met with the pharmacist to request regular audits. The medication policy has been updated and there are continuing plans to ensure that all staff have received accredited training in the safe handling of medication. A couple of items still need attention which we identified at previous inspections. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 18 We identified some new items at this inspection including: • staff had dispensed medication into a tot but had not been able to administer this, however the medication had been left unsecured in the dining room. • staff had signed the medication administration record (MAR) sheet to indicate that the medication had been administered when it had not been given. • keys to drug cupboards are not held separate from other master keys • a tube of cream had not been labelled with the date of opening • there were no guidelines as to when to administer some PRN cream For any other items discussed during inspection of these standards please see the requirements and recommendations section of this report. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. There is a comprehensive complaints policy which ensures that users’ views are listened to and acted upon. There are sufficient procedures in place to safeguard service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection the home was seen to have a comprehensive complaints procedure with timescales which exceeds the national minimum standards, and details of the Commission for Social Care Inspection (CSCI). There is also a complaints procedure which has been produced in pictorial format. The Home has included the complaints procedure in the statement of purpose/service user guide as required. There have been no complaints made regarding the service during the last year. Comments from relatives and professionals who completed feedback questionnaires confirmed that they are aware of how to make complaints. One person stated: “I find I can talk about anything that concerns me and also staff will talk to me and let me know how things are”. We were told by the acting manager that staff have received training in vulnerable adult abuse however some training certificates are still awaited to confirm that this has been carried out. During interviews staff gave good responses as to how they would deal with potential incidents of abuse although one person could not explain the principles of Whistle Blowing and another 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 20 staff member said that she would like to undergo some refresher training in vulnerable adult abuse. There is a vulnerable adult abuse policy which includes Protection of Vulnerable Adult (POVA) guidelines. None of the three residents living at the home manage their own finances. Records viewed demonstrate that individual personal allowances sheets are maintained for each person along with receipts for purchases and double signatures from staff for all transactions carried out on residents’ behalf. A couple of anomalies were identified. When we checked one resident’s money this did not balance accurately with the sum identified on their personal expenditure sheet. The acting manager was able to ascertain that staff had failed to add the extra money to the resident’s record sheet by mistake. It was seen that on one occasion a resident had paid for a staff member’s entrance fee to accompany him on an activity in the community. We discussed this with the acting manager who agreed to find out if this was covered by the residents’ basic contract fee. If this is an additional charge then it must be discussed and agreed with the resident and the Local Authority commissioners and a formal written procedure must be introduced with details added to the resident’s contract and service user guide. The acting manager told us that he still had yet to find out from insurers the total amount of money he was allowed to keep on the premises on behalf of residents. We also discussed the possibility of trying to open individual bank accounts for residents. 7 Wellington Street DS0000004774.V330078.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 and 30 Quality in this outcome area is adequate. Residents’ comfort is at present somewhat compromised as the whole house is currently undergoing a programme of refurbishment and redecoration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We undertook a tour of the premises. An extensive programme of refurbishment is currently being undertaken by the Local Council who are the landlords. This includes rewiring of the premises, refurbishment of the kitchen and bathing facilities, replacement of the central heating system and redecoration of all areas. During this period some of the kitchen appliances have had to be temporarily located in the dining room in order for the replacement of the kitchen. The acting manager told us that this had been ongoing for some time but he was hopeful that this would be completed soon. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 22 We saw residents’ bedrooms which are individually and furnished and contain lots of personal belongings and possessions. They are comfortable and homely although in need of redecoration (which is part of the refurbishment programme). There is a ground floor shower room with over head tracking, drying table and level access shower for people who have a disability. The first floor bathroom also contains a bath hoist. The slide door does not have a suitable locking mechanism and in the past a written risk assessment was completed. It is recommended that whilst the property is undergoing such an extensive refurbishment, that the acting manager re-explores with the contractors about the possibility of fitting a different type of door and lock to afford more privacy. The home is accessible for wheelchair users with ramps to the front and rear of the premises. There is a Wessex style vertical lift in the lounge which gives direct access for one resident into their bedroom. There is a ceiling hoist installed in this bedroom and a range of aids and adaptations including a hydraulic height adjustable bed. There is a large garden to the rear of the premises which offers privacy to residents. At present this is slightly overgrown; the acting manager told us that there are plans to landscape part of the garden. We saw that appropriate infection control measures are in place. Despite being in the middle of an extensive programme of refurbishment, the premises was clean and tidy. A supply of water soluble bags have been obtained for emergencies, such as the need to wash infected linen. There is a lockable clinical waste bin and staff have received training in infection control. No communal items were found in residents’ bathrooms. 7 Wellington Street DS0000004774.V330078.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): 32, 33, 34, 35 and 36 Quality in this outcome area is good. Residents are supported by a competent staff team who are well supervised and guided by management. There are robust recruitment and selection procedures so that residents are offered sufficient safeguards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that job descriptions had been updated as previously required. Information supplied by the registered manager demonstrates that only 25 of the current staff team hold an NVQ II or above qualification. We discussed this with the acting manager who told us that there are opportunities for staff to do this training but that the staff group needed more encouragement which he agreed to prioritise. A range of specialist training is on-going which we confirmed through interviews with staff and on examination of training records. For example some staff have undertaken training in epilepsy awareness and managing challenging behaviour. New staff still need to undertake training in challenging behaviour. Previously, we asked the home to provide staff with training in 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 24 breakaway techniques and non-violent physical crisis intervention in order to meet one resident’s needs. This resident is no longer living at the home and the acting manager states that this level of training is no longer required. When we looked at certificates for staff who had previously undertaken this training they stated that staff had been trained in ‘restraint’. There was no confirmation on the certificate as to how long the training was valid for, or whether the training had been provided by an accredited trainer in physical interventions as approved by the British Institute of Learning Disabilities. It is recommended that this information is obtained in order to verify the type of training that has been provided. During interviews the acting manager agreed that training in risk assessment would be beneficial for staff and this is recommended. We looked at the duty rota which confirmed that there are at least two members of staff on duty per day time shift and on occasions there are four staff on duty to accommodate residents’ individual choices with regard to activities. The duty rota does not show how many hours are worked by the registered manager as previously required. There was positive feedback about staff received by from relatives and a visiting professional. This included: “There is a good mix of staff who all come together to perform their duties very well. Aspects of each client are taken into account in order help them live life and be happy”. We saw personal files of two new members of staff. These demonstrated that good recruitment and selection procedures had been followed and all preemployment checks had been undertaken before they commenced duties. However none of the files seen contained a copy of the job description and it is recommended that these are held on their files. We interviewed two new members of staff. They both stated that they had received some induction but said that this was not an induction programme provided by an accredited learning disability awards framework (LDAF) provider. The acting manager told us that he was under the impression that both staff had received this training. There were no training certificates to validate this training and it is recommended that confirmation is obtained as to whether they have undertaken this training. Staff have undertaken training in equal opportunities and disability equality. We saw three staff personal files which contained very detailed supervision records. All staff receive regular formal supervision and an annual appraisal from their manager. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. The registered manager is supported well by her senior staff in providing clear leadership through out the home with staff demonstrating an awareness of their roles and responsibilities thereby protecting service users’ health, safety and welfare, with only slight improvement necessary. This judgement has been made using available evidence including a visit to this service. EVIDENCE: For some time there have been plans to replace the existing registered manager (Mrs. Horsley), who currently has responsibility for a number of other services owned by the provider. Mrs. Horsley has told us that this is still the intention and an acting manager has been appointed who has worked at the home for some time in a senior capacity. Mr. Ison states that he will be applying for registration in the near future but wanted to be sure he could take 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 26 on the responsibility before he applied. In the meantime Mrs. Horsley visits on a regular basis and is actively involved in the management of the home. Findings from this inspection indicate that the management arrangements continue to work effectively. Managers undertake regular meetings with staff and there were positive comments made by relatives and a visiting professional. These included stating that staff were good communicators, flexible and open to suggestions with regard to improving approaches. It was also stated that they are kind and considerate to people in their care. During interviews staff told us that they felt supported by Mr. Ison, comments included “you are working with a team with whom you are comfortable with, you can talk to him about anything and he will try and help in every way possible”. Recent interviews we have had with the registered manager confirms that very good progress is being made in introducing a comprehensive and all encompassing quality assurance system. Great efforts have been made to consult with relatives, stakeholders and staff. Residents have participated in this process and have been assisted by residents from another home which is an excellent initiative. An analysis has been carried out and the registered manager is currently in the process of establishing a suitable format for presenting the findings. The registered manager confirms that once this process is completed, an annual development plan will be created. We saw that staff files contained relevant information although one person did not have a recent photograph in their file. We examined three staff files and training certificates. These confirmed that staff had undertaken all of the necessary statutory training which is an excellent achievement. We looked at the accident book which confirmd that only a small number of ‘minor’ accidents had occurred at the home and records had been accurately completed by staff. We also looked at service and maintenance records to evaluate health and safety practice. These were found to be largely up to date. There were only a few areas which need to be improved upon. Apart from the over head tracking hoists and passenger lift, all other lifting equipment is not being inspected on an bi-annual basis this includes the portable hoist and hydraulic chair lift for the bath. In addition the hydraulic bed is only being serviced every two years (at previous inspections the contractors had stated that this should be done annually in accordance with the manufacturers’ specifications). We recommend that the acting manager contacts the relevant engineers to determine the frequency of inspections and services and obtains confirmation in writing. One resident has a pressure relieving mattress in place. As care plans contain no information regarding the pressure relieving equipment the acting manager 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 27 could not tell us how old the mattress is in order to determine whether it needs replacing. The acting manager initially thought that the mattress was checked when the bed was serviced but examination of last engineer’s report would suggest that this is not included as part of the service. We have recommended therefore that the mattress is checked by a competent person such as a district nurse in order to ensure that it still meets the needs of the resident and to identify when it will need replacing as some mattresses will only last for 2-3 years at a time. We saw that previously the acting manager had been undertaking regular health and safety checks on wheelchairs and completing detailed checklists. He has recently stopped completing these checklists and we have suggested that these are reinstated. In addition records need to be reinstated of the regular bedrail checks that we were told staff undertake. During interviews staff gave good responses as to how they observed good food hygiene practice. Staff are seen to have undertaken fire safety training but not all staff have participated in a bi-annual fire evacuation drill as we discussed with the acting manager. The provider is forwarding copies of monthly visits undertaken by senior management to the Commission as previously required. These no longer required to be sent, as we discussed with the registered manager. Copies of reports however still need to be held on the premises (made available to the registered manager). The last report held on the premises is for a visit undertaken on 4 October 2006 although the acting manager confirms that they visit on a regular basis. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 28 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 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X 2 2 X 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 4 and 5 Timescale for action To review and update the 01/10/07 statement of purpose and service user guide to ensure that they contain accurate information regarding management and staffing, telephone numbers, additional charges etc. To ensure behavioural care plans are kept up to date and identify any new strategies for de-escalation. (Previous timescale of 1/10/05 is not fully met). To review service user plans to ensure that they accurately reflect residents’ needs and contain sufficient information relating to all aspects of personal and social support and health care needs (with detailed guidelines for staff). 3. YA9 13(4)(c) To review and expand risk assessments for wheelchair users identifying risk associated with using posture belts and manufacturers specifications DS0000004774.V330078.R01.S.doc Requirement 2. YA6 15 01/10/07 01/10/07 7 Wellington Street Version 5.2 Page 30 with regard to maintenance checks and servicing. (Previous timescale of 1/7/05 is partly met). To carry out individual written risk assessments with regard to all aspects of care including: travel on minibus and/or public transport, shower chairs, mobility etc. (Previous timescale of 1/2/06 is not fully met). To ensure that all risk assessments are reviewed at least annually or sooner depending upon risk rating. Staff must date and sign risk assessment to demonstrate it has been reviewed if no changes are made. (Previous timescale of 1/2/06 is not fully met). 4. YA12 12(1)(a) To review and update 01/10/07 individualized activity programmes to identify and reflect service users preferences and needs. (Previous timescale of 1/10/05 is not met). To review the practice of two 01/10/07 hourly checks undertaken during the night for all service users. (If this level of monitoring is deemed necessary due to medical or behavioural reasons it must be discussed and agreed as part of a multi-disciplinary team). Outcomes and guidelines for staff to be documented in individual care plans and risk assessments To make the following improvements with regard to DS0000004774.V330078.R01.S.doc 5. YA18 12 6. YA19 12(1)(a) 01/10/07 7 Wellington Street Version 5.2 Page 31 healthcare monitoring and recording: 1) To introduce a formal procedure with regard to regular weight checks (using observational methods or other tools if necessary). (Previous timescale of 1/7/04 is not met). 2) To review and update nutritional screening and assessment tools. (Previous timescale of 1/10/05 is not met). 7. YA20 13(2) To make the following 01/10/07 improvements to the control and administration of medication: 1) To continue to progress plans for ensuring all staff receive accredited training in the safe handling of medication. (Previous timescale of 1/4/04 is partly met). 2) To ensure that any handwritten instructions on MAR sheets are signed and witnessed by two members of staff to confirm accuracy. (Previous timescale of 1/10/05 is not met). 3) To ensure that medication is held secure at all times. 4) To ensure that MAR sheets are accurately completed and are not signed prior to medication being administered. 5) To ensure that creams are labelled with the date of opening. 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 32 8. YA23 13(6) 6) To ensure that keys to the drugs cupboards are held separate to other master keys (or a written risk assessment is established if this is not undertaken). To continue to progress training 01/10/07 for all staff in vulnerable adult abuse. (Previous timescale of 1/9/05 is partly met). To review the practice of residents paying for staff’s entrance fees when accompanying them on activities whilst out in the community. If this practice is to continue, it must be negotiated with funding authorities and resident. A formal procedure must be agreed which is contained in individual service users’ plans, the service user guide and contracts. To securely fix wardrobes to bedroom walls. (Previous timescale of 1/1/05 is not met). To replace stained carpet on the landing. (Previous timescale of 1/9/05 is not met). 9. YA24 23(2)(b) 01/10/07 10. YA32 18(1)(c) To ensure that 50 of the care staff team are qualified to NVQ 11 or above by 2005. (Previous timescale of 01/10/05 is not met). To pursue plans to ensure that all staff receive training in managing challenging behaviour. (Previous timescale of 1/10/05 is partly met). 01/10/07 11. YA33 17(2) To ensure that the hours worked DS0000004774.V330078.R01.S.doc 01/10/07 Page 33 7 Wellington Street Version 5.2 by the Registered Manager are recorded on the duty rota. 12. YA37 18(1)(a) To ensure that the Registered Manager is qualified to NVQ 1V in care by 2005. (Previous timescale of 31/12/05 is not met). To provide evidence that the quality assurance system includes feedback from stakeholders including doctors, district nurses and other professionals, as well as families and relatives. To produce an annual development plan. (Previous timescale of 1/1/05 is partly met). To obtain and hold information and documents in respect of persons carrying on, managing or working at a care home as listed in Schedule 4 of the Care Home Regulations 2001. (Previous timescale of 1/4/04 is partly met). To ensure that bedrails are checked on a regular basis to ensure that they are securely fixed with records maintained. (Previous timescale of 1/1/05 is partly met). To ensure that wheelchair maintenance checks undertaken by the home are fully recorded. (Previous timescale of 1/8/05 is partly met). 16. 17. YA42 YA43 23(4)(e) 26(4) To ensure that all members of staff participate in a bi-annual fire evacuation drill. To ensure that copies of the monthly reports from visits DS0000004774.V330078.R01.S.doc 01/10/07 13. YA39 24 01/10/07 14. YA41 17(2) 01/10/07 15. YA42 23(2)(c) 01/10/07 01/10/07 01/10/07 7 Wellington Street Version 5.2 Page 34 undertaken by the Owners representative are available on the premises. (Previous timescale of 1/9/05 is not fully met). 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 YA2 YA6 Good Practice Recommendations To undertake a review of residents’ assessments and ensure that these are kept under regular review thereafter. To review the statement of condition of residency to include all information required by the National Minimum Standards 5.2 and Care Homes Regulations 2001, Regulation 5 (including details of additional charges). To explore different strategies for person centred planning for example essential life style planning, life story books etc. To ensure that care plans contain dates of implementation and review. 4. YA17 To consider introducing a more comprehensive nutritional screening tool such as the ‘Malnutrition Universal Screening Tool’ (‘MUST’) in order to identify issues relating to malnutrition and obesity and which utilizes a Body Mass Index scoring system. To include the maximum days a PRN medication can be administered before seeking further medical advice onto the PRN guidelines. To ensure that there are written guidelines for all PRN medication including creams. It is recommended that a running audit and balance is checked and recorded for medicines which are not dispensed into the monitored dosage system such as PRN 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 35 3. YA6 5. YA20 6. YA23 medicines (this can be entered onto the MAR sheet). To consult with insurers to seek confirmation as to the total sum of service users monies which may be held on the premises at any one time. To consider trying to open bank accounts for individual residents. 7.. YA24 To explore whether or not the first floor bathroom can be fitted with a more secure door and suitable locking mechanism as part of the current refurbishment. To consider providing staff with training in risk assessment and management. To obtain confirmation as to whether ‘restraint’ training formerly undertaken has been provided by an accredited trainer in physical interventions and to elicit how long this training is valid for. It is recommended that copies of job descriptions are held on individual staff files. It is suggested that there is a system in place for the manager to monitor whether or not new staff have been provided with induction and foundation training by an accredited LDAF provider. Training certificates need to be obtained to demonstrate whether existing staff have undertaken this training. It is recommended that the home is enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. Appropriate facilities for communication by facsimile transmission should also be provided. To seek the advice of a suitably qualified person (such as a district nurse or tissue viability nurse) with regard to the pressure relieving mattress to ensure that it does not need replacing and is still appropriate to the needs of the resident. To obtain written confirmation from manufacturers with regard to the frequency of servicing and inspection of all lifting equipment including the portable hoist, hydraulic chair lift and hydraulic bed and to ensure that servicing is carried out at the frequency recommended. 8. YA32 9. 10. YA34 YA35 11. YA37 7 Wellington Street DS0000004774.V330078.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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