Inspection on 22/01/09 for 79 Slade Road

This inspection was carried out on 22nd January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

79 Slade Road 24/01/08

79 Slade Road 02/12/06

79 Slade Road 15/02/06

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Slade Road, 79 Slade Road, 79 Erdington Birmingham West Midlands B23 7PN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 2 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Slade Road, 79 Slade Road, 79 Erdington Birmingham West Midlands B23 7PN 01213267152 F/P01213267152 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : CareTech Community Services Ltd care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 4 79 Slade Road is a care home, registered to provide care and support to four people with a Learning Disability. At the present time the home accommodates three men, who also have some behaviours that challenge. The home is staffed 24 hours a day; overnight staff provision is one waking night staff and one staff sleeping in on the premises. The home has four single bedrooms. Three are on the first floor, and people require full mobility to access this area of the home. There is also a bathroom and staff office/sleep in room on the first floor. On the ground floor there is a communal lounge, dining room, kitchen, WC, and laundry area. The home has one ground floor bedroom, also fitted with an en suite. The home is located in Erdington, Birmingham and is located close to local facilities and is conveniently sited for access to public transport. The manager said that the fees had not yet been stated in the service users guide, as they change in the new financial year. The last inspection report is available in the home for visitors who wish to read it. Care Homes for Adults (18-65 years) Page 4 of 35 Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over one day during January 2009. It was carried out by one inspector. The home did not know that we were going to visit. This is the homes key inspection for 2008-2009. The last inspection of this home was on 24th January 2008. We met with the three people who were living in the home, spoke to the manager, area manager, two staff briefly and one staff member in more depth. We had a look around the home and looked at the files of two of the people living in the home to see that the home was able to meet their needs. We also looked at other documents in the home to make sure that it was safe, that the people employed in the home had been checked to make sure they were the sort of people who should work in the home. We also looked at documents to see that the people living in the home got their medicines Care Homes for Adults (18-65 years) Page 6 of 35 as they had been prescribed by the doctors. We were not able to get very much verbal information from the people living in the home due to their verbal communication however, we were able to observe their interactions and facial expressions to see if they were happy with the home. Prior to the visit taking place we looked at all the information that we had received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Questionnaires were sent to the home and the key workers had helped the people living in the home to answer the questions. The surveys told us that the three people living in the home were happy and knew who to tell if they were not. What the care home does well: What has improved since the last inspection? What they could do better: The staff must keep better records of how decisions about the day to day lives of the people living in the home are made. This will ensure that the views of the people living in the home are taken into consideration. Care Homes for Adults (18-65 years) Page 8 of 35 There should be activity plans for each person living in the home. This will ensure that plans are made to meet the needs of each person according to their likes and dislikes. The manager must make sure that all the records required by law are kept in the home and that they are updated as needed. The manager must ensure that we are kept aware of any accidents or incidents happening in respect of the people living in the home. This will enable us to monitor the welfare of the people living in the home. The home must be redecorated, the carpets cleaned and the equipement serviced to ensure that it is safe and homely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some information was available so that people considering whether to move into the home or not to help them make a decision as to whether the home was suitable for them. They did not have information about what it would cost to live in the home. The manager was aware of the admission procedure that would ensure that only people whose needs could be met would move into the home. Evidence: The service user guide included pictures and was written in an easy read style making it easier to understand. The people living in the home all had a service user guide in their files. The fees for each person had been filled in to show what they would be paying to live in the home. The service user guide did not include a range of fees so that people who were trying to decide if Slade Road was the right place for them did not know what they could possibly be paying if they wanted to move in there. It was important that some information about what the fees could be was included in the service user guide. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: No one had moved into the home since the last inspection so we were not able to see if the home was making sure that they could meet peoples needs before moving in. The manager was aware of the admission process and the need to ensure that peoples needs could be met at the home before they moved in. One person who used to live in the home had moved to accommodation where they were being helped to live more independently but was likely to move back into Slade Road whilst their home was being redecorated. We were told that the individual was known to the people living in the home and visited quite regularly. We were told that before he moved back into the home the social worker would give the home an assessment that would tell the staff what his needs were now and that he would visit and have overnight stays. We spoke to the manager about checking that the people living in the home were happy about this person moving inot their home and she said she had not done this but would do so. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were care plans and risk assessments in place so staff knew the needs of the people living in the home. Guidelines for the management of risks were not always in place so it was not clear if risks were being managed in a consistent way by all staff. It was not always clear how people living in the home made day to day choices about their lives. Evidence: The care plans showed how the people living in the home were to be helped with their personal care. In some instances there were some very good details about what had to be done for example, for one person staff needed to put some shower gel on the individuals hand otherwise they would empty the container. In other areas there was little information for example, for one person the plan stated that the individual needed to be helped to shave. The plan did not say whether this was to be a wet shave or an electric shaver was used. It did not say what the best time of day for the shave was or whether after shave lotion was used. Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: Another example of where more detail was needed was in respect of meeting cultural needs. The plans needed to state how these needs were to be met. For example, how often an individual was to be taken out to eat culturally appropriate meals and what meals were to be cooked in the home, how skin was to moisturised, with what and how often. During an examination of the accident records it was noted that the inidividual had cut both sides of his face with the razor whilst the staff had turned away to put away the shaving cream. There was no indication that this task had been re-assessed to consider whether an electric shaver would be safer. During discussions it was mentioned that the noise may upset the individual. If this was the case a risk assessment needed to have been put in place to tell staff what steps needed to be taken to prevent the individual from injuring themself again. One member of staff spoken with thought that the individual could shave himself. in view of the injury referred to earlier this could put the individual at risk of cutting himself again. There were some risk assessments in place and these contained some good details however, the guidelines for how staff were to manage these were not always in place. For example, how someone was to be managed when accessing the community or making drinks. The care plans needed to refer staff to the risk assessments and guidelines to ensure that they knew how to manage the risks. The manager was aware that the needs of one person living in the home were changing due to age and she was starting to get these needs assessed so that future plans could be made with his involvement. The needs of the people living in the home were regularly reviewed with social workers and health professionals. This means that the individuals needs were kept monitored so that changes identified and appropriate actions taken where needed. An area that staff needed to improve was the recording of how the people living in the home made decisions about their care and daily lives. This would show how the people living in the home were consulted and how regularly they were asked about what they did and how they were supported. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place for determining what the people living in the home did on a daily basis were not adequate. This meant it was not possible to determine if the activities were chosen by the people living there or by the staff. Contact with families and friends was promoted and enabled the people living in the home to maintain contact with the people important to them. Evidence: The AQAA told us that evidence of what people want to do is recorded through talk time which is on a 1 to1 basis and service users meetings. Talk time was a system by which keyworkers talked to individuals about what they wanted to do on a weekly basis. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: During the inspection the manager told us that she did not think that talk time worked with the people living in the home as they did not want to sit and talk once a week but that staff talked to them on a regular basis. There were no records of talk times and there were no service user meetings being held either. It was important that discussions with the people living in the home were recorded on a daily basis and then senior members of staff could audit them over a period of time to determine whether their wishes had been taken into consideration. Daily records were made on a regular basis but if no other records were to be kept to evidence how choices were being promoted the level of detail in the daily records needed to be improved. None of the people living in the home currently attended college or day centres. One of them used to attend but we were told that one person no longer wanted to go. There were no specific long term goals identified for the people living in the home. This meant that there were no plans for how people were to develop their skills or aims to work towards. This would ensure that the activities had a purpose. There was evidence on the daily records that people were taken out to the pub, sports cafe and cinemas. One person living in the home went shopping with staff as they liked to push the trolley. This also enabled him to choose some of the food for the home. Another person spent a lot of time drawing and making paper chains. The people living in the home were helped to develop some skills such as cleaning their bedrooms and taking their clothes to be washed. Some people could help to make drinks and clear the tables after meals. There was no evidence that once these skills had been mastered others were identified to ensure progression as far as possible. Two of the people living in the home had keys to their bedrooms and we were told that staff only went into their rooms when they were present. The third person kept the bedroom door open throughout the day. There was contact with members of families through visits, sending cards and telephone calls. This meant that relationships were maintained and developed with people important to the people living in the home. Although there was evidence that people did go out there were no individual activities plans in place for the people living in the home so that it could not be determined whether these activities were taking place ad hoc or planned ahead. An activities plan Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: would also enable the manager to audit which activities were taking place, which were not and help to identify the reasons why they might not be taking place. Two of the people living in the home had decided where they were going on holiday this year and were being helped to save for this. The third person had not yet decided where to go. On the day of the inspection the food stocks were seen to be low due to the fact that shopping was to be done the next day. Choices available at mealtimes were shown on the menus, however it was not clear who had chosen these choices. We were told by the manager that specific cultural needs were being met as some of the staff were able to cook some culturally appropriate meals and one person went out to eat specific meals with staff. Meals and snacks were offered throughout the day. There was fresh fruit available in the kitchen and the weights of the people living in the home were monitored to stay within the guidance given by medical professionals. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people living in the home were being met in the way they preferred. The management of medicines in the home was good. This meant that the people living n the home got their medicines as prescribed. Evidence: The people living in the home all looked well cared for and each were dressed in styles that reflected their personalities and needs. Personal care needs were met in a way that promoted peoples dignity and that enabled them to do as much for themselves as possible. For example, one person was enabled to shower alone with some discreet supervision from a member of staff who stood outside the bathroom. There were men and women from different backgrounds and ages that worked in the home. This meant that the people living in the home could choose who would help them with their personal care. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Each of the people living in the home had a health action plan in place. These plans showed what appointments they had, how any health problems were to be handled and who was involved. They showed that a variety of health professionals were involved in the care of the people living in the home. The people living in the home had regular health checks and they had all attended well man clinics. They were taken to the GP as required. Optician, chioropody and dental appointments were arranged on a regular basis to ensure that they received the care they needed. Appointments were not always recorded in health action plans but it could be evidenced through other records that appointments were being attended. It was important that health action plans were kept up to date so that it was easy to track that people were getting their medical needs met. The home used a monthly monitored dosage system for the management of most of the medicines. There were some boxed medicines available and these were checked and found to tally showing that people were receiving their medicines according to the instructions of the doctors. There were no controlled medicines in the home at the time of this inspection and although there was no medicines fridge in place we were told that if the need arose one would be made available to enable medicines to be stored safely. There were some PRN (as and when required) medicines in use at the home. For the majority of these there was a protocol in place telling the staff the behaviours that would mean it was appropriate to give these medicines, the dosage to be given, who needed to be contacted before they could be given and how often they could be given in one day. These needed to be kept with the medicines adminstration records (MAR) for staff to refer to. Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements generally ensure that the views of the people living in the home are listened to but action is not always taken to ensure individuals well being and safety. Evidence: There was a complaints procedure in place that had been produced using pictures making it easier for the people living in the home to understand how to make a complaint if they wanted to. It was obvious that there were good relationships between the staff and the people living in the home and there was a good atmosphere in the home. Each of the people living in the home had completed one of our questionnaires with the help of their keyworkers. One said that they had an advocate to help them and the others said they would tell the staff about anything they were unhappy with. We had not received any complaints about the home since the last inspection and none were recorded in the home. The area manager looked at peoples finance records as part of their monthly audits. The cash balances were also regularly checked by the manager. Money was spent appropriately on behalf of the people living in the home. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: During examination of the records it was noted that one person had spent personal money on purchasing a bed after their original one was broken and we were told that this one was also going to need to be replaced in the next few months. The manager needed to risk assess if it was appropriate to purchase a double bed, due to the size of the bedroom. Also it needed to be determined whether the organisation should be providing this as the individual was not choosing the bed because they did not like the original but because it had broken. The process by which the individual was arriving at any such decisions needed to be clearly documented to show whether the choice was made by or on behalf of the individual. There had been an incident between two of the people living in the home where one had punched the other. This incident had not been referred to the relevant social worker or us. There were other incidents in the home that had not been referred to us and this meant that we were not always able to follow up issues arising in the home. It was important to ensure that where there were incidents the behaviours and what had been happening before the incident occured was clearly recorded as this could indicate any problems. There had been several new people employed to work in the home and it was important that they all attended adult protection training. However, until formal training was made available it was important that their induction training included some information that raised their awareness of adult protection issues. Care Homes for Adults (18-65 years) Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home presents as being in need of attention to decoration throughout so that people live in a homely and well maintained home. The premises generally meet the needs of the people living there. Evidence: The home is situated in a residential area and looks like a family residence. The lounge looks out onto Slade Road and there is comfortable seating for all the people living in the home. There is a television with a free view box for the people living in the home to watch. They all have televisions in their bedrooms if they want to watch television in private. The lounge was in need of decoration as the paint had been scraped off in several areas and on one wall holes had been plastered but not painted. The carpet was getting quite dirty and needed to be deep cleaned. There was an accumulation of dirt between the main window and secondary glazing. The overall presentation was that not a lot of care and attention was being paid to the premises. The dining room had a table that seated six people. This room was also used for Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: activities. It was a functional room and not very homely. The kitchen was a domestic kitchen and suited for its purpose. The extractor hood over the cooker needed to be cleaned as it was sticky and dirty. The garden was accessed through a door at the end of the kitchen. Some steps led to a paved area and beyond this was a lawned area. The garden area was accessible to all the people living in the home. The ground floor toilet was out of use at the time of the inspection as the toilet flush handle had been broken off. This needed to be repaired and made accessible as soon as possible. This meant that the two people with bedrooms on the first floor had to go upstairs to use a toilet. The third person could use their en suite facilities. Also off the corridor on the ground floor was a large cupboard that housed the washing machine, tumble dryer and cleaning materials, and, one bedroom with its own en suite shower and toilet. The other three bedrooms were on the first floor. One was unoccupied and used for storage at the time of the inspection although there were plans for someone to occupy it on a short term basis. The wall by the window was damp and the wallpaper and paint were expanding and breaking when touched. This needed to be addressed before anyone moved in. Two of the occupied bedrooms had some homely touches with belongings, photographs and small nics nacs displayed. One bedroom did not present as being homely. Some pictures had been framed but were waiting to be put up on the walls. The carpet outside of this bedroom was badly stained, and there was an odour due to incontinence from one of the people living in the home. The carpet should ideally be replaced but at the very least needed to be cleaned on a more frequent basis. The window opening was checked in one of the bedrooms and it was found to open more than the required amount. It was important that the openings were secured so that the windows did not open more than four inches to ensure the safety of the people living in the home. All the bedrooms had suitable locks on them. One person had a key and another made it known to the staff when he wanted to go to his room and it was unlocked. The third person did not have a key to his room as he could not look after it. On the first floor there was also a bathroom. There was an over the bath shower and Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: the hot water temperatures were found to be appropriate. Due to the needs of one of the people living in the home the toilet paper had to be kept out of reach and there were no paper towels available. It was acknowledged that this was an issue however, other ways of promoting good hygiene practices needed to be pursued. For example, the installation of a hot air hand dryer. Tablets of soap should not be left in communal washing facilities to minimise cross infections. The en suite ceiling of the bedroom on the ground floor needed to be reskimmed due to the problems caused by the extractor fan was not working. Although flooring in some areas of the home had been replaced and there was some new bedroom furniture in place the home presented as being in need of general upgrading and cleaning to make it homely and pleasant to live in. The home was suited to people with full mobility. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a core staff group who were skilled and knowledgeable about the needs of the people living in the home. The induction process for new staff needed to be developed to ensure they were competent to care for the people living in the home. Evidence: Examination of the staffing rota showed us that in addition to the manager there were generally three staff on duty. On the day of the inspection there was an experienced senior care and three fairly new staff in the morning. During the afternoon there was a team leader and two staff on duty. During the night there was one waking and one sleeping in staff on duty in the home. This would mean that there were sufficient staff on duty to meet the needs of the people living there. A number of new staff had been appointed recently at the home although there was a core group of staff who had been there for at least the past 12 months. The manager needed to be mindful of the balance of new and experienced staff on duty at any one time so that the people living in the home were cared for by people with the appropriate skills and knowledge. Staff undertook a multi tasking role that included care, cooking, cleaning and Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: activities. The AQAA told us that the majority of staff were of African Caribbean descent, more male than female staff, a diverse cross section of ages, skills and life experiences. This was good as it meant that the needs of the people could be met well. It also told us that all of the staff were working towards an NVQ qualification. Four of the staff had achieved NVQ level 2 and one had completed level 4. We were told that no agency staff were working at the home. This meant that the people living in the home were cared for by people they were accustomed to. There had been two staff meetings in the last twelve months. Staff were given minutes if they had been unable to attend the meetings. Staff meetings should be more frequent to ensure that they are kept up to date with best practice and the changing needs of the people living in the home. The records for two staff recently appointed were looked at. At the time of the last inspection staff files were held in the home but now a proforma had been agreed with us meaning that the records were held at the organisations head office. The proformas for some of the new staff were not available in the home. The area manager stated that all checks had to be undertaken before individuals were employed. The organisation must ensure that these proformas are in place as soon as people start working in the home. One of the proformas seen did not clearly evidence who the references were from. It was important to ensure that where an individual had been employed by two different employers at the same time references were taken from both employers. Also the proforma indicated that their visa had expired. We were told that this had been renewed but there was no evidence of this in the home. We asked to look at the induction process for two of the new staff and although they had undertaken a basic induction into the organisation, and shadowed experienced staff for a period of time, it did not show that issues such as confidentiality, privacy, dignity, adult protection and so on had been discussed with them. It was important that this was done especially where this was their first caring role. It was important that a senior member of staff met regularly with new starters to review their learning, knowledge and skills so that it could be determined when it was possible for them to be left to safely care alone for the people living in the home. One of the staff spoken with was not clear what the organisations complaints procedure was although they indicated that they would try and address any concerns Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: raised. Training records showed that staff had received training in medication, health and safety, food hygiene, moving and handling and so on but it was difficult to determine whether they were all up to date. It was recommended that the home developed one training matrix for all staff that showed what training has been undertaken and when it needed to be updated. There was a comprehensive training programme that had been set up by the organisation that staff could be nominated to attend but due to the number of people recruited recently the availability of places were limited. Earlier in the year we had been informed that one of the people living in the home had taken someone elses medicines and the member of staff would receive retraining in the administration of medicines. We could find no evidence that this had happened at the time of this inspection although we were told by the manager that the issue had been raised with the individual. The supervision records did not evidence this. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and record keeping arrangements are not sufficient to ensure that the people living there benefit from a well run home. Arrangements are not always sufficient to ensure that the health, safety and welfare of the people living there is promoted and protected. Evidence: The manager had been registered with us since the last inspection. She had been helping manage another home on a temporary basis but we were told that she would be back at Slade Road on a full time basis shortly. Staff spoken to during the inspection told us that she was always at the end of the phone if needed. We were told that the manager did not hold any budgets directly so she was not able to action some of the redecoration or maintenance of the home herself. This meant that requests had to be put to the maintenance department. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Examination of the maintenance records showed that the equipment had been serviced on a regular basis apart from the gas boiler and this meant that the Landlords Gas Safety Record was out of date. The boiler was last serviced in November 2007 and although it had been raised by the manager as needing to be serviced the maintenance department had not been proactive in organising this. This was not an acceptable situation as it left the people living and working in the home at risk. There were carpets in the home that needed to be cleaned and although the manager had requested this at the beginning of December 2008 this had still not taken place. This meant that there were areas in the home where there were odours. These were issues that the manager could not progress any further and it was up to the responsible individual to ensure that these actions were undertaken as soon as possible. The owners representative visited the home on a regular basis and reports were available. The decor and cleaning of the carpets had been noted in visits made. The manager needed to ensure that we were made aware of any accidents and incidents occuring in the home so that it can be assured that the people living in the home are safeguarded. The appropriate social workers also needed to be informed of these occurences so that they could monitor any incidents on behalf of the people they had placed in the home. Fire records were checked and it was found that they had been carried out at the appropriate intervals. The home was able to use a vehicle owned by the organisation to take the people living in the home out. The insurance certificate for this vehicle had expired. We were told that the insurance had been renewed and that the documentation was held at another home. The manager needed to ensure that up to date documentation was held in the home to ensure that the vehicle was road worthy and insured appropriately. During the inspection evidence that the water had been checked for Legionella was not seen. We were told that following inspections by CSCI an action plan was drawn up to monitor that the requirements were addressed. There was auditing of the financial records and medication but there was no evidence seen of any other form of quality assurance of the service. This issue should be addressed so that there is a plan for the Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: continued development of the service. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Risk assessments and 31/03/2009 appropriate management plans must be in place for all risks. This will ensure that individuals are protected from unnecessary risks. 2 24 13 Window opening must be restricted to 4 inches. This will ensure that people living in the home will be safeguarded from harm. 28/02/2009 3 30 13 Good hand washing and infection control procedures must be put in place in toilets and bathrooms. This will ensure that the people living in the home are safeguarded from cross infections. 21/03/2009 4 35 18 The induction training must ensure that new staff have the skills and knowledge to carry out their tasks. 21/03/2009 Care Homes for Adults (18-65 years) Page 32 of 35 This will ensure the people living in the home are supported by knowledgeable staff. 5 42 23 Equipment provided for use in the home must be safe for use. Evidence that the gas equipment is safe for use must be forwarded to the CSCI. This will ensure that the people who live and work in the home are safe. 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service users guide should include the fees charged so that people thinking about moving into the home know how much it costs to live there. The care plans should clearly show how all areas of need are to be met by the staff. This will ensure that each person living in the home receives personalised care. The way that the people living in the home arrived at decisions regarding their daily lives needed to be recorded. This will ensure that the people receiving support will remain in control of their lives as far as possible. Staff should continue to explore options available for individuals to take part in meaningful activities. Individual activities plans should be drawn to show that the people living in the home were choosing how to spend their days. Plans should be clear about how the different cultural needs of the people living in the home are to be met in the home. It was important to ensure that all appointments attended by the people living in the home and outcomes were Page 33 of 35 2 6 3 7 4 5 12 14 6 7 17 19 Care Homes for Adults (18-65 years) recorded in health action plans to provide an accurate record of the actions taken to meet their health needs. 8 9 10 20 23 23 All PRN protocols should be kept with the MAR charts so that staff can refer to them quickly. All new staff need to attend adult protection training as soon as possible. Adequate records need to be kept of the decisions made regarding large purchases made on behalf of the people living in the home. The home needs to be maintained so as to provide an environment that is homely, clean, comfortable and equipment is kept in good working order. This will ensure that the people living in the home have a pleasant environment in which to live. There should be a training matrix in place that shows who has done what and when updates are needed. There should be at least six staff meetings in a year to ensure that staff are kept updated with best practice and the changing needs of the people living there. There must be sufficient information kept in the home to show that the appropriate recruitment checks and updates have been made. This will ensure that the people working in the home have been appropriately recruited. The quality assurance system needed to be developed to incorporate the views of the people living in the home, evidence of audits carried out during the year and a report provided to anyone requesting one. The manager needed to ensure that all significant events affecting the people living in the home were referred to organisations as required. This will enable other responsible organisations are able to monitor the welfare of the people living in the home. The manager should ensure that the home no longer needs testing for Legionella. The manager should keep evidence of up to date insurance and road worthiness of vehicles used by the staff and people living in the home. 11 24 12 13 32 33 14 34 15 39 16 40 17 18 42 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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