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Inspection on 22/09/05 for 8 Trescott Road

Also see our care home review for 8 Trescott Road for more information

This inspection was carried out on 22nd September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users said: "I`m not unhappy anymore, I`m happy here". "I like the staff". Professionals said: " We have worked very well and very closely with this home through some very complex cases. They are a credit, and take up recommendations and follow these, communicating very well." The ex by ex said: "This is somewhere I would live. I felt very comfortable and relaxed in the home." Professionals also said: " I have been very impressed by the level of professional care and commitment provided by staff at this home over the last few years". Service users go out to places they want to go to. They go on holiday and away for weekends. Service users said they choose what they want to eat and if they need a special diet, this is provided. The ex by ex said: " I thought that the staff communicate well with the service users." The ex by ex also said: "The service users were well dressed. The home was nice and big. The staff were very friendly."

What has improved since the last inspection?

Some new staff have been recruited. At the last inspection there were over 100 hours support worker vacancies. At this inspection there were 60 hours. Some parts of the home have been redecorated, making it a more homely environment for the service users. The accident and missing person procedures have been updated to include the required information so that staff are aware of what to do.

What the care home could do better:

Staff must sign for all medication as they give it to service users to make sure all service users get the medication that is prescribed for them. All staff must receive training in the prevention of abuse to ensure they have all the necessary information to protect service users. All staff vacancies must be recruited to, so that service users do not have to get used to different staff who they don`t know, working with them. A new manager must be appointed to work at the home.

CARE HOME ADULTS 18-65 Trescott Road 8 Trescott Road Northfield Birmingham B31 5QA Lead Inspector Sarah Bennett Announced 22 September 2005 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 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 Stationary 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. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Trescott Road Address 8 Trescott Road Northfield Birmingham B31 5QA 0121 475 9585 0121 475 9585 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Trident Housing Association Care Home 7 Category(ies) of Learning Disability (7) , Physical Disability (7) registration, with number of places Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years, with a learning disability which may also include associated physical disabilities. Date of last inspection 15 March 2005 Brief Description of the Service: 8 Trescott Road is registered for seven people who have a learning disability and additional physical disabilities. It is a purpose built residential home. The layout and design offers an accessible and spacious facility. The home is equipped with en suite facilities for all seven bedrooms. A stair lift provides access to two bedrooms, office and staff sleep-in facilities on the first floor. It is unfortunate that a purpose built home for people who have a physical disability cannot be accessed by people who use a wheelchair. Five of the service users cannot access the first floor. Ground floor accommodation includes five en suite bedrooms and an open plan dining room/lounge and a conservatory. The kitchen is accessed off the dining area. To the rear of the home there is an enclosed garden, there is scope to develop the garden so that it could be utilised more by the current service users. To the front of the home there is off street parking for a number of cars. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out over seven and a half hours. There are currently six service users living at the home, who were spoken to. The Area Manager and the staff on duty were spoken to. A partial tour of the premises took place. Care, staff and health and safety records were looked at. Two service users records were sampled. Three relatives and two professionals involved in the care of service users completed CSCI comment cards sent to the home before the inspection. Stephen Ellis (expert by experience) and his supporter from Sandwell People First were there for part of the inspection. As a service user Stephen has an expert opinion on what it is like to receive services for people who have a learning disability. Stephen’s comments are included throughout this report where he is referred to as ‘ex by ex’. What the service does well: Service users said: “I’m not unhappy anymore, I’m happy here”. “I like the staff”. Professionals said: “ We have worked very well and very closely with this home through some very complex cases. They are a credit, and take up recommendations and follow these, communicating very well.” The ex by ex said: “This is somewhere I would live. I felt very comfortable and relaxed in the home.” Professionals also said: “ I have been very impressed by the level of professional care and commitment provided by staff at this home over the last few years”. Service users go out to places they want to go to. They go on holiday and away for weekends. Service users said they choose what they want to eat and if they need a special diet, this is provided. The ex by ex said: “ I thought that the staff communicate well with the service users.” The ex by ex also said: “The service users were well dressed. The home was nice and big. The staff were very friendly.” Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 5 Service users are told of the terms and conditions of their stay at the home. EVIDENCE: Service users records included an individual contract. These stated the terms and conditions of their stay at the home. Contracts were signed and dated by the individual or their representative and the registered manager. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8, 9 Service users assessed needs and goals are reflected in their individual care plan so that staff know how to support each individual. Staff support service users to make decisions about their day-to-day lives. Service users are supported to take risks within a risk assessment framework. EVIDENCE: Service users records included individual care plans. These stated the service users short and long term goals and their likes and dislikes. Care plans stated how individual service users cultural needs are to be met. Some information was no longer relevant to individuals and should be removed. One service user had worked with their key worker on their Essential Life Plan using the computer. They had produced it using symbols and pictures. The ex by ex said: “One service user wrote her essential life book with the support of her key worker. They read some of it to me off the computer. This was very good as it had easy words and pictures in it”. “Essential life style plans were very good”. Care plans are kept in the office. Staff showed that they have knowledge of what is included in care plans. Care plans are regularly reviewed and updated as necessary. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 10 The ex by ex also said: “The care plans were not accessible plans as they were kept in the office”. All service users care plans need to be made easy to understand and the service users that can be involved should be involved in updating them”. Service users meetings take place every two months and are taped to make them more accessible to all service users. The Area Manager said that some service users choose not to attend and this is respected. The ex by ex said: “Service users meetings take place regularly. Service users said, ‘we talk about anything’. The meetings are taped” Service users records included individual risk assessments. These stated how the risks to service users of taking part in daily activities and accessing the community are to be minimised. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 15, 17 Arrangements are in place so that people living at the home experience a meaningful lifestyle. Service users are offered a healthy diet and enjoy their meals. EVIDENCE: Most service users attend day centres Monday to Friday and some access college courses from their day centres. One service user has chosen not to attend their day centre. As the home is not funded to provide care to service users during the day additional funding had to be sought from Social Services. The Area Manager said that this was difficult but as it was clearly what the service user wanted they persisted and recently funding has been agreed. This service user chooses what they do each day and said that they enjoyed being at home. Staff said the service user is happier now they do not attend a day centre. Service users records showed that they go shopping, to restaurants, bingo, parks, beauty shop for a massage, Staff and service users said that they have been away for weekend breaks this year to Blackpool and Southport. All service users were going away for five days the week after the inspection, supported by staff, to either a hotel in Wales or Butlins in Minehead. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 12 Staff said that they support some service users to visit their relatives. The evening meal was served in serving dishes for individuals to help themselves to what they wanted. Those service users who did not wish to have the meal of pork, mashed potatoes, cauliflower, cabbage and gravy were given an alternative. One service user had soup and another had veggie burgers and chips. A choice of desserts was offered. Where service users have difficulties in swallowing the speech and language therapist and dietician are involved. The ex by ex said: “The service users are involved in putting the shopping list together. They get together on a Friday to talk about what food they would like on the list. They go shopping with the staff. Some of the service users prepare their own breakfast”. A choice of drinks were offered throughout the afternoon and evening. One service user said they have whisky in their coffee in bed every evening. Adequate food was available. Food stored in the fridge was labelled and dated when opened. Menus showed that a variety of food is offered and special dietary needs are catered for. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21 Service users receive appropriate personal support and their health needs are met. The arrangements for the management of the medication are generally adequate to ensure that service users are protected. The death of a service user was handled with respect. EVIDENCE: As service users arrived home from their day centres staff offered them a drink. Care plans stated how staff are to support individuals with their personal care. Service users said they have a lie-in at weekends to 10 or 11am and have a cup of tea in bed. The ex by ex said: “All service users can go to bed when they choose and get up when they want to”. “All service users have a key worker. Those we spoke to said that they are happy with their key workers. Staff involved the residents in their conversations”. Each service user has a Health Action Plan in line with ‘Valuing People.’ This states how the individual is to be supported to keep healthy and access appropriate services. Records showed that service users are supported to have Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 14 regular check ups with the dentist, optician and chiropodist and other health professionals are involved in their care. Boots supplies the medication using the monitored dosage system. There is a photograph of each service user at the front of their medication administration record (MAR). Two staff give medication to service users to try to avoid errors. On one of the service users MAR one of their medications had not been signed for as given for three consecutive days. All other medication had been given as prescribed. Medication is stored in a locked cabinet. Separate storage is provided for Controlled Drugs (CD). These are checked by two staff and signed for in the CD register. Sadly, one of the service users has recently died. The Area Manager and staff said that a Memorial Service was held in the home on the Saturday before, which all service users were involved in. A local vicar conducted the service with input from staff and service users. A tree was planted in the garden in memory of the service user. Staff spoke fondly of the service user and service users were encouraged to talk about how much they missed them. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The arrangements for making complaints ensure that service users views are listened to and acted on. Adequate arrangements are not in place to ensure that service users are always protected from abuse. EVIDENCE: The ex by ex said: “ The service users have an easy to understand complaints form in their rooms. They have a list of how they can complain to if they are unhappy about anything. I thought this was good because it was easy to follow”. The Area Manager said there have been no complaints since the last inspection. Service users records included a complaints procedure in a picture format. Relatives said they are aware of the home’s complaints procedure. The Area Manager said that the adult protection policy is not in line with the current multi-agency guidelines on the protection of vulnerable adults but it is being reviewed to ensure it is. Service users records included an inventory of their belongings that had been regularly updated. The ex by ex said: “The residents have their own bank accounts. They choose what they want to spend their money on”. Some staff have not received training in the prevention of abuse. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28, 29, 30 Service users live in a clean, safe, homely and comfortable environment that meets their individual needs. EVIDENCE: The home is well furnished. Service users bedrooms were personalised and decorated according to individual tastes and interests. Each service user has an en suite bath or shower room depending on their individual needs and preferences. The ex by ex said: “One service user showed me their room and it was really nice, they had all of their own personal things in their room”. Some of the paint on the lounge walls was chipped. The Area Manager said that this had recently been redecorated but it had been knocked by one of the service users wheelchairs. The ex by ex said: “The home was nicely decorated”. There are blinds on the windows and ceiling in the conservatory, which makes it more comfortable for service users to sit in when the sun is bright. Around the walls and hanging down from the ceiling of the conservatory there are mobiles and sensory lighting. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 17 The ex by ex said: “I liked the conservatory because it was a quiet place for the residents to sit. I felt very comfortable and relaxed in the home”. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36 The arrangements for staffing the home, their support and development was variable and do not ensure service users are always supported by an effective staff team. EVIDENCE: The Area Manager said there are 60 vacant hours for waking night support workers. One member of staff has recently been recruited to fill a 35 - hour support worker post working days and they are waiting to start work at the home. Two agency staff that have worked at the home for a long time cover most of the vacant hours. One other regular agency staff works in the home sometimes. At night there is one waking night staff and one member of staff who sleeps-in. There is three staff on duty in the morning and four staff on a late shift. Most of the service users attend day centres Monday to Friday. Regular staff meetings are held and minutes of these are kept. The ex by ex said: “I thought that the staff communicate well with the service users”. Three staff records were looked at. They included the required recruitment records including a completed application form, recent photograph, proof of identity, two written references, health questionnaire and a satisfactory Criminal Records Bureau check. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 19 Staff records showed that staff have received training in food hygiene, first aid, moving and handling, health and safety, fire safety, epilepsy, enteral feeding, pressure areas and dysphagia. Staff receive NVQ training in care. Some staff have not received training in the prevention of abuse. Staff records showed that staff receive regular, formal, recorded supervision sessions with their line manager to ensure they are doing their job properly and meeting individual service users needs. Each member of staff has an annual performance development review with their line manager. Agency staff receive regular, formal supervision sessions. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 Currently, the staff have ensured that the arrangements put in place by the previous manager are continued so that the service users benefit from a well run home. A prolonged absence of a manager may change this. Adequate arrangements are in place to ensure the health, safety and welfare of service users is promoted and protected. EVIDENCE: The Registered Manager has been promoted to Area Manager, leaving the Manager post vacant. The Area Manager said that the post was due to be advertised in the local press that evening. In the interim they hoped to recruit a Manager from an agency and would be interviewing the following day. Fire records indicated that an engineer regularly services the fire equipment. Staff test the fire alarm and emergency lighting regularly to make sure they are working. Regular fire drills take place involving all service users and staff to make sure they are aware of the procedure to follow if there was a fire. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 21 There is a fire- guard around the fire in the lounge to prevent the risk of service users burning themselves. Records showed that an engineer regularly services the lift, hoists and the adapted baths. An electrician tested the portable electrical appliances in July 2005 to make sure that they are safe to use. An electrician tests the electrical wiring installation every five years to make sure it is in a satisfactory condition. A Corgi registered engineer tested the gas equipment in July 2005 and stated that it was in a satisfactory condition. Staff test the water temperatures weekly and keep a record of these. These showed that they are generally maintained at the recommended safe level of 43 degrees centigrade. A current certificate of employers liability insurance was displayed. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x 2 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trescott Road Score 3 3 2 4 Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 12 (1) (a), 13 (2) 13 (6),18 (1) ( c) 18 (1) (a, b) 8 (1) (a), 2 (a,b) Requirement Staff must sign for all medication given to service users on their medication administration record. All staff must receive training in the prevention of abuse. Vacant support worker posts must be appointed to. (Previous timescale of 30th June 2005 not met). The Manager post must be recruited to. The CSCI must be informed when a manager is appointed. Timescale for action Immediate & ongoing 31 January 2006 & ongoing 31 December 2005 & ongoing 30 November 2005 2. 3. 23, 35 33 4. 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations Care plans that are no longer relevant to individual service users should be removed. Care plans should be accessible to all service users who should be involved in them as much as they are able to. Trescott Road E54 S16936 TrescottRd V244007 220905 AI stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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