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Inspection on 08/11/06 for 8 Trescott Road

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

This inspection was carried out on 8th November 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Staff support service users to go to the places they want to go to. One service user said, "I like it when staff take me to the pub". Staff support service users to go on holiday and out for day trips. They talk about these at service users meetings so they get to say where they want to go. Service users have a choice of what they eat and drink and if they want a big meal or just a snack. Service users said, "I like living here and I like the staff", " I feel safe and happy here and want to stay here forever." Service users who may want to come to live at the home have the information they need so they can make a choice about whether or not they want to live there. The views of the people who already live there are considered when a new person may be moving in. Service users and their representatives have the information they need so if they are unhappy they know how to make a complaint. The home is well decorated and homely and comfortable making it a nice place to live. The storage and giving out of medication to service users was good and staff had signed to say they had given it. This makes sure individuals get the medication that the doctor has said they need to stay healthy. Staff spend time talking to service users and finding out what they like and don`t like and what things they would like to do. The health and safety of service users and staff is considered to be important. Regular checks on equipment are done to make sure they are working and safe to use.

What has improved since the last inspection?

New chairs had been bought for the lounge making it more comfortable for service users to sit in. Staff have had training in the prevention of abuse so that they know how to keep service users safe from harm. Staff have received more training so they know how to meet the needs of individual service users. More staff had been employed to work at the home so that staff who know the service users well are always on duty. A Manager has been recruited to work at the home so that they can continue to lead staff to meet the needs of the individual service users.

What the care home could do better:

Records of all check ups that individuals have at the dentist must be kept to ensure that these are regular. Pressure area assessments must be regularly reviewed so that staff are doing everything they can to stop individual`s getting pressure sores. When individuals needs have changed their health action plans should be updated. All staff must have updated training in moving and handling so their knowledge of this is up to date and service users can be supported safely. The recruitment records of all staff employed there must be kept in the home so it is clear that suitable people have been employed to work with the service users. All staff must have regular formal supervision sessions so they know how to meet individual service users needs and any training needs they have can be identified.

CARE HOME ADULTS 18-65 Trescott Road (8) Northfield Birmingham West Midlands B31 5QA Lead Inspector Sarah Bennett Key Unannounced Inspection 8th November 2006 13:00 Trescott Road (8) DS0000016936.V311590.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 Trescott Road (8) DS0000016936.V311590.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. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trescott Road (8) Address Northfield Birmingham West Midlands B31 5QA 0121 475 9585 F/P 0121 475 9585 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) Trident Housing Association Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 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 1st February 2006 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. The pre –inspection questionnaire stated that the fees charged range from £1088.68 to £1435.67. In addition to this service users contribute to the cost of petrol for the homes minibus. For the first 20 miles – 50p per mile, subsequent 30 miles – 20p per mile and over 50 miles – 10p per mile. The latest CSCI inspection report is available in the home for visitors if they wish to read it. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home, a pre – inspection questionnaire completed by the Manager, sample menus and rotas, four comment forms completed by service users and reports from the provider. One inspector carried out the unannounced fieldwork visit over six hours. This was the homes key inspection for the inspection year 2006 to 2007. The Manager and the staff on duty were spoken to. Conversations with some service users were limited due to their complex needs and limited verbal communication. The inspector met with all the service users and time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: Staff support service users to go to the places they want to go to. One service user said, “I like it when staff take me to the pub”. Staff support service users to go on holiday and out for day trips. They talk about these at service users meetings so they get to say where they want to go. Service users have a choice of what they eat and drink and if they want a big meal or just a snack. Service users said, “I like living here and I like the staff”, “ I feel safe and happy here and want to stay here forever.” Service users who may want to come to live at the home have the information they need so they can make a choice about whether or not they want to live there. The views of the people who already live there are considered when a new person may be moving in. Service users and their representatives have the information they need so if they are unhappy they know how to make a complaint. The home is well decorated and homely and comfortable making it a nice place to live. The storage and giving out of medication to service users was good and staff had signed to say they had given it. This makes sure individuals get the medication that the doctor has said they need to stay healthy. Staff spend time talking to service users and finding out what they like and don’t like and what things they would like to do. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 6 The health and safety of service users and staff is considered to be important. Regular checks on equipment are done to make sure they are working and safe to use. 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 (8) DS0000016936.V311590.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 Trescott Road (8) DS0000016936.V311590.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice as to whether or not they want to live there. Arrangements are in place so that prospective service users individual aspirations and needs can be assessed. Service users have a written statement so that they are aware of the terms and conditions of their stay at the home. EVIDENCE: The statement of purpose of the home had recently been updated with the details of the new Manager. It included all the required and relevant information. The service users guide to the home was produced using pictures so making it easier to understand. Service users said they had information about the home before they moved in. The admission procedure stated that the home would accept referrals for individuals that have been assessed by a social worker to ensure they meet the criteria for living at the home. The views of other service users living in the home about the individual moving in would need to be considered. Before the individual moved in they would be assessed to ensure the home could meet their needs. They would also have a series of planned visits to the home including an overnight stay as part of the assessment process. The fees to be Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 9 charged for the individual would be established through the assessment process depending on their needs. Each service user had a licence agreement with Trident. This stated the terms and conditions of their stay including their rights and responsibilities. It also included details of how they could make a complaint if they were unhappy about anything. Trescott Road (8) DS0000016936.V311590.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff have the information they need so they know how to support individuals to meet their needs and achieve their goals. Service users make decisions about their lives with assistance from staff where needed and are consulted on all aspects of life in the life. Service users are supported to take risks as part of a risk assessment framework to ensure their safety. EVIDENCE: Two service users records were sampled. These included an individual care plan that had recently been reviewed and updated where appropriate to reflect the individual’s changing needs. They detailed how staff are to support the individual to meet their needs with regard to their communication, eating and drinking, health needs including medication, finances, behaviour, mobility, personal care, relationships, emotional and psychological, religion and cultural and leisure opportunities. Service users, their relatives or friends, their key worker at the home and the day centre if applicable, other health professionals and the Manager attend the review of their care plan. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 11 Care plans included details of the individual’s non-verbal communication. For example there was a table that stated ‘what is happening?’ What the person does?’ ‘We think it means’ ‘And we should’. The individual’s ability to communicate is often dismissed if the individual cannot speak. However, staff through getting to know the individual have written down their interpretation to try to help the person communicate as much as possible and help all staff to understand them. One service user has a voice output communication aid that they use to help them to communicate their wants and needs. Service users said that they could make decisions about what they do each day, in the evenings and at weekends. Regular service users meetings are held. The Tenant Participation Officer who is employed by Trident chairs the meetings. Written minutes of these are kept but they are also recorded on audio tape so that service users who do not read have an opportunity to have a copy. Service users talk about activities, holidays, what they want to do for their birthday, the menu and how to make a complaint. Service users were asked at one meeting if they would like to be involved in interviewing staff. One of the service users said they would and before doing so they attended training on interviewing to ensure they had the skills to help them to do this. Service users were observed making choices about what they wanted to do, where they wanted to spend their time and what they wanted to eat. Daily records sampled stated that a service user spent time with staff choosing what they wanted for Christmas. They also regularly recorded that service users had chosen what they wanted to wear. Service users records included individual risk assessments. These stated what action staff need to take to ensure that the risks to the individual are minimised as much as possible. They included the risks of moving and handling, financial abuse, fire, pressure areas, night time, having their food through a PEG tube, eating and drinking, using transport, using their wheelchair and going out in the community to nightclubs, pubs etc. Risk assessments were detailed, regularly reviewed and updated where necessary. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12, 13, 14, 15, 16, 17 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that the people who live in the home experience a meaningful lifestyle. EVIDENCE: Most of the service users go to day centres and some attend college courses during the week. One of the service users had chosen to stay at home and now funding has been agreed so that the staff can provide their day care. They said that the staff take them out to the places they want to go to or they stay at home and relax if they do not feel like going out every day. Service users records sampled showed that they go to concerts, watch TV, listen to music, go to restaurants. Some service users went to a bonfire and firework party. Records showed that they really enjoyed this. One of the service users records stated that they did not want to go as it was a Saturday night and they wanted to stay in and watch the X - Factor. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 13 One service user and a member of staff talked about a day out in London that they had recently. Trident was nominated for an award and they went to the Award Ceremony. Staff said that the service user bought a new outfit and some jewellery especially for the event. They enjoyed the day so much that they are now planning an overnight trip to London. Staff said that three of the service users are going to London overnight to see ‘Billy Elliott’ at the end of November and another two service users are going in December. Service users went to Blackpool for five days in June and they said that they had a good holiday. Two service users went on holiday to Majorca with staff and said that they want to go there again next year. One service users care plan stated that at the weekends they like to have a liein. Records showed that staff respected this and they had the opportunity to get up later and were given support when needed. Records sampled showed that service users are supported to maintain contact with their family, where appropriate and their friends. One service user said that staff support them to write to their friends and their boyfriend often visits the home. Some records showed that staff take service users to visit their relatives if they want to see their relative but it is difficult for them to visit the home. Service users said that they clean their bedrooms, do the washing up and the cooking. Records showed that service users are supported to be as independent as possible by helping in household tasks. Service users were observed laying the table, taking the dirty dishes to the kitchen and helping to prepare drinks. Menus sampled showed that a variety of food is offered that includes fresh fruit and vegetables. Where services users have individual dietary likes or dislikes or need an alternative meal is stated on the menu. Staff sat with service users to eat and chatted to them about their day so making it a social occasion. Staff asked one of the service users if they would like a main course or go straight to the pudding as they had a big lunch at the day centre. They opted to have just a pudding and staff gave them this. Where possible service users were encouraged to eat and drink independently of staff. Plate guards and non-slip mats were provided to enable them to do this. Some service users oral intake of food is limited as they have most of their food through a PEG tube. The Dietician and Speech and Language Therapist give advice on individual’s intake. It was observed that staff followed this advice to ensure that the individual is not at risk of choking but receives the correct nutrients to maintain their health. Adequate food stocks were available including fresh fruit and vegetables. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 18, 19, 20, 21 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that the personal care and health needs of service users are met. The management of the medication protects service users. EVIDENCE: Care plans sampled stated how staff are to support individuals to meet their personal care and health needs. These included individual cultural needs in regard to skin and hair care. The care plans for personal care stated how service users can be encouraged to do as much as possible for themselves including choosing their own night clothes or clothes for the day. Some of the service users use a wheelchair to be able to move around in the home and outside. In their personal care plans it was stated that staff need to check their wheelchair was clean and working properly as this is vital to their well being. Staff were observed supporting service users who are able to, to move from their wheelchair to a more comfortable chair. Each service user has a moving and handling assessment that states how the risk to the individual and to staff are to be minimised to ensure they are as mobile as possible but not to the detriment of them or staff. These were Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 15 detailed and stated what sling to use for the individual when using the hoist to ensure they are safe. Each service user had a Health Action Plan. This is a personal plan about what an individual needs to stay healthy and what healthcare services they need to use. Some of this included pictures so making it easier to understand. One plan sampled should be updated under Diet/Nutrition as the service user is now fed through a PEG tube. Health professionals are involved in the care of service users where appropriate. These include the Dietician, Speech and Language Therapist, Physiotherapist, Community Nurse and the Dermatologist. Clear records are kept of the outcome of health appointments attended and what action if any staff need to take to ensure that health advice is followed. Service users records sampled included an individual pressure area assessment. However, one of these had not been reviewed since 1999 and the other since 2004. Given the needs of the service users these must be regularly reviewed to ensure that staff are taking appropriate action to minimise the risk of service users getting pressure sores. One of the service users told staff that they had a headache. Staff gave them paracetamol as prescribed for them when needed. Staff also respected the individual’s wish to go to bed early and supported them to do so. One of the service users records sampled showed that they regularly go to the dentist for a check up. The other record stated that the individual needed a check up every six months but they had not been since December 2005. The Manager said that this was probably not recorded and would check with staff when the individual last had a check up. Records showed that service users have regular check ups with the Optician and the Chiropodist. They also see a beautician who regularly cuts their nails. Service users are weighed regularly and a record of this is kept. Their weight is monitored to ensure that they are not losing or gaining too much weight. This is closely monitored if they receive their food through a PEG tube to ensure that the right feed is given to ensure the individual is receiving the correct nutrients. Medication is stored in a locked cabinet. The cabinet was clean and organised into sections for each service user to help ensure that it is clear which medication belongs to whom. Staff who have been assessed as competent to administer medication give the medication to service users. Boots supply the medication using the monitored dosage system where service users are able to take tablets. There is a photograph of the individual at the front of their Medication Administration Records (MARS) to ensure that it is clear who to give the medication to. MARS cross-referenced with the blister packs indicating that Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 16 medication had been administered as prescribed. Staff had signed the MARS appropriately. Where service users had been prescribed creams staff had dated on the cream when they had opened it to ensure that it does not exceed its shelf life. Where Controlled Drugs (CD’s) are prescribed for service users these are stored separately as required. Staff check the CD’s twice daily and record this in the CD register to ensure that these drugs are not misused. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that service users views are listened to and acted on. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: Service users said that staff always listen to them and act on what they say. The complaints procedure is produced using pictures and is also available on audio tape so it is easier to understand and service users have more opportunities to understand it. It is displayed in the home and is also in each service users file. It includes all the relevant and required information so that service users and their representatives know how to make a complaint. The pre-inspection questionnaire stated that there have been three complaints in the last twelve months, one of which was substantiated. All complaints had been responded to within 28 days. One of the complaints was pending an outcome. Copies of responses to all the complaints were available demonstrating that these had been responded to appropriately and where applicable disciplinary action had been taken with any members of staff involved. Where complaints had been made even if they were not substantiated discussions were held at staff meetings. Minutes of staff meetings showed that staff discussed what they could have done better and how they could improve the service. The CSCI had not received any complaints in the last twelve months. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 18 Records showed that staff had made a complaint to one of the service users day centre on their behalf with regards to their personal care whilst on a day out. Service users records sampled included an inventory of their belongings. This were regularly reviewed and updated to ensure that all individual’s belongings could be accounted for. Service users financial records were sampled. Staff check individual’s personal money at the handover of each shift to ensure that none has gone missing. The Manager completes an audit of service users finances weekly and monitors their income and expenditure on a monthly basis to ensure that it is being spent appropriately. The money in individual’s purses cross-referenced with their financial record. Receipts are kept of all expenditure. Bank statements of individual’s Reserve accounts are kept and these indicated that money is spent on personal items for the individual. Staff training records showed that all staff had received training in adult protection and the prevention of abuse. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that the home is safe, clean, comfortable and homely for the people who live there. EVIDENCE: Since the last inspection new sofas have been provided for the lounge. There were pictures, flower arrangements and contemporary ornaments around the home. This made it look more homely and comfortable but it also reflected the age group of the majority of the service users. After tea when service users were relaxing staff turned off the ceiling lights and put on the table lamps so making it more cosy for service users to relax in. The home was well decorated and furnished throughout. One service user had a new comfortable chair. They were able to adjust this and sit in the position they wanted to. They said that it was easier to get in Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 20 and out of. Adapted bathing and shower facilities are available so that service users who have mobility difficulties can access them. The home was clean and free from offensive odours throughout. Service users said the home is always spotless. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing the home, their support and development are variable. EVIDENCE: The pre-inspection questionnaire stated that 80 of staff have NVQ level 2 or above in Health and Social Care. This exceeds the standard that at least 50 of staff should have this qualification. The pre-inspection questionnaire stated that two members of staff had left since the last inspection. However, they were both transferred to work in other homes managed by Trident. The Manager said that one member of staff is due to start working at the home in December 2006. There will then be vacancies for 3.9 staff. The Manager said that he would be interviewing for staff the following week. Following that the Manager telephoned the CSCI to say that from the interviews he was able to fill the vacant posts. Currently the vacancies are covered by staff working extra hours or by regular agency staff. An agency member of staff said that they had worked at the home for about four years and often covered shifts there so they got to know the service users well. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 22 Staff meeting minutes showed that these are held monthly. Staff discussed service users needs, holidays and activities, the language used in records, rotas, their roles and conduct. Two staff records were sampled. These included the relevant and required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken to ensure that suitable people are working with the service users. The recruitment records for the Manager were not available. The Manager said they were held at Trident’s Head Office. These must be available at the home for all staff employed there. Staff records sampled showed that staff had received training in epilepsy, food hygiene, fire safety, medication, communication, health and safety, nutrition and dietary requirements, first aid, adult protection and the prevention of abuse and person centred approach (PCP). Records showed that one member of staff had not had training in moving and handling since September 2003. The other member of staff had this training in November 2003 and it stated on the certificate that this needed to be updated in November 2006. This had not been booked. Given the needs of the service users it is important that staff have updated knowledge in this. The pre-inspection questionnaire stated that training in mental health awareness had been arranged for August but the trainer cancelled at short notice so this is to be re-booked. One member of staff had attended PCP training earlier in the week. They were working with a service user developing their circle of friends and people important to them. The service user said that this made them feel special with staff sharing with them what they had learned on a training course. Staff records sampled showed that one member of staff had received three formal supervision sessions in the last year and the other member of staff had received two. However, the Manager has only been in post since June and before then there was a period when the home was without a manager. To meet this standard staff should have at least six formal supervision sessions per year. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment of a manager has helped to ensure that service users benefit from a well run home. Registration with the CSCI will help to ensure that this is maintained. Service users can generally be confident that their views underpin all selfmonitoring, review and development by the home. Arrangements are in place to ensure that the health, safety and welfare of service users is promoted and protected. EVIDENCE: Since the last inspection a Manager had been recruited to work at the home. The Manager has the Registered Managers Award and is currently undertaking NVQ level 4 in Health and Social Care. The Manager is currently in his probationary period of employment with Trident. He said that this ends in December and if he is successful in completing this and has a permanent contract he will then apply to the CSCI for registration. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 24 A representative of the provider visits the home monthly to undertake an audit as required under Regulation 26. A copy of the report of this visit is sent to the CSCI. These include the views of service users. Trident has a detailed quality assurance system. This assesses the quality of care, staff, the environment and management and the organisation. It considers the views of service users and their representatives. It was last completed in August 2005 and should now be reviewed to ensure that there have been no changes or actions to take to improve the service. Fire records showed that staff test the fire equipment weekly to make sure it is working. Regular fire drills are held so that service users and staff would know what to do if there was a fire. An engineer regularly services the fire equipment. Staff test the water temperatures weekly to make sure they are not too hot or cold. The recommended safe temperature is 43 degrees centigrade. Records showed that at the last test these were between 40 – 43 degrees centigrade. A Corgi registered engineer had completed the annual test of the gas equipment in June and stated that it was in a satisfactory condition. An electrician had completed the annual test of portable electrical appliances in June to make sure they are safe to use. The five –yearly electrical wiring test was completed in 2002 and the electrician stated that it was in a satisfactory condition. A valid certificate of employers liability insurance was displayed. Staff test the freezer temperatures daily to make sure they are within the safe limits for food storage. Records showed that these were within the safe limits. The home has a vehicle in which staff support service users to access the community. Records showed that staff check the vehicle weekly to make sure it is safe to use. A valid MOT certificate and certificate of insurance were available. In September staff had training in how to clamp the service users wheelchairs into the floor of the vehicle so that service users who travel in their wheelchairs are secured safely. All service users wheelchairs had been serviced this year. A hoist engineer was servicing the hoists during the afternoon. A member of staff was talking to the engineer about checking the slings for supporting service users in the hoist. They said that these were checked weekly and if they showed signs of wear and tear they are replaced. An engineer serviced the stair lift in June this year. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 2 X X 3 X Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA19 Regulation 12 (1)(a) Requirement Service users must have regular dental check ups and a record of these must be kept. Outstanding from 28/02/06. Pressure area assessments must be regularly reviewed and updated as necessary to reflect any changes. Recruitment records must be available in the home for all staff employed there. All staff must have updated training in moving and handling. All staff must have formal, recorded supervision sessions with their manager at least six times per year. An application for registered manager must be made to the CSCI. Timescale for action 30/11/06 2. YA19 12 (1)(a) 30/11/06 3. 4. 5. YA34 YA35 YA36 7 9 19, Sch 2 18 (1)(a, c) 18 (2) 31/12/06 31/01/07 31/12/06 6. YA37 8 (1) 31/01/07 Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 27 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 YA19 YA39 Good Practice Recommendations Service users Health Action Plans should be updated as their needs change. The quality assurance system should be reviewed and updated where there are any changes. Trescott Road (8) DS0000016936.V311590.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham 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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