Inspection on 01/03/07 for 84 Lawrence Lane

This inspection was carried out on 1st March 2007.

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

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

Other inspections for this house

84 Lawrence Lane 12/12/05

84 Lawrence Lane 30/06/05

84 Lawrence Lane 11/01/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 84 Lawrence Lane 84 Lawrence Lane Old Hill Cradley Heath West Midlands B64 6EU Lead Inspector Mr Jon Potts Key Unannounced Inspection 1st March 2007 09:30 84 Lawrence Lane DS0000058833.V341887.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 84 Lawrence Lane DS0000058833.V341887.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. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 84 Lawrence Lane Address 84 Lawrence Lane Old Hill Cradley Heath West Midlands B64 6EU 01384 633672 01384 410429 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) info@Inshoresupportltd.com Inshore Support Limited Christine Lake Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12 December 2006 Brief Description of the Service: Lawrence Lane is a three-bedded property situated in an established residential area close to the local amenities and shops offered by the centre of Old Hill. It provides long term care for up to three younger adults with a learning disability, although only two are currently accommodated. Accommodation briefly comprises of three single bedrooms, bathroom, two lounges and kitchen/diner. The main stated aim of the home is to provide a service that reflects the expectations of the residents: identifying and fulfilling their individual needs by means that are valued by society; this in order to develop and support individual and personal experiences and characteristics which are culturally valued and maintained. There is a staff group that consists of a manager, senior support and support workers. There are waking staff available 24 hours per day. The manager is responsible to a service manager and directors of Inshore support who have a number of homes of similar size and purpose. The staffing ratio is currently at least one staff member to one resident. The current charges range between £2222 to £2742 per week with the only additional charges relating to personal requirements such as hairdressing, clothing etc. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day and involved the inspector assessing the homes performance primarily against the key national minimum standards for younger adults. Evidence was drawn from a number of sources and including case tracking the care for one of the two residents (this involving looking at all the documentation in respect of their care and cross checking this with outcomes), observation of practice, discussion with the registered manager, staff and review of management records. There was some discussion with the residents. Information was supplied pre inspection by the home. The residents and staff are to be thanked for their assistance with the inspection. What the service does well: What has improved since the last inspection? The most significant improvement is the homes introduction of a robust tool for self-monitoring, this clearly allowing the home to identify where the service performs well and where improvement is needed. Routine and robust monitoring by the company forms an integral part of this quality tool. The requirements from the last inspection have all either been addressed or the home is on the way to meeting these, the most significant the better understanding of the manager and staff in respect of what is appropriate practice and what can be seen as potentially abusive. The homes manager left following the last inspection of the home, and the company has recruited and supported the new manager through the registration process. This has no doubt had a significant input in terms of the home maintaining and improving outcomes for residents. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 84 Lawrence Lane DS0000058833.V341887.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 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective people looking to use the service, and their representatives have the information (in a standard written format) needed to choose a home, which will meet their needs, although this needs some update. People looking to use a service have their needs and aspirations assessed prior to admission. Each resident is provided with a statement of terms and conditions (lifestyle agreement) by the home. EVIDENCE: The home has not admitted any service users since the time of the last inspection so judgement was based on the knowledge of the management and the homes policies and procedures in addition to other documentation that was available to the inspector (such as assessments prior to admission of existing residents). The manager clearly understands the importance of having sufficient information available for a prospective service user when choosing a care home. There was clear information available that could be understood by the some of the current service users accommodated at the home although the 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 9 development of more pictorial based information and other formats would be advantageous. Admissions are not made to the home until a full needs assessment has been undertaken. All the residents accommodated are funded through care management arrangements and there were assessments available for all current residents. Any assessment for a new service user would be conducted professionally and sensitively and involve the individual, and their family or representative, where appropriate. Such an assessment would be carried out by an experienced member of the management and involve members of the staff team, this at the service users present location with staff working alongside them. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment/care plan. Prospective individuals are given the opportunity to spend time in the home with day visits extending to overnight stays. Practice and information giving is informed by the services written procedures. The homes statement of purpose is a specific document to the home based on a generic format used by the companies other homes (which all offer a similar service). It clearly sets out the objectives and philosophy of the home and includes a range of information about the service provided, the accommodation, staffing (experience and qualifications), how to make a complaint and so on. It was noted from the resident’s file that was examined that the statement of purpose/service user guide within was dated 2005 and the information specific to the home (as opposed to the generic information about the provider) would benefit from review (i.e. staff names). Contracts (called lifestyle agreements) were available to residents and these set out the basic terms and conditions of the service, although the manager needs to ensure that these are agreed with the residents where practicable or their chosen representative, this to be evidenced through such as signature on the document. There was an accompanying pictorial supplement to the lifestyle agreement seen to be available. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed and some of their needs/goals are reflected in a plan. The home encourages resident’s participation in planning the care and support they receive through on going assessment although their agreement with plans could be more explicit. The use of risk assessment supports resident’s independence. EVIDENCE: Each resident has a plan that was stated to follow residents preferences and choices based on assessment by staff and other health professionals although there was not explicit evidence of agreement with the plan through signature of the resident or their chosen representative. Plans are currently in written format and consider significant areas of an individual’s life although do need further development to provide a more overarching document that encompasses the full range of residents needs including such as leisure activities, socialisation, dietary needs (such as the impact of diabetes) etc. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 11 The current plans identify some goals, which the staff would work with the resident to achieve. There was evidence of in house review of the plans in the last six months and staff spoken to were clearly aware of the contents of the plans as a working tool. There was evidence of regular reviews of the residents care by outside professionals including the community nurse. The manager stated that a multidisciplinary review was to be arranged for the near future for the resident case tracked. Whilst care plans are not currently developed following person centred planning principals at present staff are currently receiving training in this area and targets have been set through the home’s quality assurance tool to develop a person centred plan with each resident. Each care plan was supplemented by comprehensive risk assessments with these taking into account the individual needs of the service users. The tool used for overall assessment of risks through behaviours did easily identify areas where there was judged to be a high risk through colour coded outcomes. There were some limitations in place, these consistent with the needs of the service users, and clearly documented. There was however no signatures of the resident or their representative (the latter where the resident was is in agreement with this) that showed agreement with these documented limitations. There were also a number of consent forms completed in respect of such as staff opening mail addressed to the resident, assisting with personal monies and such like, but again there was no evidence of explicit agreement. The manager stated that the residents have had involvement in group meetings, the last in January 2007, although she was looking to develop use of individual meetings with residents as it was felt that this would be more productive and of greater benefit to the individual service user. 84 Lawrence Lane DS0000058833.V341887.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use services are enabled by staff to make choices about their life style, and supported to develop their life skills. The home endeavours to offer social, educational, cultural and recreational activities that meet individual’s expectations. EVIDENCE: The service has a commitment to enabling residents to develop their skills, where possible including social, emotional, communication, and independent living skills. Staff support individuals to work towards achieving goals that will be beneficial to them such as increasing their independence. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 13 Residents are assisted to maintain important personal and family relationships and the home works in co-operation with families to ensure that resident’s cultural needs are addressed and where applicable attendance at such as temples is facilitated. Staff also encourage contact with residents from other inshore homes. The staff have access to information and specialist guidance about issues such as intimate relationships, this also incorporated within company procedures. Procedures also consider protection of individuals, and supporting people to make informed choices. Staff are aware of the need to pay close attention to the resident’s communication needs and how these manifest themselves, whether verbal or behavioural, with awareness of how this may influence patterns of risk within such as accessing the community to enable residents to fully participate in daily living activities. Staff when spoken to were well aware of the need to be aware of how the residents communicated whether verbally or non verbally, and possibly through challenging behaviour, with an awareness of the cues provided by the one resident when wanting their space and privacy. Residents, based on records, and discussion with one service user are involved in meaningful daytime activities, which they enjoy and are in accordance with their individual interests and capability. The one resident has involvement with local college and attends a number of days in the week and has a varied activity programme (in pictorial format) although there was concern that this was found replicated in the file for the other resident. Following discussion with the manager it was clear that the one resident did not have a weekly activity plan. Whilst the home has its own allocated transport, there had been some difficulties of late due to the breakdown of the same and had impacted on the community activities for the one resident. The manager was hopefully this was a matter that was to be resolved and was expecting to have a replacement on the day of the visit. There was reference by staff to the resident becoming frustrated to a degree due to the lack of external activity because of the lack of suitable transport. It was noted that the care plans could better reflect the strategies adopted by the home in providing activities and the ethos behind this in improving a resident’s quality of life. Staff were however, in discussion with the inspector, well aware of the reasons for structured activity for residents. Where appropriate and able residents are encouraged to be involved in the domestic routines of the home, this including some food preparation within a risk assessment framework. The staff have ascertained residents likes and dislikes based on the foods they choose to eat and the record of foods provided to residents showed that the menu is varied with a number of choices including healthy options. The foods recorded as given to one of the residents did however include some options on their dislikes list and staff did state that on occasions these would be enjoyed. Staff were clear that choices must be 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 14 presented in respect of diet and other areas and residents allowed to choose between presented options, and assumptions would not be made based on information that maybe out of date. Resident’s likes and dislikes do therefore need to be reviewed and updated. The one resident was able to make clear choices but verbal communication was more difficult for the other, hence staff judging their reactions to options that were presented. Residents are involved wherever possible in the homes grocery shopping. The meals are balanced and nutritional and cater for the varying dietary and cultural needs of the residents. It was noted that the manager has produced photographic images of food for use in offering choices of diet. This is to be seen a positive practice but would be clearer with use of colour images, preferably photographs of the actual meals prepared at the home. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their assessment of individual needs, although not all are summarised in care plans. Residents overall receive appropriate access to community healthcare services. The principals of respect, dignity and privacy are put in place. The overall management of medication is efficiently carried out with a few exceptions. EVIDENCE: Staff ensure that personal support is flexible, consistent, and responsive to the changing needs of the residents. Staff are aware of and respect service users preferences and self-determination, with staff aware of how to follow the lead of residents in respect of their daily routines, and aware of their cues where verbal communication maybe limited. In discussion staff were found to have accurate knowledge as to residents individual personal needs, relating to such as the provision of intimate care where it is was said to be provided in such a way that it caters for their dignity. An example of this is that there is clear direction as to the gender of staff providing intimate care. Staff respond appropriately and sensitively in all situations involving personal care, ensuring 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 16 that it is conducted in privacy and that they support residents to be as independent as possible, and in accordance with the written plans. Systems are in place to ensure residents receive effective personal and healthcare support. The homes policies and procedures set out how the service is to address these with this process delivered through a skilled, trained and knowledgeable staff group. The residents are encouraged wherever possible to have involvement in their own healthcare including visual, hearing and oral care. They have the opportunity to access their GP and have access to all NHS healthcare facilities in the local community with support from the staff team. Regular appointments are seen as important and systems are in place to ensure they are not missed. The home arranges for health professionals to visit residents at home when necessary. Staff are aware that the way in which support is given is a key issue for younger adults. Resident’s individual plans record in some cases what their personal and healthcare needs are and detail in these instances as to how they will be delivered although with some exceptions; for example, It was noted that the needs of one resident in respect of their diabetes was not summarised within their care plan although staff in discussion were clearly aware of this need and had knowledge of how to respond. There was an issue in respect of ensuring regular contact with external chiropody service for this resident, this important due to their diabetes. The home has been seen to arrange training on health care issues that relate to the health care needs of the residents. The home has developed an efficient medication policy, procedure and practice guidance. Staff all have access to the written information and understand their role and responsibilities. The home strongly promotes independence and whilst no individuals are currently assessed as being able, they would be encouraged to have involvement in administration of their medication in so far as their individual abilities allow. Medication records are seen as key to the efficient management of health care matters, and the home was seen to, with limited exceptions, keep them up to date. The home has systems to assist with compliance with the administration, safekeeping and disposal of controlled drugs if and when used. The only concerns that came to light was that the protocol for the administration of ‘as required’ medication that maybe taken in response to escalating behaviours was not detailed within the appropriate care plan, this despite the staff having a very clear awareness of when it should be given and what triggers gave rise to this decision. There were directions seen in the medication folder that dated from 2004 and based on the dosage indicated within would be due review. In addition injections that are booked into storage at the home were not always signed out by staff on the Medication records, this when administered by the community nurse. Two of the care staff that administer medication have the required accredited training and three are currently undertaking the same. 84 Lawrence Lane DS0000058833.V341887.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns where possible and staff are aware of the need to monitor resident’s behaviour for signs of dissatisfaction. The home has a robust, effective complaints procedure. The service has a good understanding of what constitutes abuse and the correct steps to take should it occur, this to protect residents. EVIDENCE: The service has a complaints procedure that is up to date, very clearly written, and is easy to understand and is available in written and pictorial formats. Discussion with the manager and staff indicated that where residents had difficulty understanding the complaints process they were aware of the need to be vigilant of any behaviour that indicated dissatisfaction with the service provided. Access of the residents to professionals independent of the service (community nurse, psychiatrists, social workers etc) on a regular basis has been known to provide a means by which concerns can be picked up and addressed. The homes procedure makes it very clear of what can be expected to happen if a complaint is made. Unless there are exceptional circumstances the service always responds within the agreed timescale. The policies and procedures regarding protection of individuals are of good quality and are regularly reviewed and updated with a copy of the local authorities easy read adult protection procedures available. The manager and staff are clear when incidents need external input and who to refer the incident 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 18 to. There was also evidence to support the fact that senior managers take the investigation of any allegations seriously. Training of staff in the area of protection has improved since the last inspection with five of the eight staff recently trained. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding when incidents should be reported. Issues arsing from the last inspection in respect of potentially inappropriate interaction with residents has been addressed and staff are clear as to directions given by the manager in respect of this practice. The manager was also clear as to need to inform agencies of any issues following potential altercations between the residents. Staff were clear that the use of restraint in response to any challenging behaviour is avoided wherever possible and if this occurs records are usually clearly documented although there was one incident that was not, with a lack of clarity as to when restraint was used. It is important that care is taken to ensure these records are accurate. The training staff are given is based on the avoidance of restraint (MAPA) where possible, although there was some reference to the use of a previous strategies in one care plan (i.e. use of positive approaches as opposed to the current MAPA strategies stated and documented as used in reports). 84 Lawrence Lane DS0000058833.V341887.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,29 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a overall safe, well-maintained and comfortable environment that allows independence. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the residents who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable. There are a few areas where redecoration is needed although in discussion the manager was seen to be aware of these and there were plans to address these in the very near future. It was noted that there was not system to secure wardrobes to prevent their falling forward if a resident leans on the top of the wardrobe door although the 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 20 weight of the furniture would in the judgement of the inspector lessen this risk significantly. The manager was however advised to assess the potential risk and discuss the matter with environmental services. Residents are encouraged to see it as their own home. It is a well maintained, attractive home, which is accessible to community facilities and services. The home is designed to provide small group living where residents can enjoy maximum independence in a discrete non- institutional environment that resembles a domestic dwelling. Residents have had a choice of the room they live in and the home provides only single room accommodation. The rooms are very well planned and there is easy access to toilet and bathing facilities. The fixtures and fittings are of a high quality, well maintained and adapted to meet the wishes of the present service users. Individuals personalise their rooms and bring in their own furniture if they wish. There is a selection of communal areas both inside and outside of the home, this means that residents have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen is designed to enable and promote the involvement of residents in domestic tasks and as part of developing or maintaining self-help skills. The bathrooms are homely and include aids and adaptations to meet the needs of the residents. Bedrooms enable privacy and have locks on the doors dependent upon risk assessments. There was evidence from water temperature records and checking the hot water supply that there is always plenty of hot water and the temperature in the home can be changed to meet their personal choice. The home was very well lit, clean and tidy and smelt fresh. The management has a proactive infection control policy and staff understand how to manage infection and maintain a safe and clean environment. Risk assessments and items necessary to support infection control were seen to be available (such as liquid soap and paper towels). 84 Lawrence Lane DS0000058833.V341887.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A diverse staff team are trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the service, this to allow the necessary consistency of care provision to vulnerable residents. EVIDENCE: The service has a highly developed recruitment procedure that has the needs and protection of people who use the service at its core. The recruitment of good carers was seen by the manager to be integral to the delivery of a good quality service, with an awareness that equal opportunities has to be offered through the recruitment process. Most elements of recruitment are accurately recorded and the required documentation is usually received prior to the employee starting work, however, there were some omissions in information in the three staff files examined where: • The staff members working history was incomplete in one instance; • Not all staff had a reference from their last social care employer • Not all references carried dates to evidence when received at the home. 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 22 The home has a diverse staff team that has a balance of all the skills, knowledge and experience to meet the needs of service users. There is evidence that the staff spoken to demonstrated a good understanding of the particular needs of the service users living at the home. Management prioritise training and facilitate staff members to undertake external qualifications beyond the basic requirements. The scheme introduces internal developmental training, to complement formal training as part of an ongoing training plan. The services policies dictate that the staff are supervised at set intervals as part of their induction, some of records of these one to one sessions seen in files for recently employed staff but not all. There have been difficulties reaching the required ratio of staff with NVQ level 2 training although this target should be reached soon assuming that there is minimal staff turnover, this as there are sufficient staff currently undertaking the qualification to allow the home to reach this target on their completion of the same. There are areas were some staff require further training although these are identified and staff were clear that they are well supported by individual training programmes identified through appraisals. Comment was made by staff in respect of the good quality of the training they receive for example equality and diversity which they felt gave them an insight into the need to ensure they did not impose their own personal values on the residents. The roles and responsibilities of staff are clearly defined and understood, based on accurate job descriptions and specifications that are readily available to staff. The service sees induction and any probationary period as being an extension of recruitment. There are clear systems in place to ensure that there is closer supervision of new staff and the knowledge aspect of induction training is provided by the company through external training provision, with links within this to LDAF (learning disability Award Framework). There is currently one staff vacancy and the home offers extra hours to existing workers (to assist with consistency) to cover this vacancy. The interview and selection process is based upon identified criteria that are closely related to the job being advertised and supports the procedure. Residents are not directly involved in the recruitment process although there is opportunity for prospective staff to visit the home and meet resident’s prior to employment. Staffing levels reflect the needs of the residents, and rotas are flexible to fit around the lifestyles of individuals and specific activities. Staff have the knowledge to understand how to communicate effectively with all residents, this evidenced in discussion with them, this reflecting written strategies. 84 Lawrence Lane DS0000058833.V341887.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect and has a developing and generally effective quality assurance system developed by the homes senior management. Where there is room for improvement this is acknowledged and accepted by management that express a wish to excel. EVIDENCE: The home has a recently registered manager that has only taken up management of the home during the latter half of the previous year and in discussion was stated to be working to improve the consistency of the care provided to the residents. Discussion with some of the staff team reflected the manager’s objective and all staff were clear that the home had an open atmosphere where issues could be freely discussed. The manager was stated to be able to communicate with them by the staff spoken to. The manager is 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 24 currently working towards her Registered Managers Award. The responsible individual for the company provides supervision for the manager. Based on the homes training plan the provider and manager trains and develops staff that are generally competent and knowledgeable to care for younger adults. The service is planned to be user focused, and generally works in partnership with other professionals. The home has policies and procedures that set out the aims and objectives of the service, with staff having copies of key polices provided to them within a staff handbook. The home uses questionnaires for stakeholders and staff and whilst having held residents meetings, the manager stated that she will be using individual meetings with residents on a regular basis as this would better elicit resident’s individual views. Staff meetings were seen to have been held at least quarterly. The manager is improving and developing systems that monitor practice and compliance with the homes plans, policies and procedures, this in conjunction with the services responsible individual. Whilst progress is ongoing, there has been significant improvement seen in this area since the last inspection with clear identification of the services strengths and weaknesses. The home has developed a health and safety policy that generally meets health and safety requirements and legislation. Checks show that records are generally up to date although some gaps/omissions were found in recording as detailed earlier in this report. 84 Lawrence Lane DS0000058833.V341887.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 2 2 3 3 X 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 4 26 X 27 4 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 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 2 x 3 X 3 X 2 3 X 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1) Requirement Care plans must carry sufficient detail so that the strategies the home adopts to meet residents needs in all areas of health, social and emotional care are clear and transparent. Residents with diabetes must be provided with regular and on going chiropody to ensure their foot care is maintained. The triggers for the administration of ‘as required’ medication must be clearly detailed in such as the residents care plan so as to ensure that they are only given when appropriate. Any injections stored by the home must be signed out as given to the community nurse so that stock records of such are accurate. Records in respect of any use of restraint must be accurate so that any such incidents can be accurately audited. Timescale for action 31/05/07 2. YA19 13(1)b 31/05/07 3. YA20 13(2) 15/05/07 4. YA20 13(2) 15/05/07 5. YA23 13(8) 31/05/07 84 Lawrence Lane DS0000058833.V341887.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. 3. 4. Refer to Standard YA1 YA7 Good Practice Recommendations To continue developing key policies and procedures such as the service users guide in pictorial or alternative formats that allow easier understanding by the residents. Where possible evidence of the resident’s agreement with the lifestyle agreement, care plans and any limitations should be obtained so as to demonstrate participation. To ensure there is a clear programme of activity planning linked into a residents known preferences that supports any plan related to activity, leisure and social care. To use colour images of meals in stimulating resident’s choice of foods, preferably photographs of meals prepared at the home, this to assist the home communicating meal choices to residents and reviewing their likes and dislikes. Behaviour plans should carry directions for staff that refer to the current strategies for dealing with challenging behaviour. (i.e. MAPA as opposed to positive approaches) so that it is intervention techniques are clear. To ensure more care is taken in respect of records relating to staff recruitment so that they all carry clear evidence of the full working history and references from last social care employer. YA14 YA17 5. YA23 6. YA34 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 84 Lawrence Lane DS0000058833.V341887.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!