Inspection on 20/02/07 for Careview Services

This inspection was carried out on 20th February 2007.

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 no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Careview Services 11/09/07

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 Careview Services 75 Birmingham Road West Bromwich West Midlands B70 6PY Lead Inspector Ms Maggie Bennett Key Unannounced Inspection 20 and 21st February 2007 09:30 th Careview Services DS0000067429.V326006.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 Careview Services DS0000067429.V326006.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. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Careview Services Address 75 Birmingham Road West Bromwich West Midlands B70 6PY 0121 532 6790 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) Care View Services Limited Kaldip Kaur Mandair Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Any service user with a physical disability must be accommodated in the ground floor bedroom only. The Home may accommodate one named service user over the age of 65 years. First Inspection Date of last inspection Brief Description of the Service: Careview is an older terraced property, which has been completely refurbished to a high standard. The home offers care to five adults between the ages of 18 to 65 and one adult over 65 who have a learning disability. The accommodation is provided over 3 floors. There is a large lounge and dining room on the ground floor, with a domestic style kitchen and small laundry. All bedrooms are single and provided with an en suite toilet and shower or bath. There is one bedroom on the ground floor, which meets the needs of a service user with a physical disability. There are 3 bedrooms on the first floor and 2 on the second floor. A stair lift has been installed, although this is not currently in use. The stairs to the second floor are steep. To the rear of the property is a small, very attractive and private garden. Transport is provided to assist service users to attend Day Centres during the week. The home’s aims are: “To provide high quality individualised care for our Service Users” and “To encourage and support independent living as far as possible.” Fees charged at the home range from £900.00 to £1,500.00 per week. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of Careview and took place on 2 weekdays, from 9.30 a.m. to 5.50 p.m. on the first day and from 7.00 a.m. to 1.35 p.m. on the second day. All the National Minimum Standards for Younger Adults were inspected. As it was the first inspection of the home and it was important that the Registered Manager and Registered Person be present, the Manager was notified of the inspection on the day before. Prior to the inspection a Pre Inspection questionnaire was completed by the Registered Manager. Surveys were sent to the service users and some were completed with assistance from the staff at Careview. In addition comments were received from a member of the local Social Services Community Learning Disability Team. During the inspection the home’s Statement of Purpose and Service User’s Guide were seen and the assessment information and care plans of 3 of the service users were inspected. The medication administration system was assessed and the home’s policies and procedures with regard to medication were seen. A number of staff files were inspected for evidence of proper recruitment procedures and staff training. A tour took place of the entire building, including individual bedrooms. Various other documents were inspected in order to assess the home’s compliance with Health and Safety legislation. On both days service users were spoken to and staff practice and interaction with the service users was observed. Two members of staff were spoken to and discussion took place throughout the inspection with the Registered Manager and Registered Person. 19 statutory requirements and 8 good practice recommendations have been made. What the service does well: Careview has got off to a good start in terms of providing quality care and good outcomes for its service users. Service users appear to be happy and content at the home and one person said: “I’m doing alright here, I’ve got my own bedroom, we go to the pub and the park. People look after me.” The Registered Manager has developed good systems for assessing prospective service users and for care planning. Care plans follow person centred planning principles and there is evidence that the home is committed to enabling service users to take control of their lives, as far as possible. The management of risk is carefully assessed. There are good opportunities for service users to develop their skills and a variety of activities are provided. The food at the home is of good quality and service users are involved in menu planning, shopping and preparation if they wish. The healthcare needs of the service Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 6 users are well met and they have access to a number of community based healthcare services. Careview provides a very pleasant and safe environment and there are good standards of hygiene. All service users have their own room with an en suite toilet and bath or shower. There is an enthusiastic and committed staff group and those seen at the inspection were keen to enhance their skills with further training. A very happy and relaxed rapport was observed between the entire staff group (including the management) and the service users. The Registered Manager is very competent and person centred in her approach. Staff find her supportive and approachable. The Registered Person has an active involvement in the home and is clearly known by the service users. What has improved since the last inspection? What they could do better: The home’s Statement of Purpose, Service User’s Guide and Contract lack some of the information required by legislation. (see Standards and Requirements section of the report). A number of documents and policies need to be provided in a format that is accessible to the service users. During the inspection it was found that 2 of the service users had been admitted to the home prior to an assessment being received at the home from the funding Authority. Although the Registered Manager carried out a full assessment herself, the home must not admit any new service user until they have received a proper assessment from a trained person (usually a social worker or nurse). Failure to do this may result in inappropriate admissions. The medication policy lacks a “homely remedies” policy and procedure. There are a number of staff who have not received satisfactory training in medication administration. The Registered Manager is taking steps to access this training. Some poor practice with regard to medication administration was observed during the inspection. There were some further gaps in staff training, which need to be addressed, including Adult Protection and all the core health and safety areas. Staff also require training in the specialist needs of people with a learning disability, including autism. Again, the Manager is taking steps at present to seek this training. The home have been required to produce a staff training and development plan and to ensure that all staff have an individual training and development assessment and profile on their file. This must include LDAF accredited induction training for new staff to Skills for Care specifications. Although service users’ views of the home are regularly sought, Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 7 a quality assurance and quality monitoring system now needs to be introduced in order to measure success in achieving the aims, objectives and statement of purpose of the home. There is currently some confusion about management roles within the home and this needs to be clarified in the manager’s Job Description. 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. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 8 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 Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 9 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, 3, 4 and 5. Quality in this outcome area is adequate. The home has developed a Statement of Purpose, which sets out the aims and objectives of the home and this includes a pictorially illustrated service user’s guide. Both the service user’s guide and contract need to contain full details with regard to fees. These documents should be provided in an accessible format so that service users can (if possible) be assisted to understand what the home is responsible for providing. Not all of the service users received the benefit of a full needs assessment under Care Management arrangements, although the Registered Manager did carry out her own thorough assessment prior to the person being admitted. A full assessment is essential so that the service user and their representatives can be assured that the home will be able to meet their needs. The home provides very good opportunities for prospective service users to visit and spent time with the other service users before making any decisions about moving in. This judgement has been made using available evidence including a visit to this service. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 10 EVIDENCE: There is a Statement of Purpose in place, which sets out the home’s aims and objectives, philosophy and services and facilities. Although details are given with regard to individual rooms, the Statement must contain the room sizes. The Service Users’ Guide is a comprehensive document, which contains pictures of the various areas of the home and facilities provided. Details are provided of the qualifications and experience of the Registered Manager. The Guide contains a copy of the home’s Agreement with the service user (see also Standard 5) and this gives information of what the fees cover and what they do not cover. It does not, however, contain details of what the fees are and there needs to be more information on the key contract terms. The Registered Manager and Responsible Individual are referred to Regulations 5, 5A and 5B of the Care Homes Regulations 2001 as amended in September 2006. The home have begun to develop a format for gathering service users’ views of the home. There is a copy of the home’s complaints procedure, but this needs to be amended as it currently does not contain the correct address of the local office of the CSCI. Apart from the pictures in the Service Users’ Guide, none of the above information is available in a format accessible to the service users. The Registered Manager has already taken steps to remedy this and has ordered a Makaton Compact Disc, which she will use to develop accessible formats. The assessment information of 3 service users was seen during the inspection. For the first service user there was an Individual Care Specification from the funding Authority in place, but this had not been signed or dated. The home had completed their own assessment and this covered all those areas listed in Standard 2.3. Information from the assessments had been used to develop a care plan (see also Standard 6). Any potential risks or restrictions on choice had been assessed (See also Standard 9). Family interests had been documented. The files of the other 2 service users did not contain an assessment from the funding Authority. The only information received for one service user was a letter from her previous placement. There was no assessment information for the other service user. The home must ensure that no new service user is admitted to the home until a full assessment has been received from the placing Authority. In the above 2 cases there was evidence that the Registered Manager had, however, carried out a thorough assessment herself of the service users concerned and was satisfied that the home would be able to meet their needs (see also Standard 3.8). During the inspection the Registered Manager and staff at the home were able to demonstrate their ability to meet the needs of the current group of service users. (See also Standard 32). The Registered Manager has over 3 years’ experience of working with adults with a learning disability and other staff seen during the inspection have experience of working with this service user group. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 11 All the current group of service users are White European, but the Registered Manager is confident that the home would be able to meet the needs and preferences of a person from a minority ethnic community and any specific religious or cultural needs. Staff were observed to be communicating effectively with the service users, all of whom are able to understand and communicate through speech. An Advocacy service is available locally and three of the service users are currently supported by an Advocate. At present the home does not provide respite care. There was evidence from care plans that new service users have good opportunities to spend time at Careview before making any decisions about moving in. The care plan of one service user gave a detailed account of her introductory visits to the home, including day visits and “sleep overs”. There is a minimum three-month “settling in” period, which is followed by a review meeting. The home’s policy is not to accept emergency admissions. As stated above in Standard 1, care plans seen contained copies of a Contract/Agreement, but none contained details of the fees charged and none were signed or dated. The contract is not in a format which is accessible to the service user. Apart from this copy in the service users’ files, there is not evidence that the service user has been consulted about their contract. The Registered Manager is aware that this area needs review and attention. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 12 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): Standards 6, 7, 8, 9 and 10. Quality in this outcome area is good. The management of the home is committed to enabling service users to take control of their lives as far as possible and to exercise their right to make decisions and choices. Service users are consulted on some aspects of the day-to-day life of the home. Care plans follow person centred planning principles. They are written in clear language, but more use of illustrations will enhance them further and enable service users to be more fully involved in their care planning. Risks are assessed and the management of risk takes into account the individual needs of the service user. There are clear policies in place to protect the service users’ rights to confidentiality. This judgement has been made using available evidence including a visit to this service. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 13 EVIDENCE: The care plans of 2 of the service users were looked at in detail in order to assess the home’s care planning practice. Care plans are person centred and set out how individual needs, including personal care needs, are to be met. The plan is divided into “My Morning Routine”, “Afternoon Routine” and “Evening and Weekend Routine”. Any restrictions on choice are detailed and suggested interventions provided for particular behaviours, such as “hugging” or “approaching traffic”. The plan is provided with illustrations and the Registered Manager intends to develop the format further by the use of Makaton symbols. There is a key-worker system in place and staff spoken to during the inspection displayed a good understanding of the key-worker role. The plans have been regularly reviewed and formal reviews are to be held every six months (one such review has already taken place). Numerous examples were seen during the inspection of service users being enabled to make decisions about their everyday lives. The care plans give details of individual’s likes and dislikes and the diary for each service user provides examples of how decisions have been made on a daily basis. 3 service users are assisted by Advocates. Service users are helped to manage some areas of their finances, where possible. One service user is responsible for some of his monies, to enable him to take charge of Day Centre fees and money for the bets he likes to make at the local Betting Shop. The Registered Manager is the Appointee for one service user. Service users are given opportunities to participate in the day to day running of the home. A weekly meeting is held when an Activity Plan is discussed and agreement reached with the service users. Service users are also involved in menu planning and shopping (see Standard 17). When new staff are appointed service users are involved in selection during the staff’s probationary period. None of the home’s policies and procedures are yet available in accessible formats. There are very good risk assessments in place, which are written for each individual and describe the particular risks to that person, with control measures to minimise the risk. Desired outcomes are described. Risks have been assessed prior to admission and are reviewed on a regular basis. Evidence of these reviews was seen at the inspection. The home are strongly recommended to carry out a risk assessment with regard to one particular service user and their safety on the stairs. The home have a clear policy and procedure in place with regard to Confidentiality. This includes a statement on confidentiality for its partner agencies. All service users’ individual records are kept securely. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. The home seeks to enable service users to develop their skills, including social, communication and independent living skills. A number of meaningful daytime activities are provided to suit the individual. Service users take part in a variety of leisure activities, many of which are in the local community and are often accessed by public transport. The home is committed to assisting service users to retain and develop personal and family relationships. Service users are involved in the daily routines of the home, assisting with choosing menus and taking responsibility for their own rooms. A variety of healthy foods are offered. This judgement has been made using available evidence including a visit to this service. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 15 EVIDENCE: There is evidence from care plans and daily diaries of service users being provided with opportunities for personal development. During the inspection it was observed that service users are encouraged to set the table and to choose their foods for meals. Service users are asked at assessment about any spiritual needs they may have. Examples of this were seen in care plans, with illustrations. Service users’ responses and wishes had been noted. Four of the present group of service users have been enabled to continue with the Day Centres they went to before they moved to Careview. This has helped them with continuity and provided stability during their move. One service user still travels to Walsall to continue with the Day Centre they previously attended. A number of local facilities are used, including the cinema complex in Dudley, Sandwell Park Farm and the Nature Reserve at Cannon Hill. Although the home does have its own vehicle, service users often travel by public transport and all have bus passes. 3 service users continue to travel to a pub in Blackheath, where they meet with friends to play skittles. Currently 2 service users are on the electoral register, the remaining service users are to be consulted about this. The Registered Manager confirms that staff time with service users outside the home, at evenings and weekends, is regarded as part of their duties. Service users’ individual likes and dislikes with regard to social activities are recorded in their care plans. One service user likes to bake and help in the kitchen and also likes meals out. She confirmed that she was able to pursue these activities at Careview. Another service user likes gardening and she confirmed during the inspection that she spent a lot of time in the garden. The Registered Manager stated that they were hoping to provide some raised beds in the Spring. At the time of the inspection there were plans for service users to be taken on holiday in the summer. Various holidays are being arranged to meet the needs of the individuals. 3 of the service users who moved to Careview from another home have retained their links with friends from that home. Friendships are also formed at Day Centres. Service users are enabled to keep in touch with their families. The home have appropriate policies in place with regard to service users having intimate personal relationships. Daily routines are in place during weekdays, which also promote independence and individual choice. This was observed during the inspection, which commenced at 7.00 a.m. on the second day. Four of the service users were Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 16 going out to Day Care, all received one to one assistance with personal care. Service users choose their own clothes, with advice given if needed. It was noted that service users chose their breakfast from a number of options and went into the kitchen so that they could see what was available. The fifth service user, who does not attend Day Care, was able to get up at a time which suited her. A cleaner is employed on 3 days a week, but there is also a cleaning rota for the staff and service users are involved with staff in general household tasks. This includes working with staff on cleaning their own rooms. Suitable locks and keys have been provided to all bedrooms, but none of the current group of service users have chosen to use their keys. During the inspection staff were observed to knock before entering rooms. The Registered Manager states that mail is opened with the service user and explained to them. It was observed during the inspection that staff interact fully with the service users, sitting in the lounge and being very much part of the overall group. There are rules on smoking, alcohol and drugs, which are clearly stated in the home’s contract. Menus seen at the inspection show that a variety of nutritious foods are offered to the service users. The meals are planned a week ahead with the service users and some service users go shopping with staff, if they wish. Choices are offered for all meals and during the inspection it was noted that a cooked breakfast is available, one service user choosing to have a bacon sandwich. During the week the main meal is taken during the evening. Service users who go to Day Centre take a packed lunch. On Saturdays there is often a “takeaway” and Sunday lunch is always a traditional roast. One service user prefers to eat undisturbed and is able to take her meal in a separate, small dining area. Care plans contain details of service users’ nutritional needs and there is evidence that everyone is regularly weighed. There was evidence from one care plan that a service user had been helped with a weight reducing diet. In another care plan there were clear instructions regarding thickening agents to be used in drinks, the cutting up of food and the amount of assistance the person needed. The care plan also stressed that the service user would indicate when they needed assistance. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 17 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): Standards 18, 19, 20 and 21. Quality in this outcome area is adequate. Service users’ needs and wishes with regard to personal support are clearly documented and staff are responsive to their individual requirements. The healthcare needs of service users are well met and they have access to a number of community based healthcare services. There are sound medication policies and procedures in place. The addition of a “homely remedies” policy and procedure is required. All staff who administer medication must undertake accredited training. An area of poor practice with regard to medication administration, which was observed at the inspection, must be addressed so that service users are fully protected. This judgement has been made using available evidence including a visit to this service. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 18 EVIDENCE: Care plans seen during the inspection demonstrate that service users’ preferences and needs with personal support are clearly documented. Staff are expected to read all care plans and sign to verify that they have understood them. Evidence of this was seen at the inspection. All service users have their own rooms, with an en suite bathroom, so all personal care takes place in private. Times for getting up and going to bed are flexible, but during weekdays the majority of service users attend Day Centres and are therefore assisted to get up in time for this (see also Standards 2 and 6). Guidance needed with regard to personal care is clearly documented in the care plans. Some service users are able to choose what they wish to wear from their wardrobes. Others are assisted to choose their clothes by staff. In such a small home, it is not always possible for service users to choose to have staff working with them from the same gender or ethnic background. The home does, however, have 2 male carers and the Operations Manager is also male. Equipment to assist service users is provided as needed: one person has a “Parker” bath in their bathroom, another has been provided with a hoist for the bath. A stair lift has been fitted, although this is not currently in operation. Additional specialist support is provided from healthcare professionals in the community. Evidence of this was seen in care plans: instructions to staff from a physiotherapist were seen for 2 service users and instructions from a speech and language therapist were seen for another service user. There is a key-worker system in place. The healthcare needs of service users are clearly documented. There is evidence that female service users have been offered routine screening. It is recommended that the male service users are also offered screening, perhaps at a “Well Man” clinic. Service users have been registered with the same local G.P., who is regularly in touch with the home and carries out regular checks. Medication is periodically reviewed, including any medication prescribed by the Psychiatrist. There is evidence in care plans of service users being supported to attend G.P. and outpatient appointments. Service users visit healthcare professionals, such as dentist and optician in the community. 3 service users have chosen to retain the dentist and optician they had in Blackheath. The home have policies and procedures in place with regard to medication receipt, administration and storage. The Registered Manager is recommended to access the Guidance Log with regard to medication, available on the CSCI website to ensure that all policies and procedures are in line with this guidance. There is a need for the home to produce a “homely remedies” policy and procedure. None of the service users take charge of their own medication. All medication is stored securely in the office. Appropriate records are kept of all medication received, administered and leaving the home. No controlled drugs are prescribed at present. If they are in future, the home must ensure Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 19 that they are stored, administered and recorded properly. Staff who administer medication have taken part in a one day training course. All staff who administer medication must take part in appropriate accredited training. Information on this training is available on the CSCI website and the Skills for Care website. The Registered Manager carries out an audit of the medication and records on a monthly basis. She also carries out spot checks on the staff to check their competence. The Pharmacist also carries out a regular audit. The medication and accompanying records were checked at the inspection. On 2 occasions medication had been administered, but not signed for on the administration sheet. It was observed during the inspection that staff placed 5 tablets on a spoon for a service user, who was asked to swallow them all at one time. This is not good practice and the Registered Manager was asked to speak with staff following this observation and ensure that proper practice is followed in future. The home do not yet have a policy in place with regard to how the home deals with the ageing, illness and death of a service user. Service users’ wishes, however, with regard to what happens after their death has been discussed with them as far as possible and recorded. Family wishes have also been taken into consideration. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 20 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): Standards 22 and 23. Quality in this outcome area is adequate. The Complaints Procedure contains all the required information, but is not provided in a format that is accessible to the service users. At present service users would be unable to understand how to make a formal complaint. There is a satisfactory Adult Protection Procedure in place, which protects the service users. The management and staff at the home are aware of their responsibilities with regard to the Protection of Vulnerable Adults, but require more in depth training in this area, which is currently being arranged. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear Complaints Procedure in place. The Procedure is not yet available in an accessible format and it is unlikely that the current group of service users would feel able to make a formal complaint without an explanation of how to do so provided in an accessible way. The provision of a suitable procedure is, therefore, a high priority. An independent Advocacy service is available locally and this is used by 3 of the service users. No complaints have been received by the home or by the Commission since the home opened. The home have an Adult Protection Procedure in place, which is in line with the Sandwell Social Services Procedures. No allegations or instances of abuse have occurred at the home. The Registered Manager and some staff have Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 21 attended a half day Adult Protection Training Course. The Manager is currently in touch with the Council’s Adult Protection Co-ordinator and is seeking additional training for herself and her staff in this area. During the inspection both the Manager and staff spoken to gave a good account of their responsibilities with regard to the Protection of Vulnerable Adults. The home has policies and procedures in place with regard to any physical and/or verbal aggression from a service user. The Registered Manager states that restraint is not used at Careview. It is recommended that the policy be reviewed and clarified, as at present it states that restraint can be used as a last resort. It is further recommended that if this is the case, staff receive appropriate training in restraint. There are clear policies and procedures in place with regard to service users’ monies. 3 service users have their own Bank Accounts and Bank Accounts are to be opened for the newly arrived service users. Personal allowances received from the Funding Authority are paid into the service users’ Bank Accounts. Clear records are kept of all withdrawals made by the service users and cash kept at the home on behalf of the service users is stored individually and securely, with appropriate records maintained. Receipts are kept of all the purchases made by the service users. An audit of the monies and records is made at each staff handover meeting and the record signed by the Manager. A check was made of the monies and records during the inspection and all were in order. It is recommended that the Registered Person speak with staff so that they are clear about when service users should pay for meals out. The home already pays for “takeaways”, but if service users go out as part of a planned activity, this should also be funded by the home. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 22 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): Standards 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. Careview provides a very pleasant and well-maintained home, which meets the needs of the service users. All bedrooms are en-suite and personalised by the individual service user. Accommodation is over 3 floors and access to bedrooms is via stairs. A stair lift is to be provided to the first floor. The stairs to the second floor are steep. There are good standards of hygiene within the home and policies and procedures are in place to control infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Careview is an older 3 storey terraced property situated on the Birmingham Road in West Bromwich. It has been refurbished and redecorated to a high standard and provides comfortable and homely accommodation. There is a large lounge/dining room, domestic style kitchen and small laundry on the ground floor. Also on the ground floor is one of the single bedrooms. The remaining bedrooms are approached by stairs. On the days that the home was Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 23 inspected the premises were clean, cheerful and warm and free of any offensive odours. The rear entrance contains a small car park and is on level ground. The front entrance is approached from the main road, with steps leading to the front door. The premises are in keeping with the local community. The Fire Officer visited the home at the time of registration and more recently following the installation of a stair lift. There are CCTV cameras to the front and rear of the premises. Each service user has their own single room, which has an en suite toilet and either a bath with a shower attachment or a shower. One room has been provided with a “Parker” bath, to meet the needs of the service user. The home does not have an emergency call system in place. There are no wheelchair users living at the home. Because of the steep stairs, five of the four bedrooms are only suitable for service users who are mobile. All the service users bedrooms were seen at the inspection. All were comfortable and tastefully decorated to suit the individual service user’s taste. All bedrooms have been provided with a suitable lock and key. There is a very pleasant, small garden to the rear of the property. There is a small staff sleep in room and staff are also provided with individual lockers. There is a no smoking policy in the building, although smoking is allowed in the garden. As stated above, a “Parker” bath has been provided for one service user and another service user uses a hoist for bathing. A stair lift has recently been installed, which is currently not in use. The Fire Officer has requested that some alterations be carried out to the stair lift. The running rails to the stair lift are to be extended and a replacement handrail is to be fixed to the right hand side of the wall. Following this the home will review their fire risk assessment and emergency plan. The home are advised to seek advice from the Fire Officer with regard to the large gaps at the bottom of some of the doors. At present the home does not offer intermediate care or rehabilitation. There is a very small laundry and no separate sluice facility. At the time of the inspection there laundry was clean and in good order. There home has policies and procedures in place for the control of infection. At the time of the inspection one bedroom had a leaking ceiling. The Responsible Individual stated that this was due to be repaired and made good during the week of the inspection. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 24 Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 25 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): Standards 31, 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. Staff are cheerful, enthusiastic and committed to providing the service users with good quality care. They are able to communicate well with the present group of service users, although training in alternative forms of communication, such as Makaton, is needed. Staff are employed in sufficient numbers to meet the needs of the service users. Recruitment checks have not been carried out in a robust and satisfactory manner and this practice could have placed service users at risk. Although some appropriate training is being provided, there is no long-term training plan in place and this needs to be developed to ensure that all staff have the required knowledge and skills. Individual supervision sessions take place regularly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff have been provided with Job Descriptions and a blank copy of the home’s standard job description was seen during the inspection. The home is reminded that a copy of each person’s individual job description must be kept on their file. There is a key-worker system in place and staff spoken to during Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 26 the inspection demonstrated that they had a good understanding of the keyworker role. All staff have been given copies of the General Social Care Council Code of Conduct. In addition staff are required to read the home’s policies and procedures and sign to say that they have understood them. There are no volunteers employed at the home. During the course of the inspection staff seen were observed to have a very good rapport with the service users. They had a friendly and cheerful approach and when different staff members came on duty service users were clearly pleased to see them. Staff were seen to be communicating effectively with the service users, all of whom are able to use speech. The majority of staff have had previous experience of working with service users with a learning disability, but have not received specific training in this area while they have been at Careview. The Registered Manager states that she is currently seeking specialist training, including training in autism, and has been in touch with Skills for Care in order to access further appropriate training. The majority of staff at the home have either completed or are undertaking an NVQ at the moment. Staff rotas seen during the inspection show that during day-time shifts (8.00 a.m. to 9.00 p.m.) there are 3 members of care staff on duty. Overnight there is one waking member of staff and one sleep-in. The manager carries out some care duties, but also has supernumerary hours for management tasks. There are low rates of staff sickness and only one member of staff has left the home since it opened. There are 3 male members of staff employed. Regular staff meetings take place and notes of meetings were seen during the inspection. The Registered Manager states that training in methods of communication, including Makaton, is to be provided. The present group of service users are able to use speech. A number of staff files were seen during the inspection in order to assess recruitment procedures and practice. One application form did not contain a full employment history. Not all of the staff files seen contained 2 written references. In a number of the files seen there was evidence that staff had commenced at the home prior to the receipt of a satisfactory Criminal Records Bureau check or Protection of Vulnerable Adults check. Since that time, both satisfactory POVA 1st and CRB checks had been received for all the staff. The home must ensure that from now on no new member of staff commences at Careview until a satisfactory CRB check and POVA check have been received. Commencing staff without proper checks can place service users at risk. In rare circumstances, where it is essential for the health and safety of service users that a new member of staff be employed, the person may commence work only if: a satisfactory POVA First has been received, the home have carried out a risk assessment and the person employed works only under supervision. All staff receive a statement of their terms and conditions and their appointment is subject to a 3 monthly probationary period. No volunteers are employed at the home. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 27 At present there is no staff training and development plan in place, although the Responsible Individual states that there is a training budget and this was seen on the home’s computer. Since the home opened there has been very little money spent on training. The Registered Manager has accessed a number of appropriate training courses (including “Dealing with Difficult Situations”) at no cost, but there are some areas where this has not been possible. Further work needs to be carried out with regard to training, so that all staff can feel confident that they have the competencies and skills to meet the complex needs of the service users. This includes training in equal opportunities. Induction training for new staff is not up to Skills for Care specifications. The home must develop a training and development plan for the staff group as a whole and each staff member must have a training needs assessment on file. Training must be LDAF accredited. Guidance on training can be found on the Skills for Care website. Staff seen at the inspection confirmed that they received formal supervision on a regular basis. Staff files contained a Supervision Agreement and notes of supervision sessions, which take place each month. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 28 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): Standards 37, 38, 39, 40, 41 and 42. Quality in this outcome area is good. The Registered Manager is very competent and person centred in her approach. She has a background of working with people with a learning disability and aims to provide a good quality of life for the service users. Staff feel that they are listened to and are well supported. The Responsible Person has an active involvement in the home and is known and recognised by the service users. Lines of accountability in the home with regard to management need to be more clearly defined, as set out in Standard 37.3, so that everyone is aware of who is responsible for what. This judgement has been made using available evidence including a visit to this service. There are sound policies and procedures in place, which are already being reviewed by the Manager. The home now needs to develop a quality assurance system, which involves the service users. The Manager is aware that a number of staff need updated training in the core health and safety areas. The home’s health and safety policies protect the service users. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 29 A regular health and safety check would further enhance this protection. The Registered Person has a satisfactory business plan in place and all the necessary insurance cover. EVIDENCE: The Registered Manager is a qualified nurse and has previous experience of working with people with a Learning Disability. She is currently undertaking the Registered Managers’ Award, to be followed with the NVQ 4 in Care. At the time of the inspection the Manager did not have a Job Description. It was not, therefore, possible to verify that the Manager is given overall responsibility for all the duties set out in Standard 37.3, which should be encompassed in the Job Description. Currently there is some confusion with lines of accountability, around who is responsible for the overall running of the home. Some responsibilities with regard to recruitment and health and safety appear to have been delegated to the home’s Operations Manager. It was apparent during the inspection that the Registered Manager had not been fully involved in discussions with the Fire Officer about the stair lift. The Responsible Person is reminded that the running of the home is the overall responsibility of himself and the Registered Manager, who must be able to make final decisions with regard to all areas which effect the health and safety and wellbeing of the service users. Prior to the home being opened the Manager worked with the Responsible Person to produce appropriate policies and procedures. She has ensured that all staff read these policies and procedures and that they sign to verify this. The Manager is aware of her responsibilities with regard to compliance with the Care Standards Act and Regulations and the General Social Care Council Code of Conduct. The Manager updates her skills and knowledge by taking part in training and has been proactive in accessing a number of appropriate training courses for herself and the staff group. Staff spoken to during the inspection feel that there is an open and transparent atmosphere at Careview and that the Manager is always willing to listen to them. They feel that she is responsive and offers strong support. One staff member said that they felt “very comfortable” at the home. In addition the Responsible Person also spends time at the home, some of that time with the service users. There are regular staff meetings and copies of the notes from these meetings were seen at the inspection. At the time of the inspection the home had not produced an annual development plan, but have commenced some systems to obtain the views of service users and other stakeholders. This has included monthly audits, weekly meetings with the service users and 3 monthly reviews with individual service users. Both the Registered Person and Registered Manager are aware Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 30 that the home now needs to develop a quality assurance system (preferably one that is professionally recognised), which involves the service users. As the home has only been open for a few months, policies and procedures are mostly up to date. The Registered Manager states, however, that she is aware that several now need to be updated and that she will be reviewing them. There are policies and procedures in place for all those topics set out in Appendix 3 of the Care Homes Regulations and evidence of this was seen at the inspection. Staff are asked to read the policies and then sign to verify that they have done so. The policies and procedures are not yet in a format that is accessible to the service users. As stated earlier in the Section on Staffing, not all those staff records required by Regulation are available in the home. All records at Careview are kept securely. There is no training plan in place at the home and staff files seen during the inspection did not, in all cases, contain certificates to verify that staff had up to date training in moving and handling, fire safety, first aid, food hygiene and infection control. Records seen showed that fire alarm tests, emergency lighting tests and fire drills take place at the required intervals. There is a Fire Risk Assessment in place, which has been seen by the Fire Officer. This was recently updated following the installation of a stair lift. The Gas Safety Certificate, Electrical systems and electrical appliances certificates are still in date. Thermostats have been fitted to all the water outlets which are accessible to the service users. The temperature of the water must be regularly checked and recorded. It is recommended that the temperature of the water in the kitchen and staff toilet is also regularly checked and recorded, as, although service users would not normally be in the kitchen without staff supervision, there is the slight risk that this might occur. The water was checked for legionella in August 2006. Window restrictors have been fitted to all first and second floor windows. All hazardous substances are stored securely and analyses are kept of all the products used. All service users have individual risk assessments. A risk assessment needs to be completed with regard to one service user and their use of the stairs. (see Standard 6 above). It is strongly recommended that a weekly tour of the home is carried out to assess hazards and that this be recorded. As stated in the section on Staffing (above) the current induction training is not to Skills for Care specifications and needs to be developed further with regard to all safe working practice topics. There is a business and financial plan in place, which was seen on the Registered Provider’s computer at the time of the inspection. Evidence was seen of satisfactory insurance cover. The Registered Person states that the business strategy has been discussed with the staff group. Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 3 5 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 3 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 3 3 2 3 2 2 3 Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? First 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. 2. Standard YA1 YA1 Regulation 4 5, 5A, 5B Requirement The home’s Statement of Purpose must contain details of room sizes. The Service User’s Guide must contain details of all the key contract terms, including details of fees, as required by Regulation. Timescale for action 30/04/07 30/04/07 3 YA2 14 The Guide must be provided in a format accessible to the individual service users. No new service user must be 21/02/07 admitted to the home until a proper assessment has been received from the Funding Authority. When service users are privately funded, the assessment must be carried out by the Registered Manager of the home. (It is acknowledged that the home had carried out thorough assessments for all service users, but where service users are funded, an initial assessment must also be provided by the Funding Authority). Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 33 4 YA5 5, 5A, 5B, Schedule 4.1 Each service user must have an individual written contract or Agreement, which contains all those details required by Regulation and which is signed and dated. The contract must be provided in an accessible format. The home must have a “homely remedies” policy and procedure. All staff who administer medication must take part in accredited medication training. (For further information on the required training the home is advised to consult the Guidance Logs on the CSCI website and the Skills for Care website). Administration record sheets must be properly completed. Proper medication administration procedures must be followed. (Tablets must be administered one at a time). The home must have a policy, procedure and practice guidance to help staff in the event of them caring for service users with degenerative conditions, terminal care and death. The home must produce the Complaints Procedure in a format that is accessible to the service users. All members of staff must have an individual Job Description, a copy of which must be kept in their staff file. Staff must receive specialist training in the needs of people with a learning disability. This should include training in autism. Application forms for new staff must contain a full employment history. Any gaps in employment must be explored with the applicant. DS0000067429.V326006.R01.S.doc 30/04/07 5 6 YA20 YA20 13(2) 13(2) 30/04/07 31/05/07 7 8 YA20 YA20 13(2) 13(2) 21/02/07 21/02/07 9 YA21 12(1)-(4) 31/05/07 10 YA22 22(2) 30/04/07 11 YA31 18 31/03/07 12 YA32 18(1)(c) 30/04/07 13 YA34 19 Schedule 4.6 09/03/07 Careview Services Version 5.2 Page 34 14 YA34 19 Schedule 4.6 15 YA35 18(1)(c) No member of staff must 21/02/07 commence employment until satisfactory Criminal Records Bureau and POVA checks have been received. In exceptional circumstances, where it is essential for the health and safety of service users that a new member of staff be employed, the person may commence work only if: a satisfactory POVA First check has been received, the home have carried out a risk assessment and the person employed works only under supervision. A staff training and development 31/03/07 plan must be produced. Each staff member must have an individual training and development assessment and profile, a copy of which must be available on their file. Training must be Learning Disability Award Frameworkaccredited. New staff must receive LDAF accredited Induction Training to Skills for Care specifications. The home must develop a quality assurance and quality monitoring system in order to measure success in achieving the aims, objectives and statement of purpose of the home. All staff must receive regular training in moving and handling, first aid, fire safety, food hygiene and infection control. Certificates to verify the successful completion of this training must be available in staff files. Water temperatures at all outlets accessible to service users must be regularly checked and DS0000067429.V326006.R01.S.doc 16 17 YA35 YA39 18(1)(c) 24 31/03/07 31/05/07 18 YA42 13 (3-6) 31/05/07 19 YA42 13(4)(a) 28/02/07 Careview Services Version 5.2 Page 35 recorded. This should include the water temperature in the kitchen and staff toilet, as sometimes these areas are accessed by the service users. 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 Refer to Standard YA6 YA19 YA23 Good Practice Recommendations The home are recommended to carry out a risk assessment with regard to one particular service user and their safety on the stairs. It is recommended that the male service users be offered healthcare screening. It is recommended that the home’s policy on physical and/or verbal aggression by service users be reviewed so that the policy on restraint is clarified and clearly understood by all staff. If staff are to restrain as a “last resort”, they must receive appropriate training in physical restraint. It is recommended that staff be made clear about when meals out are to be funded by the home or by the service user. There appears to be some confusion on this at present as on occasions service users have been charged for a meal out when the meal out has been substituted for a meal normally provided at Careview. The home is recommended to seek advice from the Fire Officer with regard to the large gaps at the base of some of the fire doors. The Registered Person is strongly recommended to develop a Job Description for the Registered Manager and to ensure that the Manager has overall responsibility for all those duties set out in Standard 37.3. Policies and procedures should be available in a format that is accessible to the service users. It is strongly recommended that a health and safety check of the premises takes place on a weekly basis, with findings and measures to be taken recorded. 4 YA23 5 6 YA24 YA37 7 8 YA40 YA42 Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Careview Services DS0000067429.V326006.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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