Inspection on 14/08/08 for Charles House

This inspection was carried out on 14th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charles House 29/07/09

Charles House 04/09/07

Charles House 03/11/06

Charles House 27/10/05

Charles House 21/04/05

Charles House 18/11/04

Charles House 21/04/04

Similar services:

10 Whitfield Avenue

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

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Charles House (Pb) 257 Birchfield Road Perry Barr Birmingham West Midlands B20 3DG Lead Inspector Kerry Coulter Key Unannounced Inspection 14th August 2008 09:15 DS0000016722.V370180.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 DS0000016722.V370180.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. DS0000016722.V370180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charles House (Pb) Address 257 Birchfield Road Perry Barr Birmingham West Midlands B20 3DG 0121 331 4972 0121 331 4972 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) Not known Alphonsus Homes Edward Paul Brown Care Home 10 Category(ies) of Learning disability (10) registration, with number of places DS0000016722.V370180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Learning Disability (maximum number of places 10). The maximum number of service users who can be accommodated is 10. Service users must be aged under 65 years on admission to the home. 2. 3. Date of last inspection 4th September 2007 Brief Description of the Service: Charles House provides accommodation, personal care and support for ten people with learning disabilities. The Home is part of a group owned and run by a private company, Alphonsus Homes. The house is a large, well-maintained, three-storey period style property situated in the Perry Barr area of Birmingham. It is set back from the main A34 route into the city centre. At the front of the house is a small, neat garden and limited off-road parking. To the rear of the property is an enclosed private garden with flowerbeds and lawn and patio areas, which can be accessed through the large conservatory or kitchen back door. A ramp and handrails have been fitted to facilitate access for people with sight and mobility difficulties. Each person living at Charles House has a single bedroom, and these are situated on all three floors of the Home. One bedroom on the ground floor has en-suite facilities. All other bedrooms have wash hand basins and there are either bathroom or shower and toilet facilities on all floors. There is no passenger lift facility in the Home, so most people living there must have good general mobility and be able to manage stairs. On the ground floor is a large lounge, which leads directly into the conservatory. There is also a full-sized dining room, giving access to the kitchen. The house is well served by public transport and close to a range of community facilities and amenities, including shops, pubs and restaurants, parks, places of worship and medical centres. Visitors to the home can see a copy of CSCI reports, these are located in the home’s office. The range of fees charged were not stated in the statement of purpose of the home or service user guide. DS0000016722.V370180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection visit was carried out over one day, the home did not know we were coming. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an annual quality assurance assessment about the home (AQAA). We sent out seven surveys to care professionals but did not receive any back. Eight surveys were sent to staff and four were returned to us. People who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. All people who live at the home were spoken to. Due to their communication needs most people who live at the home were not able to comment on their views. Discussions with two staff and the manager, a tour of the home and sampling of health and safety records also took place. What the service does well: Staff were observed to give support with warmth, friendliness and patience and treat people respectfully. Each person has a care plan so that staff have information on how to meet peoples needs so that they get the care they need. People are offered a healthy diet to maintain their well being. When needed health professionals get involved to give advice and support so that individual’s health needs can be met. DS0000016722.V370180.R01.S.doc Version 5.2 Page 6 The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. People who live at the home all have their own bedrooms that are individual in style and contain their personal things. Staff support the people living there to be as independent as possible in their own home, encouraging and supporting them to do the cleaning, cooking and their washing. People are supported to keep in touch with their family so they do not lose relationships that are important to them. Robust recruitment practices are undertaken so that staff employed are suitable to work with vulnerable people. What has improved since the last inspection? Health action plans have been improved so that staff have more information on how to make sure people stay healthy. Moving and handling assessments have been improved for people living there so that staff know how to support people safely. The complaints procedure has been reviewed so that it is in a format that is easier for people to understand. The commission and social services have been notified of potential adult protection incidents to ensure people are being protected from the risk of abuse. Action has been taken so that the home smells nicer and is a pleasant place to spend time in. Staff have had more training so they have the skills and knowledge to meet the needs of each person who lives there. Staffing levels have been improved, but could still be further improved to make sure there are enough staff to meet peoples needs. Staff have supervision more frequently so that they receive the support they need to carry out the job and receive feedback on their performance. DS0000016722.V370180.R01.S.doc Version 5.2 Page 7 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. DS0000016722.V370180.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 DS0000016722.V370180.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 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have most of the information they need to ensure they can make a choice about whether or not they want to live at the home. Before people move in their needs are assessed so they know that their needs can be met there. EVIDENCE: The statement of purpose for the home was on display and people who live at the home have a copy of the service user guide in their care plan file. These include all the relevant and required information and terms and conditions with the exception of the range of fees that are charged for people to live at the home. However the manager was able to show a new guide he was working on, this had a section for information on fees and was also in an easier to understand format that included pictures. The annual quality assurance assessment completed by the manager detailed that it is intended to develop an audio format in the next twelve months. There have been no admissions for a couple of years and there is currently one vacancy. As reported at previous inspections there are systems in place to ensure that individual’s needs can be assessed appropriately. Discussion with the manager shows that there is no pressure on him to fill the vacancy and DS0000016722.V370180.R01.S.doc Version 5.2 Page 10 that consideration will be given to a new persons compatibility with people already living at the home. DS0000016722.V370180.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans generally detail how staff need to support the people living there to meet their needs. People are given choices in their day-to day lives and are supported to make decisions. People living there are supported to take risks within a risk assessment framework. EVIDENCE: Care records for four people who live at the home were looked at. These included an individual care plan that detailed how staff are to support the individual to meet their needs and achieve their goals. They included how staff are to support the person with their daily living skills, during the night, their activities, occupation, personal care, behaviour, social skills, communication, family contact and health needs. All plans were up to date and cross referenced to peoples risk assessments. At the last inspection some improvements were needed to manual handling assessments. These have now been made so that staff have more information about how to help people move around. DS0000016722.V370180.R01.S.doc Version 5.2 Page 12 Care plans includes peoples goals for the future, this is generally person centred and progress sheets are completed to check actions are being worked towards. Annual review meetings are also held for each person where their care is discussed. Where appropriate relatives, health professionals and social workers are invited to attend. Some people at the home may sometimes display behaviour that can be challenging. Where needed behaviour management guidelines are in place so that staff know how to reduce the likelihood of the behaviour occurring and how to manage it. Staff spoken with had good knowledge of peoples needs and were able to give examples of how choices are offered to people. During the course of the visit, it was possible to observe members of staff supporting people to make choices about what they wanted to do and where they wanted to go. Sometimes this is limited because of people’s communication support needs and learning disabilities. However staff are working towards improving systems of communication, for example the introduction of objects of reference for one person. This involves using everyday objects to facilitate communication such as using a cup to ask the person if they would like a drink. Staff were also observed to communicate with one person using Makaton (a form of sign language). One person who was at home during the visit said he had chosen not to go to college that day. He was observed to have free access to the kitchen and made himself a drink during the visit. Records sampled included individual risk assessments. These stated how staff are to support the person to minimize risks such as being scalded, using the kitchen, accessing the community, shaving, falls, using stairs and steps, and the risk from behaviours of people who live at the home. All assessments were generally satisfactory and up to date. DS0000016722.V370180.R01.S.doc Version 5.2 Page 13 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, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home would benefit from the range of activities available being developed so that they take part in activities at times similar to others of the same age, gender and culture. People have good quality food that they enjoy. EVIDENCE: During the day most of the people who live at the home attend local daycentres or colleges. Activities on offer in the evenings and weekends for four people were tracked. People do take part in activities such as shopping, domestic tasks, progressive mobility, sensory sessions, reading magazines, playing football in the garden and going out for lunch. Records did however show that for some people community activities did not happen frequently, despite for some people that it was part of their identified goals. The annual quality assurance assessment completed by the manager also lacked information about how people are supported to become part of the local community. DS0000016722.V370180.R01.S.doc Version 5.2 Page 14 For some people records did not show that they always had opportunities for interesting and fulfilling activities. For example examples recorded for one person included ‘spent time in dining room’ and ‘walked in the house’. During the visit one person did not attend the day centre. The manager took him to the bank and staff later took him out for lunch and to buy a birthday card for a relative. For one person there has been some involvement from an occupational therapist to look at the type of activities they might benefit from. Part of their report says there are limited opportunities for activities within the home environment. This person has also had input from the Community Options team to look at suitable community activities and as a result they have been put on a waiting list for a gardening group. People who live at the home usually have the opportunity to have a holiday. The manager said that holidays had not yet been booked but it was intended that people could either go abroad or to Centre Parcs. Records show that people are well supported to and friends. Some stay with families for weekend at the home itself, or are supported to meet according to individual preferences. One relative made me very welcome’. keep in touch with families visits and also receive visits up out in the community, said ‘the staff have always Members of staff were directly observed encouraging people to take an active part in jobs around the house, so as to develop their personal independence. One person was being supported by staff to do some washing up during the visit. Generally people’s rights are respected, for example one person who chose not to go to college that day had his choice respected by staff. It was identified at the last inspection that one person has a listening monitor in their room so that staff can hear if they have a seizure. Whilst this ensures the person is safe it was not clear if the persons right to privacy had been discussed. Their care plan did not record that consent for the use of the monitor had been obtained. At this visit the manager said that consent issues had still not been explored but that consideration was also being given to using alternative equipment that would better protect the persons privacy. Food stocks were examined and supplies were ample, including fresh fruit and vegetables. The record of meals taken indicates that people have access to a balanced diet that is sufficiently varied and nutritious. Special diets are catered for, for example diabetic diets. One person indicated in the homes satisfaction questionnaire that they were not happy with the food on offer, but other comments were positive. However the home had listened to the comments DS0000016722.V370180.R01.S.doc Version 5.2 Page 15 and reviewed the menu. One person who lives at the home told us ‘food is nice, we get a choice’. One member of staff said ‘this is the best place I have worked at for food, we do healthy options, people can also have snacks in between, kitchen is open, we encourage fruit’. DS0000016722.V370180.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal care and health needs of the people who live there are generally met so ensuring their well being. The management of the medication needs improvement to protect the people living there so that they receive their prescribed medication safely. EVIDENCE: Care plans sampled detailed how staff need to support each person with their personal care. People were well dressed and this was appropriate to their age, gender, their cultural background and the activities they were doing. Interactions between members of staff and people who live at the home were seen to be informal and relaxed, and support was given respectfully and in a warm and friendly manner. Records sampled showed and staff said that a range of health professionals are involved with individuals where needed to ensure their health needs are met. Records sampled included an individual Health Action Plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. The format of the plans has been improved and plans now DS0000016722.V370180.R01.S.doc Version 5.2 Page 17 detail the frequency that people need to attend appointments such as the dentist or optician. Records sampled showed that people have regular check ups with the dentist and optician where necessary to ensure they keep healthy and action can be taken if a person’s health is deteriorating. One person at the home has epilepsy, information was available to staff so that they know what to do if the person has a seizure. Two staff spoken with had a good understanding of what to do to keep the person safe. One person has recently been diagnosed with diabetes. Their health action plan had some information about their diabetes but this could be further improved to detail the type of diabetes they have and what signs staff need to look at out for that would indicate the diabetes is not being well controlled. Staff who administer medication have been trained so that people receive their medication safely. Medication is stored securely within a locked cupboard in the office. Medication Administration Records (MAR) sampled included a photograph of the person at the front so if unfamiliar staff were giving medication they would know who to give it to. MAR’s had been signed appropriately indicating that medication had been given as prescribed. The manager had made some amendments to some MAR’s. One handwritten amendment for ‘as required’ medication did not record the actual dose prescribed. The home should consider that when making amendments that these are checked and signed by two staff to ensure they are accurate and people are not put at risk of getting the wrong medication. One person at the home was seen to be prescribed medication ‘as required’ to manage behaviour. There were no written guidelines for this, these are needed so that staff have the information they need about when to give the medication. Some people had written guidelines in place for ‘as required’ medication but the medication was not actually recorded on their MAR. The MAR must record all medication prescribed to people so that they receive the medication they need safely. Discussion with the manager indicates that the home does not have a copy of the Royal Pharmaceutical Society guidelines for administration of medication in care homes. The home is advised to obtain a copy so that staff have more information of what is good practice when administering medication. DS0000016722.V370180.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems need to improve so that people can be sure their views are listened to and people are protected from abuse. EVIDENCE: People who live at the home have a copy of the complaints procedure, this has been improved since the last inspection so that it includes photographs, making it easier for people to understand. A copy of the complaints procedure has been put on the notice board in the hallway, this ensures that people who live at the home and visitors have access to the procedure. The annual quality assurance assessment completed by the manager details that the home intends to develop an audio version of the procedure in the next twelve months. The homes complaint log detailed that the home had received one complaint in the last twelve months. The complainant was concerned that staff had left people unsupervised in lounge and about lack of communication with staff. The log indicated the manager had met with the complainant and issues had been resolved. Minutes of a staff meeting referred to a complaint received from relatives about the appearance of one person who lives at the home. The minutes show that staff had been reminded that it is important that people look smart. However the complaint log for the home did not record this complaint. The manager said this was because it was not a formal complaint. The home therefore needs a system to record where minor concerns are raised and the DS0000016722.V370180.R01.S.doc Version 5.2 Page 19 action taken, so that any patterns can be tracked and action taken to prevent future occurrences. Staff have completed training in the protection of vulnerable adults and policies and procedures to include whistle blowing are readily available to them. Staff spoken with knew what to do to keep people safe if they had suspicions of abuse occurring. Prior to the last inspection there has been an allegation made about two members of staff. Appropriate action had been taken by the home in informing us and social services. Staff had been suspended as a safeguard measure pending an investigation. The investigation has now been concluded and allegations were not upheld. There have also been two incidents regarding the behaviour of one person who lives at the home towards another. The incidents have been reported to us and social services. However, staff delayed reporting one incident to the manager until the next morning rather than immediately. Staff also did not follow the correct procedures with regard to preserving evidence. Staff supervision records show that the manager has spoken with staff concerned regarding this. Staff meeting minutes show that all staff have been reminded about adult protection procedures. The manager said it was also intended to do some refresher training with staff. DS0000016722.V370180.R01.S.doc Version 5.2 Page 20 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, 26, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable, safe environment that meets most of their individual need’s. EVIDENCE: A tour of the building was completed. Charles House is an old property that has character and is generally maintained to a good standard. People’s bedrooms are individual in style according to gender, age and culture, and personal effects and possessions are in evidence. These include personal televisions, video / DVD players, music systems and computer games, so that people can enjoy private time on their own if they so choose. Communal areas were homely in style and generally in good decorative order. There were some areas of décor that needed some minor attention and these were included in the homes schedule for redecoration. The home benefits from having a conservatory. As identified at the last inspection one side of the conservatory external windows were dirty but staff DS0000016722.V370180.R01.S.doc Version 5.2 Page 21 have no access to be able to clean this area. The conservatory was quite hot and was not a comfortable temperature to spend a lot of time in. It is therefore recommended that blinds or curtains are fitted so that this area looks nicer and is a more comfortable temperature. Some people who live at the home need assistance with their mobility. It is not clear that the design of the home best meets their needs. There are several steps to the front of the home meaning that one person needs support from two staff to get in and out of the home. One person has an en-suite shower but has to step in to the shower tray when a level access shower would be easier to access. The home does not have an adapted bath and one person is assisted by two staff to get in and out. Staff spoken with felt that people were safe but that things could perhaps be made easier for people. At the last inspection the manager had said that people were on a waiting list to be assessed by an occupational therapist. At this inspection the manager said that the occupational therapist had said they were unable to offer assessments to people. Due to peoples mobility needs and the current design of the home assessment that the building and bathing facilities meet peoples needs need to be undertaken by a competent and qualified person. One bedroom had an unpleasant odour at the last inspection this is now being managed with an effective odour management system, making this a more pleasant room to spend time in. Infection control procedures needed some improvement. Bathrooms, toilets and the kitchen did not have satisfactory hand wash facilities as there was not always liquid soap and paper hand towels available. The plug to the bath was attached via a piece of string, this is poor as the string would not provide good infection control. The floor to the bathroom is carpeted, however the homes replacement schedule indicates this is to be replaced. The annual quality assurance assessment completed by the manager indicates it is intended to develop a pro-active infection control policy in the next twelve months. DS0000016722.V370180.R01.S.doc Version 5.2 Page 22 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, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development ensure that the people living there are well supported by staff that know them well. EVIDENCE: Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. It is good that all of the staff team have completed or are working towards the Learning Disability Qualification (LDQ). Previous inspections have identified that not enough staff have a National Vocational Qualification (NVQ) in care and that progress towards this was slow. This has now improved and the home is using external NVQ assessors and more staff have now completed this qualification. This means that staff have the skills and knowledge to meet the needs of the people living there. At the last inspection it was recommended that staffing levels were reviewed to make sure there were always enough staff on duty to meet peoples needs. Previously there were usually three staff on duty during the day when everyone was at home. There has been some increase in staffing levels and DS0000016722.V370180.R01.S.doc Version 5.2 Page 23 there are now sometimes four staff on duty. Staff spoken with said that there were usually enough staff on duty but that four staff better meets people’s needs. Due to the behaviour of one person at the home there has been increased pressure on staffing levels as staff are having to maintain close supervision to make sure other people are safe. The manager recognises that it would be better if there were four staff for every shift but said there is currently only funding for three. The annual quality assurance assessment completed by the manager said that the home has applied to social services for extra funding for staff. Recruitment procedures were checked. A number of checks are done to make sure that staff are suitable to work with vulnerable people to include obtaining written references and Criminal Record Bureau checks. Copies of recruitment records are available in the home where they are kept on the individual member of staffs file. Files sampled showed that robust procedures had been followed so that people are not put at risk by having unsuitable staff working with them. Staff surveys received and discussion with staff indicate that the majority of staff are satisfied with the training on offer. One staff spoken with said ‘training is very good’. The training matrix for the home shows that staff get the training they need to meet peoples needs. This includes training in food hygiene, first aid, manual handling, medication, adult protection, epilepsy, fire, autism and health and safety. As required at the last inspection staff have received training in challenging behaviour and diabetes. There were some staff who needed further training and the homes training schedule showed that training needed had been arranged. Staff meetings are generally held monthly and formal supervision for staff has improved so that staff now receive the support they need to carry out the job and receive feedback on their performance. DS0000016722.V370180.R01.S.doc Version 5.2 Page 24 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, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management systems generally ensure the home is well managed and people’s views underpin the development of the home. General practice promotes people’s health safety and welfare, but some items need attention to ensure this. EVIDENCE: The manager has the right experience to manager the home and is qualified to NVQ level 4 and holds the Registered Manager’s Award. The manager completed the Annual Quality Assurance Assessment and sent it back to us on time. Requirements made at the last inspection have been met so that some outcomes for people at the home have improved. One staff spoken with said ‘the home has got better’. Staff spoken with said that the manager was very approachable. DS0000016722.V370180.R01.S.doc Version 5.2 Page 25 Quality assurance systems are in place. The service manager visits the home and writes a report of their visit to ensure the home is being well managed. Reports provided showed these visits are generally done monthly. Reports showed these had all been carried out during the day when most people who live at the home are out. Whilst some people’s communication is limited and they may not be able to communicate their views of the service observation of staff interactions is important to make sure that people are happy. Timings of visits needs to be looked at and take into account that people attend day centres during the day. Other quality assurance systems in place include an annual quality assurance audit, the manager said this was due to be done in the next few weeks. Satisfaction surveys had also been completed by some people who live at the home with help from staff or their relatives. The manager had collated the results of the surveys and completed a report that detailed what action had been taken as a result of listening to people. The manager said that the next stage was to complete an annual development plan for the home. A number of checks are undertaken regularly by the home to make sure that the health and safety of people living there is maintained. A number of these were sampled. Systems are in place to monitor the temperature of the fridge, these records showed that food is stored at safe temperatures to reduce the risk of food poisoning. Up until March 2008 the home had been regularly monitoring the temperature of the water to make sure it was not too hot. However after March the only record of monitoring was for the 4th June. The manager said that the staff responsible for monitoring the water had left and it had not been realized that the checks were not being done. The hot water at the bath was hand tested during the visit and was found to be safe. Fire records showed that a risk assessment is in place so that the risks of there being a fire are minimised as much as possible. Staff have fire safety training so that they know what to do in the event of a fire. Staff regularly test the fire equipment to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Certificates were available to show that gas and electrical installations had been checked to make sure they were safe. The home has a weekly health and safety audit. However examination of the records showed this had not been completed since June. It was later observed that a window restrictor was broken in the bathroom, the manager did not know about this. If the weekly audits had been completed it is likely it would have been noticed as part of the audit. The manager contacted the maintenance person during the visit to arrange for urgent repair to the restrictor. DS0000016722.V370180.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 2 X DS0000016722.V370180.R01.S.doc Version 5.2 Page 27 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 YA20 Regulation 13(2) Requirement Medication administration records must record all prescribed medication, to include the dose prescribed so that people get the medication they need safely. Timescale for action 18/09/08 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 YA12 YA13 YA16 Good Practice Recommendations The fees charged to the people who live there should be stated in the service user guide to help them decide whether or not they want to live there. People should have more opportunities to take part in activities at times valued by others of a similar, age, gender and culture to ensure they have a good lifestyle. The range of activities available to people to participate in within the community should be expanded and reflect individuals taste and interests. The use of listening monitors that have the potential to impact on people’s privacy must be agreed with them or their relatives / advocate. DS0000016722.V370180.R01.S.doc Version 5.2 Page 28 5 YA19 6 YA20 7 YA20 8 YA20 9 YA22 10 YA23 11 YA24 12 13 14 15 YA29 YA30 YA33 YA39 16 17 YA42 YA42 Information about diabetes in peoples plans could be further improved to detail the type of diabetes they have and what signs staff need to look at out for that would indicate the diabetes is not being well controlled. Where people are prescribed ‘as required’ medication written guidelines for these are needed so that staff have the information they need about when to give the medication. The home is advised to obtain a copy of the Royal Pharmaceutical Society guidelines for administration of medication so that staff have more information of what is good practice when administering medication. When making amendments to medication administration records these should be checked and signed by two staff to ensure they are accurate and people are not put at risk of getting the wrong medication. Where people have ‘grumbles’ but do not wish to make a formal complaint a system should be developed so that any patterns can be tracked and action taken to prevent future occurrences. Further training for all staff in adult protection is recommended to ensure all staff follow the correct procedures in the event of adult protection incidents so that people are kept safe from abuse. Blinds or curtains should be fitted to the conservatory windows that cannot be accessed for cleaning so that this area looks nicer and is maintained at a comfortable temperature. People need to be fully assessed by a qualified person to make sure the home meets their mobility needs. Infection control procedures need to improve so that people are not put at risk of being ill from infections. Staffing levels need to be increased to ensure there are enough staff on duty to meet people’s needs. Visits to the home by the service manager should be conducted at times when people are likely to be at home. This will help to ensure their experiences / views underpin the future development of the home. Re-commence regular monitoring of water temperatures so that people are not put at risk of being scalded. The homes procedures for the frequency of completing internal audits should be adhered to so that minor health and safety repairs that are needed are identified and acted on. DS0000016722.V370180.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000016722.V370180.R01.S.doc Version 5.2 Page 30 - 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!