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 4th September 2007 09:45 Charles House (Pb) DS0000016722.V343838.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 Charles House (Pb) DS0000016722.V343838.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. Charles House (Pb) DS0000016722.V343838.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 Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 3rd November 2006 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 and also to the office. 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. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was carried out over one day; the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. 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 a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Surveys were received from four people who live at the home, four relatives and three staff, some of their comments are included in this report. Two 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. The people who live at the home were spoken to, however most of them were out at activities for most of the visit. Due to some people’s learning disability and communication needs it was not always possible to get their views on the home. What the service does well:
Everyone who lives at the home has their own up to date care plan. The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. 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. The people living there said they can keep in touch with their family and friends, staff support them to do this where needed. One relative said ‘the staff have always made me very welcome’. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 6 Each person living there has their own bedroom. These include their personal things. The home is clean and well decorated so it is a nice place to live. Recruitment practice is good, and promotes the safety of people who use the service. What has improved since the last inspection? What they could do better:
Moving and handling assessments should be completed for people living there so that staff know how to support people safely. Ensure the CSCI and Social Services are notified of any potential adult protection incidents to ensure people are being protected from the risk of abuse. Make arrangements for members of the care team who need training in areas of challenging behaviour and diabetes to receive the training they need to ensure they can meet the needs of people who live at the home. The range of activities available to people to participate in within the community should be expanded and reflect individuals taste and interests. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 7 Health action plans would benefit from further development to include information about the frequency needed for general health checks such as dentist and optician to ensure people receive the healthcare they need. Further work needs to be done to ensure people know how to make a complaint and that staff know how to respond to make people feel comfortable in raising their concerns. Staffing levels need to be reviewed to ensure there are enough staff on duty to meet people’s needs. Action is needed to ensure all areas of the home smell nice. Some health and safety issues need addressing to ensure people are safe. 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. Charles House (Pb) DS0000016722.V343838.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 Charles House (Pb) DS0000016722.V343838.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, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users generally have the information they need to make a choice as to 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 and they can visit the home so they know what it is like to live 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. The information is in a standard written format. It is recommended that consideration is given to making the guide easier to understand, perhaps by including some pictures or photographs so that people who are considering moving to the home will have all the information they need to make a decision about moving there. The AQAA recorded that in the next twelve months the home intends to produce a brochure and service user guide in alternative formats. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 10 There have been no admissions since the time of the last inspection and there is currently one vacancy. As previously reported, there are systems in place within the Organisation to ensure that individual’s needs can be assessed appropriately, and that people have the opportunity to visit and stay over prior to making any decisions about placement. Discussion with the Manager shows that there is no pressure on him to fill the vacancy and that consideration will be given to a new persons compatibility with people already living at the home. Charles House (Pb) DS0000016722.V343838.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. Generally the people living there are supported to take risks within a risk assessment framework. EVIDENCE: Two records of the people who live there 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, and health needs. All plans were up to date. One person was identified as being at risk of falling and needs the support of two staff to get in and out of the bath and when using the stairs. Discussion shows this person is having difficulty getting in and out of the bath but there was no manual handling assessment available to fully evaluate the risks and guide staff how to safely support the person. This is further detailed in the personal and healthcare
Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 12 section of this report. Since the last inspection goal setting with individuals is now more person centred and progress sheets are completed to check actions are being worked towards. It is good that people who live at the home are involved and where able they are given the opportunity to sign their own care plans. 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. 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, he also answered the phone, he said ‘I always answer the phone’. Records sampled included individual risk assessments. These stated how staff are to support the person to minimize the risks of them 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. Charles House (Pb) DS0000016722.V343838.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 have the opportunity to attend college courses and to practice their self-help skills to enable them to maximise their independence. Opportunities for community activities are not always satisfactory to ensure everyone who lives at the home do the things they enjoy. People have good quality food that they enjoy. EVIDENCE: Sample checking of peoples’ files showed that people attend local colleges and centres for structured activities during the day, and are able to access the local community with support. The organisation provides day activities from a local centre. Most people’s programmes involve a mixture of these components in varying degrees. People who live at the home have the opportunity to go on holiday. The activities on offer to two people at the home were looked at. Discussion with the Manager and sampling of records showed that one of them undertook
Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 14 a variety of activities that included college, shopping, going to the bank, pub, cooking, food shopping and bowling. Records for the other person showed that their main activity was usually attendance at the day centre. Their care plan recorded that it was one of their goals to go out more at weekends but there was little evidence of this being achieved. One member of staff commented that more outdoor activities were needed, one relative said some people did not go into the community much and that it was always the same ones that go out. The Manager needs to ensure that everyone who lives at the home are offered opportunities to attend community activities that they enjoy. Discussion with the Manager shows that new activities are being considered for people, for example on the day of the visit a new basket ball hoop had been fitted to an external wall. The Manager said this would give people the chance to try something new. The Manager has also introduced a new recording system for activities undertaken but this had only been in place a few days and so it was difficult to establish its effectiveness at the time of the visit. Records also show that people are well supported to keep in touch with families and friend. Some stay with families for weekend visits and also receive visits at the home itself, or are supported to meet up out in the community, according to individual preferences. One relative said ‘the staff have always made me very welcome’. 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 empty the dishwasher 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. One person has a listening monitor in his room so that staff can hear if they have a seizure. Whilst this ensures the person is safe it is not clear if the persons right to privacy has been discussed. Their care plan does not record that consent for the use of the monitor has been obtained. If the person themselves is unable to consent the use of the monitor needs to be agreed with their relatives, advocate or health professionals to ensure its use is in their best interests. Guidelines should also be available for staff as to when the monitor should not be used, for example when personal care is being undertaken. 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. The meal on the evening of the visit was pasta. One person who lives at the home commented ‘I like pasta’. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that the personal care and health needs of the people living there are met so ensuring their well being. The management of the medication protects the people living there so that they receive their prescribed medication at the right time. 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. One person was identified as being at risk of falling and needs the support of two staff to get in and out of the bath and when using the stairs. Discussion shows this person is having difficulty getting in and out of the bath but there was no manual handling assessment available to fully evaluate the risks and guide staff how to safely support the person. A referral has been made to an Occupational Therapist for an assessment to be completed but there is a
Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 16 waiting list. To prevent accidents occurring whilst awaiting professional input staff need some guidance on how to support the person. Accident records show this person has fallen on the front steps a couple of times, it is recommended that the Occupational Therapist is also consulted about their suitability for the individual. Records showed that where appropriate health professionals are involved in the care of individuals. There is continuing involvement from members of the multidisciplinary team including GP, consultant psychiatrist, community nurse, and psychologist. People generally have regular health check ups including going to the dentist and having their eyes tested but for one person their was no record of them visiting the dentist since 2005. The Manager said he would ensure an appointment was made for them. Records include charts for monitoring individuals’ weights and also epileptic seizures, where appropriate. Since the last inspection the Community nurse has reviewed one person’s epilepsy protocol and this was available in their file. Each person has a health action plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to use. These documents were basic in content and would benefit from further development such as information about the frequency needed for general health checks including dentist and optician and the support they need to attend health checks. 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. At the time of this visit medication administration was well managed. The home retains copies of prescriptions so that staff can check the correct medication has been received from the chemist. Medication administration records were sampled and found to be in good order. As required at the last inspection where people are prescribed medication on an ‘as required’ basis protocols are in place so that staff know when to give this medication. As required at the last visit topical creams are now dated on opening so that staff know when they need discarding. The home has its own systems in place for checking that medication is being given safely, a weekly audit is done that covers medication stock, administration records, expiry dates of medication and cleanliness of the cabinet. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate complaints procedures are in place but further work is needed to ensure people know about the procedure so that people feel listened to. General practice promotes the protection of people from abuse, but one incident was not managed in line with adult protection procedures. EVIDENCE: The CSCI has not received any complaints about this home in the last twelve months. The home’s complaint log shows the home has not received any complaints directly. The complaint procedure is on display, a simplified version is also available for people who live in the home. Most of the people living at Charles House have communication support needs, and a formal complaints procedure has little relevance for them. They are reliant on the vigilance of relatives or staff members who know them well to interpret changes in demeanour, behaviour or body language, to alert them to the fact that something is amiss. One person, who is able to speak for himself, advised the inspector that he knew he could talk to the Manager or members of staff if he had any concerns. Two people who live at the home said they did not know who to talk to if they were unhappy, one relative said they were not aware of the complaints procedure and another relative said they felt uncomfortable raising concerns with staff. Further work needs to be done to ensure people know how to make a complaint and that staff know how to respond to make people feel comfortable in raising their concerns.
Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 18 Staff have completed training in the protection of vulnerable adults and policies and procedures to include whistle blowing are readily available to them. The Manager was aware of the new Mental Capacity Act but has yet to complete training on this subject. This Act provides a statutory framework to empower and protect vulnerable people who may not be able to make their own decisions. Since the last inspection there has been an allegation made about two members of staff. Appropriate action has been taken by the home in informing the Commission and Social Services. Staff have been suspended as a safeguard measure pending an investigation. Records sampled showed there had been an incident in the home concerning one person who lives there and their behaviour towards another person. Whilst this behaviour had been reported to health professionals it had not been reported to the Commission or Social Services. The person who the behaviour was directed at is vulnerable and a discussion should have been held with Social Services to see if adult protection procedures needed to be instigated for the future protection of the person. An up to date inventory of people’s belongings is maintained so that staff can track if anything has gone missing and people’s property is looked after. The home holds people’s personal money on their behalf. Receipts are available to evidence any expenditure. On the day of the visit the records of money held were accurate. People’s finances are checked by the Service Manager as part of their monthly visits to the home. Recruitment records sampled showed that a robust procedure is followed for the protection of people living in the home. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable, safe and clean environment that meets their individual needs EVIDENCE: A tour of the building was completed. Charles House is an old property that has real character. The house is maintained to a high standard, and kept clean and tidy. Satisfactory hand washing facilities were observed in the bathrooms, laundry and kitchen. 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. One person spoken with had their own key to their room, they said they liked their bedroom and had everything they needed. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 20 Since the last inspection the dining room has been redecorated to a good standard and new modern dining furniture has been purchased. The carpet has been cleaned and this room now looks very nice and is a pleasant place to have a meal. The lounge has also been redecorated, carpet cleaned and new furniture purchased. This room now looks modern but is still homely in style. The home benefits from having a conservatory, one side of the conservatory external windows were very dirty but staff have no access to be able to clean this area. It is therefore recommended that blinds or curtains are fitted so that this area looks nicer. Minor repairs as required at the last inspection were observed to have been completed such as repairs to the loose skirting board in the kitchen. There were some areas of décor that needed some attention and these were included in the homes schedule for redecoration. The home generally did not have any unpleasant odours with the exception of one person’s bedroom. The Manager was able to provide evidence that a quote had been obtained the day before the visit to have the carpet in this room cleaned. The Manager said it was hoped that the unpleasant smell would be removed if the carpet is cleaned. As the person who uses the room has some incontinence thought should be given to installing an odour management system within the room. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are generally competent and have access to a good range of training opportunities, but identified gaps in training should now be addressed so as to improve the quality of support to people living in the house. People are supported and protected by the organisations recruitment processes. 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. One person who lives at the home said ‘staff are nice’. It is good that all of the staff team have completed or are working towards the Learning Disability Awards Framework (LDAF). To ensure people are supported by a fully qualified staff team at least 50 of staff need to achieve an NVQ in care, currently only five staff have completed an NVQ (or equivalent qualification). Discussion with the Manager indicates he is currently the only NVQ assessor in the home. This means that if no other arrangements are made for assessing staff then progress towards 50 of staff having an NVQ will be slow as the Manager does not have the capacity to assess everyone. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 22 Current staffing levels in the home are generally three staff when everyone is at home. The home does not use agency staff and instead uses bank staff or staff work extra hours to cover any gaps. The Manager said that staffing levels are generally adequate but sometimes one person would benefit from extra 1:1 support due to his behaviour. Sampling of risk assessments shows that this person should not be left alone with other people who live at the home and this impacts on the number of staff needed. A letter from this person’s psychologist has recommended he has extra staff support. The Manager said the home is not currently funded for this and social workers have said that the request for extra funds must be put in writing. 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. The organisation has a good record of providing training opportunities for staff via a rolling programme and the home has an annual training plan. Staff who returned surveys said they were happy with the training provided. Training records show that most of the staff have had training in adult protection, food hygiene, health and safety, first aid, epilepsy and manual handling. Staff who needed manual handling training were due to have this at the end of September. Autism training is scheduled to take place in November. Some people who live at the home have behaviours that can be challenging but staff records showed that only three staff had done managing challenging behaviour training. The Manager said that further training was scheduled for November. Observation of the annual training plan showed that it did not include the new Mental Capacity Act, this should be considered for inclusion. Diabetes training also needs to be provided as one person who lives at the home has diabetes but only one member of staff has done this training. Staff meetings are generally held monthly and formal supervision for staff is scheduled. Checking of files and discussion with the Manager indicates that he has fallen behind with doing some staff supervisions. At the last inspection he advised that some supervisions been delegated to senior staff in order to promote their personal development, but this has not worked out. The Manager said he was now doing all the supervisions and has scheduled dates with thirteen staff to try and catch up so that staff receive the support they need to carry out the job. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager must complete his training to ensure that he is suitably qualified to run the home. General practice promotes people’s health safety and welfare, but some items need attention to ensure this. EVIDENCE: The AQAA records that the Manager is working towards the Registered Managers Award. The Manager presents as an approachable individual and appears to have a good working relationship with his team. At the last inspection it was required that a completed application be submitted to CSCI to register a manager for the home. This has now been done and the Manager is being assessed for registration. One relative’s survey said ‘the manager is very kind and approachable’. Quality assurance systems are in place. The Service Manager visits the home and writes a report of their visit as required under Regulation 26 to ensure the
Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 24 home is being well managed. Reports provided showed these visits are generally done monthly. Audits are also completed twice a year, performed by one of the other home managers. In addition to providing a separate assessment of the quality of the service, this provides managers with a good learning opportunity by directly observing practice elsewhere. This initiative should be commended. Where issues that need improving had been identified a plan was seen to be in place to address the issues. Quality assurance would be further improved if the information from the audits was used to develop an annual development plan for the home. This is something that the home intends to do, as indicated on their AQAA form. The home has some other audits in place, for example a weekly health and safety audit. However examination of the records showed this had not been completed for several months. It was later observed that one persons bedroom window restrictor was broken, 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. 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. The temperature of the water is monitored weekly to ensure it will not pose a risk of scalding to people. Staff regularly test the fire equipment to make sure it is working and fire drills are conducted regularly. Discussion with the Manager shows that one person sometimes refuses to evacuate when the alarms sound. This was not included in the home’s fire risk assessment and will need to be added so that staff know what to do if this happens. An engineer regularly services the fire equipment to ensure it is well maintained. Records show that staff have had fire training so they know what to do in the event of a fire occurring. The gas safety certificate for the home had expired two days before the inspection visit. The Manager said a gas engineer had been due to visit the home the day before but had not arrived, he said this would be re-arranged and a copy of the new certificate would be forwarded to the Commission. This was received soon after the inspection. It was identified at the last inspection that the 5 yearly electrical installation safety check was due. A requirement was made for the new certificate to be forwarded to the Commission by the end of December 2006. This certificate has still to be received but a sticker on the homes fuse box indicates it was checked in May 2007. A copy of the certificate is needed to ensure there were no immediate requirements regarding the electrics of the home. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 25 Charles House (Pb) DS0000016722.V343838.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 2 2 3 3 X 4 3 5 2 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 2 25 3 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X X 2 X Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Timescale for action 30/11/07 2 YA23 37 3 YA35 18(1a,c) 4 YA42 13 (4c) Moving and handling assessments should be completed for people living there so that staff know how to support people safely. Ensure the CSCI and Social 30/11/07 Services are notified of any potential adult protection incidents to ensure people are being protected from the risk of abuse. Make arrangements for members 31/01/08 of the care team who need training in areas of challenging behaviour and diabetes to receive the training they need to ensure they can meet the needs of people who live at the home. Forward an up to date copy of 31/10/07 the home’s 5-year electrical hard wiring certificate to CSCI Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 28 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 YA13 YA16 YA19 Good Practice Recommendations The fees charged to the people who live there should be stated in the statement of purpose or service user guide to help them decide whether or not they want to live there. 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. Health action plans would benefit from further development to include information about the frequency needed for general health checks such as dentist and optician to ensure people receive the healthcare they need. Ensure people are supported to attend regular health checks to ensure their well being. Further work needs to be done to ensure people know how to make a complaint and that staff know how to respond to make people feel comfortable in raising their concerns. Blinds or curtains should be fitted to the conservatory windows that cannot be accessed for cleaning so that this area looks nicer. Thought should be given to installing an odour management system within the bedroom that has a strong odour of urine. Make arrangements to meet target of 50 of staff team achieving qualification at NVQ level 2 or above. Staffing levels need to be reviewed to ensure there are enough staff on duty to meet people’s needs. Ensure staff receive supervision at least six times per year to ensure that they are supported to meet the needs of the people living in the home. The homes procedures for the frequency of completing internal audits should be adhered to so that minor repairs that are needed are identified and acted on. Produce an up to date annual development plan for the home as part of an effective quality assurance system. The fire risk assessment should be up dated to include that one person who lives at the home sometimes refuses to
DS0000016722.V343838.R01.S.doc Version 5.2 Page 29 5 6 7 8 9 10 11 12 13 14 YA19 YA22 YA24 YA30 YA32 YA33 YA36 YA39 YA39 YA42 Charles House (Pb) evacuate when the alarms sound. This is to ensure staff know how to respond when this happens. Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Charles House (Pb) DS0000016722.V343838.R01.S.doc Version 5.2 Page 31 - 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!