CARE HOME ADULTS 18-65
Chester Berry 766 Chester Road Erdington Birmingham B24 0EA Lead Inspector
Gerard Hammond Announced 09 September 2005 & 03 October 2005 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 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 Stationary 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. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Chester Berry Address 766 Chester Road Erdington Birmingham B24 0EA 0121 386 2290 0121 386 2290 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Birmingham Institute For The Deaf Mr. Steve Davis Care Home 5 Category(ies) of Sensory Impairment (5), Learning Disability (5) registration, with number of places Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 23 February 2005 Brief Description of the Service: Chester Berry is registered to provide accommodation, care and support for five people with learning disabilities and hearing impairment. The service is managed and staffed by Birmingham Institute for the Deaf, and the premises are owned by Trident Housing Association. The property is a large, detached period-style house situated on the main Chester Road in the Erdington area of Birmingham. On the ground floor is a large, comfortable lounge, a spacious kitchen with dining area, a small laundry, an activity room, staff sleep-in room, office, toilet and garage. Upstairs are five single bedrooms and separate shower and bathrooms, each with a WC. To the rear of the property is a very large private garden, with patio area and garden furniture and lawned areas with shrubs and flowerbeds. At the front of the house is a small fenced garden and limited off-road parking. The Home has its own vehicle, but the area is also well served by public transport. The shopping areas of Wylde Green and Erdington are both close by and include a wide range of local amenities. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over two visits. On the first occasion, the Inspector was supported by an Interpreter, Louise Rhodes. Three of the residents agreed to be interviewed. The Inspector was able to meet with all of the residents during the course of the inspection. The Registered Manager was formally interviewed, and other staff members seen informally. Direct observation and sampling of records (including previous inspection reports, care plans, personal files and safety records) were used for the purposes of compiling this report. A tour of the premises was also completed. What the service does well: What has improved since the last inspection?
It should be acknowledged that the departure of three members of staff, and the absence of others, has put a considerable strain on the remaining members of the care team. Positive efforts have been made to minimise the negative effects of this on the residents.
Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 6 Since the last inspection efforts have also been made to meet requirements. Improvements to the environment include a refurbishment of kitchen cupboards with new doors and the installation of a new oven. Glazing in the office area has been upgraded to be fire-resistant. Plans are being developed to improve the overall living environment, with a range of options under consideration. The Manager has made progress towards meeting the required standard for formal supervision of members of staff. 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. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Residents’ needs have been assessed but, in view of impending changes to the service, statements of need should be brought up to date. EVIDENCE: There have been no admissions to the Home since the last inspection. At the time of the last inspection a requirement was made that an assessment of need should be carried out at the time of admission, and care plans developed from this. The last person admitted to the Home did not have an appropriate assessment at that time. Since then, his support needs are said to have altered significantly, and his current assessment should reflect this. The whole service at Chester Berry is currently under review, with major decisions affecting the overall provision due to be made in the near future. This would be an appropriate time to revisit each resident’s statement of need, and update or amend it as required, so as to inform future care planning as appropriate. (See next section “Individual Needs and Choice” also) Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Residents’ care plans require development so as to reflect fully how support should be given to meet assessed needs, and to include personal goals. Residents are supported to make decisions about the things that affect them, and encouraged to take risks responsibly. Risk assessments need to be developed so that hazards are identified correctly. EVIDENCE: The personal records of two of the residents were sample checked. Care plans need to be developed so that clear guidance is given about how each individual is supported to meet his or her identified needs. If someone requires assistance to perform a task, then the plan should explain exactly what help is required. Small details are important and need to be recorded in the plan. An example of this might be support for bathing. The plan should make it clear, for example, if the person knows how to run the bath, knows how hot the water should be, if they can undress themselves, if they can physically get into the bath, if they are able to wash independently, and so on. Care plans should be directly cross referenced to the risk assessments that support them. It is also recommended that plans and risk assessments are numbered and indexed accurately, so that it is easy to find information quickly.
Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 10 Risk assessments are in place, but hazards are not always correctly identified, and some further work is required in this area, so that information is recorded appropriately. It is clear from records and from observations that staff have a positive attitude towards supporting residents to take risks responsibly, so as to enhance opportunities for learning and personal development, and to encourage personal independence. Staff use British Sign Language and their knowledge of individuals’ own communication styles to provide information to enable people to make choices about what they do on a day-to-day basis. Care plans also need to set goals with outcomes that can be measured. As much as possible, these should be agreed with the person involved, and cover all areas of identified need. Goals should be evaluated at review and amended as necessary. Whole care plan reviews should take place at least every six months. A written record should be kept, indicating who takes part and how decisions are made. It is recommended that person-centred approaches should be introduced in carrying out the review and development of people’s individual plans, in keeping with the aspirations of the Government White Paper “Valuing People”. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 & 17 Residents are able to take part in appropriate activities, and are very much a part of their local community. People are well supported to maintain contact with their families and friends. Staff respect people’s rights and encourage them to do what they can for themselves, so as to enhance their levels of independence. People enjoy the food they get, and have access to a balanced diet. EVIDENCE: Three residents were interviewed with the assistance of the interpreter. (One other resident was out at the time, and the other was unable to take part due to her learning disability.) Previous reports, personal records and individual testimony all indicate that residents are able to take part in activities that they both value and enjoy. These include going to college, going bowling, swimming and riding. One resident particularly likes being involved in jobs around the house, and specifically enjoys working alongside staff doing the laundry, housework and cooking and cleaning. Residents also access local amenities on
Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 12 a regular basis including restaurants, pubs, shops, the cinema, hairdressers, and local parks. The home has a well-established presence in the local area, and the residents are very much part of the local community. Residents are supported to keep in touch with their families and friends, both at the house and away from home. Some visit their families and stay overnight on a regular basis. One resident gets a member of staff to help write a letter whenever he wants to arrange to see his relatives. Residents also have access to fax and minicom facilities to support communication with family and friends if they so wish. During the second visit, the Inspector met with relatives of one of the residents, and they expressed their general satisfaction with the service. There is a well-developed ethos among the staff team of encouraging residents to do as much for themselves as possible, and to take an active role in day-today things around the house. Residents were observed accessing the kitchen freely to make drinks, and also taking part in food preparation and cooking, with support. Some of the residents spoke about going out to do the main grocery shopping to a local supermarket, and choosing things they liked so that the cupboards were stocked appropriately. People are also supported to keep their rooms clean and tidy, and to take care of the laundry also. Some residents are more able, or more willing, to be involved actively in these things than others. Menus and of records of meals taken were examined, and provided evidence that residents have access to a diet that is sufficiently balanced and nutritious. Food stocks were seen to be adequate and included fresh fruit and vegetables. As indicated above, residents are able to exercise choices about what food they have, and people who were interviewed reported that they liked the meals they were given. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Residents receive personal support in accordance with their needs and preferences. The physical and emotional healthcare needs of people living in the house are appropriately met. General practice in medication administration offers residents appropriate protection. EVIDENCE: Direct observations of interaction between residents and members of the staff team indicate that they enjoy a good rapport, and are comfortable in each other’s company. Communication is always supported with appropriate sign language, and staff actively engage with people living in the house. Routines of daily living are flexible, and generally dictated by what residents are likely to be involved in on any particular day. Previous reports indicate that, as much as possible, residents shop for and buy their own clothes, with support from staff as necessary. Many of the residents, though not all, are generally self sufficient in most areas of their personal care, requiring supervision and prompts from staff in varying degrees. As indicated earlier in this report, care plans should show clearly the degree of support each person requires. However, observation of people’s dress and grooming provides evidence that residents receive support at an appropriate level.
Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 14 Sample checking of residents’ records and previous reports indicate that residents are enable to access healthcare support in accordance with their individual needs. Everyone is registered with a local GP and also attend regular appointments with other health professionals including dentists, opticians and chiropodists. The service uses the monitored dosage system supplied by Boots Pharmacy for the administration of residents’ medication. Storage of medication was seen to be appropriately secure. The medication administration record (MAR) was examined and had been completed as required. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Residents know how to complain, and feel that staff listen to their concerns. General practice offers residents protection from abuse, neglect or self-harm. EVIDENCE: The complaints procedure was examined at the last inspection and adjudged to meet requirements. The procedure is also provided in a pictorial format. The Manager reported that residents are routinely asked about any concerns they might have in one to one conversations with staff. In the course of interviews held with some of the residents, people indicated that they knew whom they could speak to in the event of any problems. The adult protection policy and procedure includes the most recent edition of the local multi-agency guidelines. Since the last inspection, allegations were made about the conduct of some members of staff. This led to the Organisation invoking adult protection procedures and conducting an investigation into the incidents, as required. The outcome of the investigation was that members of staff involved were dismissed or left the company. The action taken clearly demonstrates that the Organisation is aware of its responsibilities and is willing to put procedures into practice as necessary. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Residents live in a house that is homely, comfortable and safe: their home is kept clean and tidy and a good standard of hygiene maintained. EVIDENCE: Proposals aimed at substantially refurbishing, extending and improving the current building at 766 Chester Road are currently under discussion at the most senior level within the organisation. Other options, including relocating the service to another property, have also to be considered. The current owners of the property, Trident Housing, have done some work in improving the facilities in the kitchen, and meeting other requirements made at the time of the last inspection. The house has a certain charm and character of its own. Staff try hard to ensure that it is a homely and welcoming place. The large kitchen tends to be a hub of daily activity, and the lounge at the front of the house is pleasantly furnished and comfortable. Residents’ rooms are individual and reflective of the occupants’ personalities, with their own possessions and effects in evidence. Clear efforts and a lot of work have gone into trying to make the garden an attractive place to be, for the residents’ benefit. The house is kept clean and tidy, and a good standard of hygiene maintained.
Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 & 36 The effectiveness of the care team is currently hindered by staff vacancies. A staff training assessment and development plan is required so as to judge accurately whether or not the team is appropriately trained. Arrangements for formal supervision of staff need to improve. EVIDENCE: At the time of the inspection, the staffing complement for the home was significantly depleted. This was in part due to recent dismissals, but also to staff being away on maternity leave or illness. The Manager has tried to cover absences from within existing personnel resources, so as to ensure continuity of care. However, this has proved difficult and he has had to rely on agency staff input to maintain adequate cover. The Organisation must recruit to vacant posts as a matter of high priority. A training assessment and development plan is also required for each member of staff working in the Home. This should show all training and qualifications obtained to date, and highlight any gaps, including “refreshers”. The plan should also clearly show when outstanding training is scheduled, and who is to deliver it. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 18 Formal supervision of staff is not yet up to the required standard (a minimum of six times in any twelve month period, pro rata for part time staff). However, it should be acknowledged that current pressures and other responsibilities have made this difficult for the Manager to achieve in recent months, and there is clear evidence of efforts being made to address this appropriately. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 & 42 The management style in the home is open and inclusive. General practice promotes the health, safety and welfare of the residents, but some aspects of recording need to improve. EVIDENCE: Throughout the inspection, the Manager showed himself to be approachable and open to constructive discussion about ways of improving the service for the benefit of the residents. He also has managerial responsibility for another small unit located a short drive away from this home. Shortages of staff have resulted in the Manager having to spend more time on shift. The Organisation must ensure that the Manager has sufficient time “off rota” to perform his management tasks appropriately. Safety records were sample checked. The fire alarm and fire-fighting equipment has been serviced, but the fire risk assessment is now due for review. Weekly testing of the fire alarm is generally being done, but there were one or two gaps in recording. It may be that this task should be delegated.
Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 20 Since the inspection, a copy of the Fire Officer’s Report (dated 12 October 2005) has been forwarded to CSCI, and it is a requirement of this report that his recommendations are complied with, as indicated. Testing and recording of water temperatures is also generally being done, but there were also some gaps in the record of this. Portable appliance testing on electrical equipment has been carried out, and the Landlord’s Gas Safety Certificate and the electricity hard wiring certificate are both in date. Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 2 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chester Berry Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 2 x E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 22 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 2 Regulation 14 (2) Requirement Timescale for action 31/12/05 2. 5 5 (1c) 3. 6 15 (1-2) 4. 9 13 (4a-c) Residents assessments of need should be updated so as to inform development of care plans. Each resident must have a 30/11/05 contract that specifies the room allocated, terms and conditions of occupancy, the personal support, facilities and services provided, fees charged and the rights and responsibilities of both parties. Outstanding since 30/04/05 Not assessed at this inspection Care plans should be developed 31/12/05 as indicated in the main body of this report, to include specific detail about how support is to be given, to set goals with measurable outcomes and to be kept under review as required. Risk assessments should be 31/12/05 reviewed and developed as indicated in the main body of this report, so that hazards are correctly identified and control measure included in care plans. Risk assessments should also be cross-referenced with the care plan(s) to which they relate, and vice versa.)
Version 1.40 Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Page 23 5. 6. 33 35 18 (1) 18 (1c) 7. 36 18 (2) 8. 42 13 (4a-c) 9. 42 13 (4a-c) Action must be taken to recruit to vacant posts as a matter of priority. A training and development assessment and plan for each member of staff, including all information indicated in the main body of this report, should be forwarded to CSCI All staff must receive formal, recorded supervision with their designated line manager at least six times in any twelve month period (pro rata for part-time staff). Outstanding since 31/03/05 Ensure that testing of the temperature of water at all outlets is conducted every week, and an accurate record maintained. Ensure that the fire alarm is tested every week and an accurate record maintained. Review the Homes fire risk assessment, and ensure compliance with the Fire Officers report (12 October 2005) 30/11/05 30/11/05 31/12/05 30/11/05 07/12/05 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. Refer to Standard 2&6 Good Practice Recommendations Introduce person-centred approaches into the review and development of peoples care plans, in keeping with the aspirations of the Government White Paper Valuing People Number and index care plans and risk assessments, so as to facilitate easy access and cross referencing. 2. 6&9 Chester Berry E54 S16724 Chester Berry V242898 090805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor , Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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