CARE HOME ADULTS 18-65
Chesterwood Road, 64 Kings Heath Birmingham West Midlands B13 0QE Lead Inspector
Alison Ridge Unannounced Inspection 25th January 2006 08:15 Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Chesterwood Road, 64 Address Kings Heath Birmingham West Midlands B13 0QE 0121 444 3736 0121 444 3736 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) TRACS Mrs Sheila Lynn Horton Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Residents must be aged under 65 years The home may provide care for 6 service users with an acquired brain injury. That the Registered Manager is employed to work no less than 28 hours each week. That the effectiveness of the management structure in the home be reviewed by TRACS and the CSCI every three months. That a full time deputy manager be employed to work in the home. Date of last inspection 26th September 2005 Brief Description of the Service: 64 Chesterwood Road is owned by TRACS and provides a service for six adults. The home is registered to accommodate people with a learning disability and physical disabilities. The home currently accommodates six service users who have an acquired brain injury, and one service user with additional physical disabilities. 64 Chesterwood Road is a two-storey traditional style detached residence situated in the middle of a quiet residential road in Kings Heath, Birmingham. The home is within walking distance of a variety of community facilities, which includes shops, parks, a leisure centre, places of worship, pubs, restaurants and a good selection of public transport. There is off road parking to the front of the property and a well-maintained garden to the rear. A wooden ‘chalet’ has been erected at the bottom of the garden to provide an area for staff meetings and breaks. Service Users and staff assist in maintaining the garden areas. Disabled access to the home requires improvement. There are two ground floor bedrooms one with en-suite shower facilities and WC, ground floor shower room and toilet and four single bedrooms on the first floor. There is a communal lounge / dining area, kitchen and laundry facilities. A new conservatory has recently been completed. The laundry area is housed in a ‘lean-to’ undercover area, adjacent to the office. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector undertook this inspection over one day starting in the early morning. During the visit she was pleased to meet with all the people that live at 64 Chesterwood Road, to talk with staff on duty, tour the premises, and look at records about care, staffing, and health and safety. Comment cards were received from two people who live in the home, and from one professional. This is a service that continues to move forward and to develop in positive ways for the people living there. It is suggested that this report be read along side the previous report of this home, written in September 2005. The inspector extends her thanks to everyone who assisted with this inspection. What the service does well:
The people who live at 64 Chesterwood Road generally report that it is a good place to live, that they like the staff that support them, and that they are satisfied with the opportunities available to them. One person said, “I think it is really nice here.” In one comment card it was written, “I am pleased to say that Chesterwood is extremely well run, the staff are professional and show empathy in many aspects of our lives.” Another person wrote, “Most of the staff are great…. I get on well with most of them.” At the start of the day staff have dedicated time to read the care notes, and plan the day. One person’s care records were assessed. These showed the person had been supported to undertake a wide range of health appointments. The care-plan for this person was very individual and told the reader about things that were important to that person. The person had been involved in writing the plan. The food available is very varied. The staff buy good quality brands of food. There is a planned menu, but there is a lot of flexibility about what is eaten, and it was good to see people making and eating food that they fancied. The food was all well stored. The people who live at Chesterwood, staff and visitors are well protected by regular servicing and inspection of health and safety appliances.
Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 6 The staff help people to stay in touch with family and friends. This is in person, by phone and by letter. The commitment of staff to helping people with this is commendable. There is a very open culture and comments and ideas are welcomed from people living in the home, staff and others. The records showed these are taken seriously and that action is taken to ensure issues are resolved. What has improved since the last inspection? 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. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 the following standard(s): X Standards not assessed at this inspection. EVIDENCE: The home has a stable service user group, and no residential vacancies. These standards were not assessed. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 the following standard(s): 6, 9, 10 Service users are consulted about their care and lifestyle, and the operation of the home is such that these are mainly well planned and delivered. Previously made requirements regarding risk management had been met in full. Information about service users is transmitted and stored in a confidential manner. EVIDENCE: The plan of one service user was assessed. The plan had been reviewed recently. It was evident that the care plan had been generated after consultation with the individual, and relevant other people. The plan was very personalised, and reflected the person’s wishes and life goals. It was positive that the plan had been written in such a way as to promote the person’s independence and maintenance or development of life skills. A number of goals had been set by the service user at the last review. When tracked these had been translated onto the activity planner, and the daily notes showed these had been undertaken as planned.
Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 10 The inspector assessed previous requirements made about risk assessments. These had been met in full. The information pertaining to service users was well stored and managed. No breaches of confidential information were noted during the inspection. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 the following standard(s): 11, 12, 13, 14, 15, 16, 17 Service users have opportunities to undertake activities of their choice on a regular basis. The staff undertake a lot of work with service users to ensure relationships are maintained with family and friends. Food offered and served is varied, nutriticious, and to the service users liking. EVIDENCE: The opportunities for one service user to access the community, undertake activities and personal development were assessed. The inspector considered the range of opportunities to be very positive, and to include exercise, skill development and leisure. The planned activities were as identified by the service user in their planning meeting. (IPP) Discussion with one service user and staff identified some very positive opportunities for this person to develop in an area of personal interest and talent. Another service user was pleased with the support offered to them regarding trying to find a new activity in which to engage.
Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 12 The staff show a strong commitment to helping service users stay in touch with people who are important to them. This includes making visits in person, having people visit them at Chesterwood Road by letter and by phone. The home does have a planned menu. It was very positive that this is developed and changed by service users, if they fancy a meal different to that planned. Service users with full mobility were observed to have free access to the kitchen, and to help themselves to food and drinks. The person utilising a wheelchair required staff assistance to access the kitchen, and reach drink making items, or snacks. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 the following standard(s): 18, 19, 20 Service users were happy with the way personal and healthcare was delivered. Personal care was well planned. A minor shortfall must be addressed to ensure challenging behaviour is recorded, evaluated and planned for. . Medication management was generally good, ensuring service users get the right medication at the right time. EVIDENCE: The plans sampled contained detailed, and personalised routines for the morning and evening. The healthcare appointments for one service user were tracked. It was evident these had been undertaken as required and that follow up had been undertaken. The service user tracked has some support needs regarding challenging behaviour. Entries in the daily notes did not always enable the reader to establish what had happened, the duration of the incident or any possible triggers. Entries such as “Had a go at fellow residents”, and “often agitated” were drawn to the managers attention. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 14 Staff recording of such incidents must improve to ensure that a clear record is maintained, that can be used to inform care and medical reviews, and staffing interventions. Where appropriate the manager must ensure such incidents are reported to the CSCI. Previously made requirements regarding healthcare were assessed and met in full. It was positive to hear from one service user of their personal determination, and support from staff resulting in success with a healthy lifestyle choice. Medication management was generally good. The medication prescribed was all available and safely stored. Records of administration had been fully completed. Minor amendments to the medication audit were suggested. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 the following standard(s): 22, 23 Concerns and complaints are investigated robustly and to the satisfaction of the complainant. Service users reported feeling safe living at 64 Chesterwood Road. EVIDENCE: The home has received two complaints since the last inspection. The records available showed these were investigated and resolved quickly to the satisfaction of the complainant. The service users and staff all commented that the home operates a very open culture and that concerns, complaints or ideas can be raised. It was pleasing to hear people felt able to do this, and confident that they would be listened to. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 26, 27, 28, 29, 30 64 Chesterwood Road is domestic and homely. Work is required to upgrade the presentation of the environment, and to improve access for people without full mobility. EVIDENCE: The provider is taking positive action to improve the premises of 64 Chesterwood Road. Since the last inspection a new conservatory had been completed, and was in use. The lounge had been re-decorated, and a new carpet lay. The lounge area needed “finishing off” with pictures and homely touches. Some additional comfortable seating was also required in the lounge. The home does face some challenges as a care home, and particularly regarding meeting the needs of people who require a wheelchair. The need to address access to the front of the home, and out into the garden is now urgent. The inspector was pleased to see four of the service users rooms. These were all very individual, and contained items important to each person. One bedroom is very small. The inspector was informed plans are currently with the council-planning department regards possible further development of these premises.
Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 17 The general décor of the home requires some improvement in some areas. The kitchen requires replacement, and the Environmental Health Officer recommended this in November 2005. At the time of inspection the delivery temperature of hot water was not hot enough in which to wash or bathe. An immediate requirement about this was made. TRACS subsequently informed the inspector this had been addressed. Some service users rooms have freestanding wardrobes. It is required these be secured to the wall. The home was clean in all of the areas inspected. There is a long-standing issue with access to the laundry. TRACS have undertaken all possible action to address this within the restrictions of the current premises, and have submitted plans to the council regards possible structural changes. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 36 Adequate numbers of staff are provided to support service users with their lifestyle. All recruitment documents are collected prior to a person commencing work in the home. Evidence that these have been reviewed needs to be provided. Staff reported feeling supported to undertake their job role. EVIDENCE: The number of staff provided has been adequate to meet people’s needs. The inspector considered it positive that staff recruitment has been successful, and that when all new staff `are in post there will be no staff vacancies remaining. This will ensure the service users are always supported by people they know, and who know them. The service users and staff seem to have good relationships with each other. It was good to hear people chatting, and planning events or activities. The recruitment records of one staff were assessed. All the required documents were available. The file didn’t show that someone had reviewed the information collected prior to the job offer being confirmed, as in this case the references were not robust, and it would have been good practice to request a further reference. The senior staff team undertake supervisions with staff. The documents show these are undertaken to a high standard. The manager has made plans to ensure these are undertaken with the required frequency. Staff the inspector spoke with reported feeling supported in their job role.
Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42 This is a well run home, where the needs and wishes of service users are key to service delivery. Service users, staff and visitors are protected by health and safety checks and servicing. EVIDENCE: The management of the home is strong, and clearly focussed on the needs of the service users. The senior/management team appear to be complimenting each other well, and the manager had devised ways to ensure that work is delegated and shared. There was on display a current certificate of employers liability insurance and registration. The provider undertakes monthly visits to the home, and provides a report to the CSCI. Record keeping has continued to improve, and records have become more ordered. The health and safety records showed that all routine tests and servicing of gas, electric and fire equipment had been undertaken.
Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 20 It has been required that the provision of a heat detector in the conservatory be explored with West Midlands Fire service and provided if required. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 3 28 2 29 1 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X X X 3 2 X Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA19 YA19YA41 YA24YA29 Regulation 12(1)(a) 37 12(1a)(4b) 23(2n) Requirement Accurate monitoring of difficult to manage behaviour must be undertaken. As required incidents must be reported to the CSCI. Plans to address this have been discussed with the CSCI. Timescale for action 06/02/06 06/02/06 01/06/06 4 YA24YA25 23(2)(a) 5 YA24YA30 16(2)(f)(j) Environmental adaptations that meet the needs of service users accommodated must be undertaken. Re-carpeting of the ground 01/05/06 floor hallway of the home must be undertaken. Decoration of bedrooms must be undertaken as required. Building plans have been 01/08/06 explored. Progress towards meeting the requirement made. A review of the current laundry facilities is required. Access to the laundry is not satisfactory, through the staff office / sleeping in room. Alternative access to the laundry must be explored. Wardrobes and freestanding
DS0000016716.V280709.R01.S.doc 6 YA24YA42 13(4)(b-c) 01/03/06
Page 23 Chesterwood Road, 64 Version 5.1 7 8 9 YA28 YA36 YA42 16(2)(c) 18(2) 23(4)(a) furniture must be secured to the wall. Additional comfortable seating must be provided in the lounge. Supervision must be undertaken at least bi-monthly with all staff. It is required that the provision of a heat detector be explored with West Midlands Fire service and provided if required. 01/04/06 01/04/06 11/02/06 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 5 Refer to Standard YA9 YA14 YA20 YA27 YA28 Good Practice Recommendations It is recommended that risks associated with going out with supporters other than the homes staff is assessed. It is recommended that additional drivers be recruited/provided at weekends. It is recommended that the time of the medication audit be recorded. It is recommended the layout of the office be reviewed to ensure best use of space, and that staff using the computer/desk can sit safely. It is recommended that finishing touches such as pictures, shelves or plants be provided in the lounge. Chesterwood Road, 64 DS0000016716.V280709.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Birmingham 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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