Inspection on 29/05/08 for Conway House

This inspection was carried out on 29th May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Conway House 29/05/07

Conway House 29/11/05

Conway House 09/06/05

Conway House 12/01/05

Conway House 11/08/04

Conway House 13/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Conway House 44 George Road Oldbury West Midlands B68 9LH Lead Inspector Lesley Webb Unannounced Inspection 29th May 2008 09:30 Conway House DS0000004821.V364761.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 Conway House DS0000004821.V364761.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. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Conway House Address 44 George Road Oldbury West Midlands B68 9LH 0121 552 1882 F/P0121 552 1882 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) Mrs Julie Birks Mr Peter Birks Mrs Lynne Ann Strudley Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1), Physical disability (7), of places Physical disability over 65 years of age (1) Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 1 PD(E) and 1LD(E) and up to 7 LD/PD Date of last inspection 29th May 2007 Brief Description of the Service: Conway House is a large bungalow, which was originally built in 1954. It was converted and extended in 1994 to provide residential care for eight service users with learning and physical disabilities. The Home is situated on a suburban road, opposite a small row of shops and nearby public house. Access to the front of the Home is via a small parking area and a concrete ramp. There is a large garden to the side of the property and a sensory room situated to the rear of the house. There are eight single bedrooms, some of which have sliding doors, which lead onto the patio and give a pleasant view of the garden. The decoration and personal belongings reflect the individuality of the residents. There is a lounge area, dining room and kitchen with a separate laundry. There are two large bathrooms with toilets. One bathroom has a bath with a Jacuzzi. There is an in-house day care provision for some service users. The Home provides a range of activities for service users. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this visit over two days with the home being given no prior notice. During the visit time was spent interviewing staff and the registered manager, examining records and observing care practices before giving feedback to the registered manager. The people who live at this home have a variety of needs. We took this into consideration when case tracking three individuals care provided at the home. For example the people chosen consist of both male and female and have differing communication and care needs. The home is registered to provide long term care for people by the reason of learning and physical disability. Discussions with people living at the home were not appropriate. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI) in the form of its Annual Quality Assurance Assessment (AQAA). Also 2 relatives and 7 staffs surveys were completed and returned to us. Information from all these sources was used when forming judgements on the quality of service provided at the home. We were shown full assistance during the visit and would like to thank everyone for making us welcome. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: There is a detailed assessment tool. This means residents can be confident their needs are known and can be met before moving into the home. Some residents were seen moving around the home freely, choosing where to sit and who to interact with. Staff continue to strive hard to include families in important aspects of residents lives and build positive relationships. Both relatives questionnaires returned to CSCI state the home helps their relative to keep in touch, with one person also stating ‘I have a good relationship with the home, and I am always made welcome’. Resident’s privacy and dignity is respected. For example staff were seen escorting residents to their bedrooms so that personal care could be given in private. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 6 Staff were seen to ensure clothing was co-ordinated and appropriate for the age of individuals. All of which promotes residents dignity. As at the previous inspection evidence indicates that people living at this home have access to a range of specialist community services should they require them. These include general practitioners, opticians, chiropodists, speech and language therapists and psychologists. Both relatives’ questionnaires received by CSCI prior to the inspection state that they have been informed of how to make a complaint about the care provided by the home if they need to and that the home responds appropriately if concerns are raised. All bedrooms are decorated and furnished to a high standard and individualised with personal possessions, photographs and stereo equipment. It is pleasing to see that colour schemes, décor and furnishings reflect resident’s individual tastes. The homes recruitment and selection practices safeguard people living at the home. What has improved since the last inspection? Since the last inspection the home has re-instated the sensory room. We viewed this and found it to contain a range of sensory stimulating equipment. The home has re-instated offering choices on its menu, which is a positive. The registered manager informed us that food diaries have also been introduced to record what residents eat and comments to whether they have enjoyed the meal. A senior support worker is responsible for the medication system and demonstrated good knowledge of her responsiblities. We found all records for medication entering, being administered and leaving the home to be appropriate, with no errors identified. A bedroom has been redecorated with a mural painted by a member of staff. This is bright and colourful and we were informed the resident who resides in the room “really loves it”. The homes laundry was viewed and found to be much improved from the previous inspection. This has been refurbished and includes new fitted cupboards and flooring. It was pleasing to find fifteen staff have received autism training since the last inspection, improving their knowledge in this area. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 7 A quality assurance system has been devised and implemented that includes obtaining the opinions of residents, relatives and stakeholders in the community. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Conway House DS0000004821.V364761.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 Conway House DS0000004821.V364761.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): 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive tool so that new residents are admitted only on the basis of a full assessment. This means residents can be confident their needs are known and can be met. EVIDENCE: There has been one new admission to the home in the last 12 months. The files of three people who live at the home (including that of the newest resident) were sampled, with all containing needs assessments either completed by the relevant placing authorities or the home. The homes own assessment covers all subjects as listed in Standard 2.1 of the National Minimum Standards for Younger Adults and policies are in place for introductory visits and overnight stays. Three relatives completed questionnaires prior to the inspection and returned them to the Commission for Social Care Inspection (CSCI). Of these two state the home ‘always’ meets the needs of their relative and one ‘usually’. Evidence gathered during the inspection indicates that in the main the home meets the needs of individuals, but that further work is required specifically Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 10 relating to support for the management of behaviour and communication (see sections relating to care planning, protection and training in this report). Conway House DS0000004821.V364761.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 adequate. This judgement has been made using available evidence including a visit to this service. Attempts are made to involve individuals in decisions about their lives. Further improvements will give people greater control over how their care is delivered. EVIDENCE: All the residents’ files that we examined contained care plans and risk assessments. These included plans for personal care, medication, communication, socialising and other identified needs. Plans include details of strengths and needs, skills promotion, short and long term goals, how these will be achieved, by whom and when. We found some of the plans have not been signed or dated. This means we do not know who was responsible for the completion of the plan or when last reviewed. We noted that one resident had specific guidelines for communication produced by a Speech and Language Therapist but that these were attached to the back of a letter and not included in the residents communication care plan. This could mean staff do not have all the information needed to communicate effectively with the resident. None Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 12 of the files we looked at contained evidence that formal reviews are taking place at least six monthly. Observation of care practices, discussions with staff and viewing of documentation demonstrate that attempts are made to involve individuals when making decisions about their lives but that further work should take place in this area. For example documentation is still not available in alternative formats such as person centred plans. This will enable residents to participate in how their care is delivered and make their wishes and aspirations known. We were concerned to twice witness a member of staff restricting a resident from leaving the lounge by putting themselves in the doorway. The resident appeared to become distressed by this, putting themselves to the floor and shouting. As we explained to the registered manager any restrictions on choice and movement must be in the best interests of the resident, agreed within a multi disciplinary meeting and a comprehensive care plan compiled. As with care planning we found risk assessments to be in place for identified needs but some have not been reviewed to reflect changes. For example we were informed one residents behaviour needs have changed but the risk assessment in place was dated 16/03/05 and states ‘high risk review monthly’. Conway House DS0000004821.V364761.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): 12,13,14,15,16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people who live at this home are assisted to participate in a range of leisure and social activities based on their individual needs. Staff fully support residents to keep links with their families thereby ensuring important relationships are maintained. Some daily routines are operated on the principles of choice and respect. EVIDENCE: Observations made during the visit indicate that although attempts are made to ensure resident’s routines are flexible some improvements could be made in this area. As mentioned in the care planning section of this report we witnessed one resident’s movement around the home being restricted without any care planning documentation in place to justify this. Some individuals were seen moving around the home freely, choosing where to sit and who to interact with. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 14 All of the people who live at this home have differing communication needs that resulted in us being unable to ascertain their views on activities. Therefore records were examined in order that we could be satisfied that the home is meeting its obligations in this area. Evidence indicates that there are a range of activities undertaken including cooking, craft work, visits to the cinema, watching DVDs, hand and feet massages, visits to shops and public houses and listening to music and games. We did note that some residents’ records indicate they are not given the opportunity to participate in as wide a range of activities as others. For example one residents records detail participating in fourteen activities while another only five. We did ask a member of staff if any other records were available detailing activities that residents have participated in and were informed, “anything he does will be in there apart from going to centre”. As we explained to the registered manager all residents regardless of their needs and abilities should be given equal opportunities to participate in a range of activities that meets their needs. During our visit we observed residents being escorted to the lounge after having breakfast. Staff put the television on without any volume and during the morning a member of staff was seen changing the channel without consulting any of the residents. As we explained to the registered manager staff should receive guidance regarding this to promote person centred approaches to care and support. Since the last inspection the home has re-instated the sensory room. We viewed this and found it to contain a range of sensory stimulating equipment. It was therefore disappointing to find very little evidence of residents being supported to use this facility. For example of the three residents records we examined for 12/02/08 to 31/03/08 one used this facility once and the others not at all. As we explained to the registered manager this is a concern especially as one resident has a recorded identified need for sensory stimulation. Staff continue to strive hard to include families in important aspects of residents lives and build positive relationships. All relatives questionnaires returned to CSCI state the home helps their relative to keep in touch, with one person also stating ‘I have a good relationship with the home, and I am always made welcome’. Since the last inspection the home has re-instated offering choices on its menu, which is a positive. The registered manager informed us that food diaries have also been introduced to record what residents eat and comments to whether they have enjoyed the meal. All residents’ files that were sampled contained nutritional risk assessments and weight records but some were found to need reviewing. At the last inspection we recommended that the home review the current system of everyone having to eat together and waiting for others to finish eating before being able to leave the area in order that person centred approaches to care and support are promoted. We were informed no changes have been made in this respect. However we did witness Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 15 two residents having their lunch in the lounge on trays on one of the days we were at the home. We examined the food stock in the home and found a range of cereals, dry goods, vegetables and salad. Skimmed milk was available. We asked if any other choice such as full fat milk was provided with a member of staff stating, “they all have that” (indicating the skimmed milk). We discussed residents’ dietary needs with the member of staff not being aware of what products contain high protein. The member of staff informed us that a dietician has been consulted for one resident who now has all foods liquidised. It is recommended that the home seek training for its staff with regards to nutrition and health to promote the wellbeing of residents. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Observations and examination of records confirm that resident’s privacy and dignity is respected. For example staff were seen escorting individuals to their bedrooms in order that personal care could be given in order not to compromise their dignity. Assessments and care plans contain comprehensive guidelines for staff regarding individuals’ personal preferences about how they are guided, supported, moved and transferred. Staff rotas detail male members of staff on duty during the night. We were informed some residents require personal care during the night. If male staff are undertaking this for female residents who lack capacity to consent under the Mental Capacity Act agreement and documents must be put in place in line with the Act. This is to ensure people’s rights are not compromised. During the inspection we observed all residents to be dressed appropriately for the climate. Staff were Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 17 seen to ensure clothing was co-ordinated and appropriate for the age of individuals. All of which promotes residents dignity. As at the previous inspection evidence indicates that people living at this home have access to a range of specialist community services should they require them. These include general practitioners, opticians, chiropodists, speech and language therapists and psychologists. Health care plans were seen to be in place for identified needs such as diabetes and epilepsy. We informed the registered manager that further details must be included in their epilepsy plan to ensure staff have sufficient information in the event of a seizure. For example under action needed in the event of a seizure the plan states ‘if I have an epileptic seizure I must be monitored and reassessed until my condition is acceptable. Regular checks are necessary during the night’. The seizure chart for this person details two seizures on lasting 30 seconds the other five to six minuites. As we explained to the registered manager the care plan must include maximum timescales that a seizure should last, at what point medical intervention should be sought and how many checks of the resident should be undertaken by the night staff. This added information will ensure the resident is not placed at undue risk in the event of a seizure. Since the last inspection the home has changed its medication supplier. A senior support worker is responsible for the medication system and demonstrated good knowledge of her responsiblities. We found all records for medication entering, being administered and leaving the home to be appropriate, with no errors identified. At the last inspection the home was instructed to seek advise regarding secondary dispending of medication. We were informed that this does not take place now, with residents taking the whole blister pack supply of medication with them when they go to visit family. We advised that the home obtain a receipt when this occurs to ensure effective auditing if medication was to go missing. We also made a number of further recommendations to offer safeguards with regard to the management of medication. These being to seek advice from the GP for any medication that states ‘as directed’ on the dispensing label to reduce the risk of misadministration, to gain advice regarding expiry dates for creams, eye drops and lotions said no and to introduce temperature monitoring of the medication cabinet ensure medication is stored in line with manufactures guidelines. It was pleasing to find all staff responsible for administering medication have received training. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place in order that residents concerns are heard. Improvements to some practices and procedures are required to ensure people are not at risk from harm and their rights are protected. EVIDENCE: Both relatives’ questionnaires received by CSCI prior to the inspection state that they have been informed of how to make a complaint about the care provided by the home if they need to and that the home responds appropriately if concerns are raised. The home has a complaints system with timescales for response. The complaints procedure is not available in alternative formats. The registered manager explained that a copy of the procedure is given to relatives who act on behalf of residents, raising concerns. When looking at the daily records for one resident we found staff to have recorded ‘mother complained about personal care….’ As we explained to the registered manager this should be recorded in the homes complaints folder, along with evidence of a satisfactory conclusion. The home also maintains a record of compliments received. This includes thank-you cards from relatives and other interested parties. Before this inspection concerns were raised with us, which we looked at during our visit. These related to staffing, management and equipment. In the main we found little evidence of these being upheld and informed the registered manager that we would write separately about these. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 19 As at the previous inspection there are a number of safeguards in place to protect residents from abuse including a robust recruitment and selection procedure for new staff. Staff have also received vulnerable adult training. It is recommended that staff undertake safeguarding training every three years to ensure their knowledge is kept up to date with any changes in legislation. Some of the people living at the home have behaviour needs. Although care plans are in place for some of these others are missing or do not contain enough information to ensure people are fully protected. For example one residents care planning documentation includes a risk assessment completed by the CLDT with regards to the use of mitts. This informs that the resident can cause damage to their hands and instructs staff ‘warn X 3 times before putting mitts on’. We found night staff having to use this form of physical intervention once in May, recording ‘X been restless all night, kept biting hand so checked on her and put mitts on’. We could find no care plan or risk assessment for the management of this need. As we explained to the registered manager the night staffs record does not demonstrate guidelines issued by the CLDT are being complied with and a comprehensive care plan must be implemented that meets not only the residents needs but also complies with legislation with regards to physical intervention. The records for another resident detail an incident where they threw a cup of tea over another resident. We found no evidence of the CSCI being notified in line with Regulation 37 of the Care Home Regulations 2001 or of a safeguarding referral being made. The home should refer any incidents of aggression between residents to ensure people’s rights are upheld. As already mentioned earlier in this report we witnessed a member of staff restrict a resident from twice leaving the lounge, with no documentation in place to support this practice. As we explained to the registered manager this is viewed as a physical intervention and the home must be able to justify it is in the person best interests. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe and comfortable environment that encourages independence. EVIDENCE: We looked around the home with a member of staff escorting us. Since the last inspection a bedroom has been redecorated with a mural painted by a member of staff. This is bright and colourful and we were informed the resident who resides in the room “really loves it”. All bedrooms are decorated and furnished to a high standard and individualised with personal possessions, photographs and stereo equipment. It is pleasing to see that colour schemes, décor and furnishings reflect resident’s individual tastes. Since the last inspection signage has been put in place to identify glass in patio windows, the uneven flooring in the hallway has been repaired and the sensory room has been re-instated to the rear of the building. We found that two residents who Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 21 use moulded wheelchairs cannot use the sensory room due to no suitable seating that the hoist can be used when transferring residents. As we explained to the registered manager suitable equipment should be provided in order that all residents regardless of their disability can access this facility. We also suggested that advice is sought from a professional such as an Occupational Therapist with regard to suitable seating. The home has two bathrooms, both of which are located near to resident’s bedrooms. One has an assisted bath and the other a spa bath. Since the last inspection the home has ceased the practice of providing communal towels, with all residents now being provided their own, which are stored in their bedrooms. It is recommended that the bathrooms be considered for refurbishment as these do not present as homely and welcoming as other areas of the home. The kitchen was seen to be well stocked and clean. The homes laundry was viewed and found to be much improved from the previous inspection. This has been refurbished and includes new fitted cupboards and flooring. A written procedure for the sanitising and storing of mops has been introduced however this needs further work as it does not specify how often mop heads should be either cleaned or replaced. Staff that we spoke to were unclear about this. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Day staff are deployed in sufficient numbers to support the people who live at this home. Night staff levels do not meet all residents’ needs. Improvements to some specialist training will provide staff with the necessary skills and knowledge to meet the needs of some individuals. People who live at this home are protected from harm by its recruitment procedures. New staff do not receive a detailed induction, which means they may not know what is expected of them. EVIDENCE: The AQAA that we received states of the 16 permanent care staff 8 hold a National Vocational Qualification (NVQ) level 2 or above and 4 working towards this. It also states 2 bank staff who work at the home also hold a NVQ level 2 or above. This is the majority of staff working at the home, to which the home should be congratulated. The matrix details seventeen staff (not including the registered manager and administrative person). Of these six have received epilepsy training, none diabetes or continence management, eight communication and ten basic person centred planning and four LDAF (now Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 23 known as LDQ). We advised that further work be undertaken with regards to communication, diabetes, continence management; epilepsy, LDQ and person centred approaches to care and support to ensure staff have sufficient knowledge to support people living at the home. It was pleasing to find fifteen staff have received autism training since the last inspection. Throughout the inspection we witnessed both good and poor staff practices. For example one member of staff was seen using sign language to communicate with a resident and another time residents were seen left by themselves in the lounge with all staff either in the dinning room or kitchen. As we explained to the registered manager it is positive that staff understand the communication needs of the resident but it is not appropriate that residents with high needs are left unattended. The registered manager agreed that this was unacceptable. We viewed staff rotas and which show between four and five staff on duty am and pm and one wake night person and a sleep-in member of staff during the night. In addition to this the registered manager works 37 hours per week supernumery to care. Evidence through interviewing staff and looking at records indicates staffing levels do not meet the needs of residents safely. For example we were informed three residents need assistance with continence needs during the night. We question how this can be undertaken safely with one member of staff. Records show that the registered manager has been monitoring the situation since June 2007 and that it has been identified two staff are needed. As we explained to the registered manager staffing levels of a night must be increased in order to meet residents’ needs and reduce risks of injury. Discussions with staff and examination of rotas also evidence that some staff have been undertaking additional shifts to cover absences. These range from working six and twelve days consecutively without a day off. Signed agreements are in place between staff and the home where they have agreed to work above the maximum 48 hours per week. As we explained to the registered manager further action should be taken to ensure the home complies with the Work Time Regulations 1998. We looked at three staff files in order to see if the homes recruitment and selection practices safeguard people living at the home. Of those files seen all of them contained an application form and suitable written references. It was also pleasing to see that checks such as the PoVAfirst and Criminal Record Bureau disclosures were in place ensuring people living at the home are protected from harm. Since the last inspection the homes application form has been reviewed and now asks for a full employment history and for explanations in gaps in employment. Of the three staff files we sampled all contained evidence that staff receive supervision in order that they can perform their duties and support people living at the home. In addition to this staff meetings take place, again as aids to supporting staff to fulfil their roles. An area that must be improved is Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 24 inductions for new staff. These do not cover the Common Induction Standards as recommended by Skills for Care and none of the files we looked at contained evidence that new staff receive more than one shift in a shadowing role. Also induction records are poor and do not evidence that staff have received an induction that enables them to undertake their roles confidently. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including a visit to this service. Quality monitoring systems take place to ensure people living at the home can be confident it is achieving its aims and objectives. Staff moral is low and could impact on the service residents receive if it continues to decline. Practices employed by management and staff actively promotes service users’ health, safety and welfare. EVIDENCE: Mrs Lynne Strudley is the registered manager of Conway House. She is qualified and competent to run the home. She has completed her Registered Managers Award and the NVQ 4. As mentioned earlier in this report concerns were raised with us before this inspection. Some of these related to Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 26 management of the home. In the main we found little evidence to up hold the concerns (apart from one aspect of management which we have wrote separately to the home about). As we explained to the registered manager from interviewing staff there currently appears to be a communication issue at the home that is affecting staff moral. We recommend that team-building exercises be arranged and that staff be given the opportunity to meet with the registered proprietor in order to discuss any concerns they have as an aids to improving staff moral. We also recommend that the registered manager be given formal supervision on a regular basis as a support mechanism to aid the smooth running of the home. Since the last inspection a quality assurance system has been devised and implemented that includes obtaining the opinions of residents, relatives and stakeholders in the community. Also an improvement plan for 2008 has been completed that details proposed improvement in areas including policies and procedures, staff meetings, the statement of purpose, COSHH and risk assessments, training and induction. The improvement plan states that it is intended to lengthen the induction period to 3 shifts. As we explained to the registered manager this in itself would not ensure the home induction processes are in with Skills for Care Guidance. Prior to this inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. The contents of this were brief in parts and give minimal information about the service provided to residents. We discussed this with the registered manager, acknowledging this was the first time this document has been completed but advising greater detail is included when next requested by the CSCI. A random sampling of records during the inspection confirmed in the main appropriate action is taken to manage health and safety. We noted from accident records that a resident finger sustained a cut whilst staff were trimming nails. We discussed this with the registered manager advising that a procedure be devised giving guidelines for staff with regard to cutting of finger and toe nails in case a resident has diabetes that has not been diagnosed. This would promote further the health and wellbeing of residents. We also advised that a new oven be purchased by the target date of July 2008 to reduce the risk of injury to staff. When looking around the building we found the ramp to the sensory room to be unstable. We advised the registered manager to seek advise from a professional such as an Occupational Therapist to ensure access to this facility is safe and meets the needs of wheelchair users. Sufficient numbers of staff have received training in moving and handling, fire, first aid and food hygiene. We did instruct the registered manager to complete a risk assessment for a member of staff who has not received moving and handling training due to them undertaking duties where they assist residents. We also explained that priority must be given to arranging training for this person to reduce the risks to residents if inappropriately handled. Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 27 A full list of recommendations is located at the back of this report Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 28 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 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 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 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 2 X Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 13(7) Requirement Any restrictions on choice and movement must be in the best interests of the resident, agreed within a multi disciplinary meeting and a comprehensive care plan compiled. If male staff are undertaking personal care for female residents who lack capacity to consent under the Mental Capacity Act agreement and documents must be put in place in line with the Act. This is to ensure people’s rights are not compromised. Care plans for epilepsy must include maximum timescales that a seizure should last, at what point medical intervention should be sought and how many checks of the resident should be undertaken by the night staff. This added information will ensure the resident is not placed at undue risk in the event of a seizure. A comprehensive care plan must be implemented for a named resident for the use of ‘mitts’. This must meet the resident’s DS0000004821.V364761.R01.S.doc Timescale for action 30/08/08 2 YA18 12(2)(3) 30/08/08 3 YA19 13(4) 30/07/08 4 YA23 13(7) 30/07/08 Conway House Version 5.2 Page 30 5 YA23 13(4)(6) 6 YA33 12(1)(a) 7 YA42 13(5) needs and also comply with legislation with regards to physical intervention. The home must refer any 01/07/08 incidents of aggression between residents to the local authority (following safeguarding procedures) to ensure peoples rights are upheld Staffing levels of a night must be 30/07/08 increased in order to meet residents’ needs and reduce risks of injury. A risk assessment must be 30/07/08 completed for a member of staff who has not received moving and handling training due to them undertaking duties where they assist residents. Priority must be given to arranging training for this person to reduce the risks to residents if inappropriately handled 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 YA6 Good Practice Recommendations To produce care plans in suitable formats in order that individuals care be involved in decisions relating to their care. To ensure care plans are signed and dated in order to monitor who completed and when last reviewed. To correlate communication guidelines produced by a Speech and Language Therapist with communication care plans in order that that have all information needed to communicate effectively with residents. To undertake formal reviews of care plans at least six Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 31 2 3 YA9 YA14 monthly in order that any changes in needs are identified and met. Risk assessments should be reviewed as and when changes occur to ensure any risks to residents are appropriately managed. All residents regardless of their needs and abilities should be given equal opportunities to participate in a range of activities that meets their needs. Staff should receive guidance regarding the television and residents’ choices to promote person centred approaches to care and support. Residents should be supported to use the sensory room on a regular basis for sensory stimulation. That the home reviews the current system of everyone having to eat together and waiting for others to finish eating before being able to leave the area in order that person centred approaches to care and support are promoted. Residents nutritional risk assessments should be reviewed to ensure dietary needs are being effectively monitored. That the home seek training for its staff with regards to nutrition and health to promote the wellbeing of residents. That the home obtain a receipt when medication is given to families of residents to ensure effective auditing if medication was to go missing. To seek advice from the GP for any medication that states ‘as directed’ on the dispensing label to reduce the risk of mis-administration. To gain advice regarding expiry dates for creams, eye drops and lotions to ensure they are stored in line with recommended guidelines. To introduce temperature monitoring of the medication cabinet ensure medication is stored in line with manufactures guidelines. All concerns raised by relatives of residents should be recorded in the homes complaints file to ensure effective monitoring. That staff undertake safeguarding training every three years to ensure their knowledge is kept up to date with any changes in legislation. Suitable equipment should be provided in order that all DS0000004821.V364761.R01.S.doc Version 5.2 Page 32 4 YA17 5 YA20 6 7 8 YA22 YA23 YA24 Conway House residents regardless of their disability can access the sensory room. That the bathrooms be considered for refurbishment as these do not present as homely and welcoming as other areas of the home. The procedure for the sanitising and storing of needs further work as it does not specify how often mop heads should be either cleaned or replaced. Staff should received communication, diabetes, continence management, epilepsy, LDQ and person centred approaches to care training, to ensure they have sufficient knowledge to support people living at the home. Action should be taken to ensure the home complies with the Work Time Regulations 1998 Staff should receive an induction that enables them to undertake their roles confidently. That team-building exercises be arranged and that staff be given the opportunity to meet with the registered proprietor in order to discuss any concerns they have as an aids to improving staff moral. That the registered manager be given formal supervision on a regular basis as a support mechanism to aid the smooth running of the home. That a procedure be devised giving guidelines for staff with regard to cutting of finger and toe nails in case a resident has diabetes that has not been diagnosed. That a new oven be purchased by the target date of July 2008 to reduce the risk of injury to staff. To seek advise from a professional such as an Occupational Therapist with regards to the ramp at the entrance of the sensory room to ensure access to this facility is safe and meets the needs of wheelchair users. 9 10 YA30 YA32 11 12 13 YA33 YA35 YA37 14 YA42 Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Conway House DS0000004821.V364761.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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