Inspection on 21/01/08 for Danzey Green

This inspection was carried out on 21st January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Danzey Green 41-45 Danzey Green Castle Bromwich Birmingham West Midlands B36 9EE Lead Inspector Kevin Ward Key Unannounced Inspection 21st January 2008 08:00 Danzey Green DS0000070421.V353663.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 Danzey Green DS0000070421.V353663.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. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Danzey Green Address 41-45 Danzey Green Castle Bromwich Birmingham West Midlands B36 9EE 0121 730 1781 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) www.CareTech-uk.com CareTech Community Services Ltd Mrs Jacqueline Damico Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability (LD) 12 The maximum number of service users to be accommodated is 12 Date of last inspection 10/07/07 Brief Description of the Service: 41-45 Danzey Green are three adjoining bungalows. Each is home for up to four people, requiring care and support for reasons of Learning Disability. The home is located in the Parkfield residential estate in Castle Bromwich. The homes are owned and maintained by Solihull Care Housing Association and the care and support is provided by Care Tech Community Services. Each bungalow provides single bedroom accommodation; rooms are fitted with a wash hand basin. Each home has a kitchen/diner, communal lounge, laundry, bathroom and WC. At the rear of each home is a patio seating area, and sloped gardens. At the front of the home is parking for four-six cars. The home has a vehicle for service users use. Most of the service users accommodated access local day opportunities provided by the local authority. The current scale of charges for living at the home was not available in the service user guide. The manager has agreed to amend this information to show the current fees. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use the service experience good outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. This was the first inspection of the home since Care Tech Community Services took on the running of the service 27th July 2007. The manager and the staff team transferred their employment to Care Tech Community Services at the same time. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. Questionnaires were completed and returned by two people that live at the home. Two relatives and a health professional also completed questionnaires giving their views of the service. An annual quality assurance questionnaire was completed and returned by the manager, providing helpful information about the home. The inspection included meeting everyone living at the home and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Due to some people’s communication needs it was not possible to ask them about the service. Discussions took place with the staff on duty, including two team leaders and the home manager. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Care plans are in place for people containing valuable information about their needs and providing guidance for staff to provide sensitive care and support. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 6 In some cases, extra guidance has been sought from health professionals, such as speech and language therapists, e.g. swallowing assessments and communication dictionaries. People are being supported to access consultants and health professionals to investigate and monitor any heath concerns. Good systems are in place for storing and giving out medication and the manager audits the medication system on a regular basis to ensure good practice is maintained. A person with an African Caribbean cultural background receives the support of a key worker from a similar background. Suitable hair care products have been purchased for this person so that their hair is maintained in good condition. There have been no complaints to us about the home since the last inspection and there have been no complaints made directly to the home during the same time period. Staff are trained to recognise and report any suspicions of abuse. The manager has taken appropriate action to report concerns about an agency worker to Social Services and the agency to follow up and investigate. The home is clean and comfortable. The bathrooms are well equipped to assist people with disabilities to bath and shower safely. Where necessary the home has assisted people to gain access to other specialist equipment, such as beds chairs and hoists. The home has good systems in place for monitoring quality in the home, including “resident meetings” and meetings involving senior managers, commissioners, landlord and relatives, to monitor the development of the home. What has improved since the last inspection? Flooring has been replaced in a bedroom where there was previously an odour, providing a more pleasant environment for the person using the room. The home has started to improve the opportunities for people to get out and about and the manager has made a commitment to seeing this progress continue. The controlled drugs record is now being routinely signed by two staff to properly account for medication. More staff have been recruited to fill vacancies at the home and the manager explained that additional staff are in the process of being recruited, with a view to the home providing daytime activities for people at the home instead of Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 7 attending day centres. This is part of a plan agreed with Solihull Social Services Department. Ongoing training has taken place sine the last inspection in Health and Safety related subjects, such as first aid, and food hygiene and more training is planned. The training plan shows that staff are also to be provided with sensory training to further help them to meet people’s needs. The dining chairs have been replaced throughout the home with sturdier furniture that is safer for people to use. The kitchen in bungalow 43 has been refurbished recently and there are plans for the last remaining kitchen to be improved in the coming year. 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. Danzey Green DS0000070421.V353663.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 Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitable admission procedures are in place so that people are introduced to the home sensitively. Shortfalls in written information, most notably the Statement of Purpose, have compromised the rating for this group of Standards. EVIDENCE: There have been no new people admitted to the home since the last inspection. In the annual quality assurance assessment the manager explains that people referred to the home will have opportunities to visit the home to meet with the people that live there. This will provide an opportunity to check that everyone is happy that the home can meet the person’s needs and to ensure that people are happy living together. This is in keeping with previous admissions to the home that have been managed by the current manager and records viewed at previous inspections. In the annual quality assurance assessment the manager states a commitment to referring new people admitted to the home for an advocate where they have no family members to represent their interests. Two people files were checked and observed to contain copies of new service user guides / contracts. These documents have been issued by Care Tech to explain people’s entitlements at the service since the new organisation has taken on the running of the home. These documents do not currently include Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 10 the fees for the service. The manager said that she would arrange for the service user guide to be amended to include the fees. Both people’s files contained copies of their Social Services financial assessment, detailing the breakdown of their personal charges so they are aware of the financial contribution they need to make to their care. The manager said that a new Statement of Purpose is still currently being developed to reflect the service under the new service provider. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are planned for and reviewed so that staff have the information they require to meet people’s needs appropriately. EVIDENCE: Two people’s care plans and risk assessments were looked at in addition to other samples of other documents from other people’s files. Both care plans contained helpful information to enable staff to carry out care tasks effectively and to make staff aware of people’s health needs that need to be monitored. The care plans include information about people’s daily routines and the way in which they like their care provided, e.g. one person likes music playing in his room in the morning as he is supported with his personal care. This was observed to occur on the morning of the site visit and was understood to be important by the member of staff providing the support. Similarly a member of staff was able to explain the support given to a person at the home to eat safely and the special cutlery and equipment required at mealtimes. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 12 The two care plans seen included information about people’s communication needs to help staff to interpret people’s behaviours and non-verbal cues. This is particularly important for people who are unable to readily communicate their needs verbally. Staff were seen to include people in conversations and pay appropriate attention to their needs during the morning, as they got ready for their day services. Care plans have been dated to show they have recently been reviewed. Two key workers explained that they read through the care plans each month and check if anything needs changing or adding. The manager also adds information to the care plans where necessary following changes in people’s needs. An assistant manager explained that care plans are in the process of being written in a new format preferred by the new care provider. Comments by the manager and staff indicated they prefer the new format and believe it to be easier to read. Risk assessments were seen for people which take account of their personal needs and everyday living activities, e.g. moving and handling needs, eating, health / falls, bedrails, behaviour guidelines fire and personal care. Where necessary the home has also made use of other professionals to contribute to people’s care plans and risk assessments, e.g. Speech therapy are involved in developing communication passports (detailing communication needs and best responses) with some people at the home and to support safe eating guidance. Due to concerns that the webbing on bed rails is abrasive and a possible cause of skin abrasion the manager has changed a person’s risk assessment to include soft fabric bumper covers, (which were seen to be in place). Following concerns related to a person recently taking a fall at nighttime, waking night staffing has been introduced in one of the bungalows that did not previously have a waking night worker (all bungalows now have waking night staff). The risk assessment and records show that waking night staff carry out hourly checks to check on the person concerned. The manager also agreed to arrange for a pressure mat to be provided which will trigger immediate staff support in the event that the person concerned gets up in the night. Records of regular monthly meetings were sampled. These show that people are encouraged to take part in decisions about everyday matters that effect them such as arrangements for their holidays and Christmas celebrations, as well as checking that they are happy at the home. The manager explained that there also plans to introduce 1:1 talk time to provide specific opportunities for people to sit down with their keyworkers to discuss any topics or issues that are important to them. The manager said she also has plans to introduce activities white boards in bedrooms with photographs, which outline people’s plans for each day of the week. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Access to community activities is improving though scope remains for increasing opportunities for people to get more, particularly at weekends, so that they enjoy a more varied social life. People are provided with a choice menu based on their preferences so that they enjoy the food provided at the home. EVIDENCE: Most people attend day services during the week where they are provided with a timetable of educational and leisure activities. When people stay at home they are provided with staff support. A person with good verbal communication explained that when he is not at day service he likes to go for walks locally (which he did during the morning) and do some jobs about the house. In particular the person enjoys gardening and has a small green house in the back garden. The person concerned has planted Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 14 tomato, sunflower and pumpkin seeds, which he was germinating in a dark cupboard, in readiness for transfer to the greenhouse in the spring. Other examples of activities provided at the home included, access to parks, shops dancing, progressive mobility sessions, board games, bowling, music man (involves people playing musical instruments, such as maracas and bells to music), Wednesday club (disco), some light shopping and meals out. One person at the home was seen to enjoy a relaxing hand and arm massage from a staff member after lunch. A beautician also visits the home to provide pedicures and nail painting sessions. Whilst there are some examples of good activities entries in people’s day records, there is still scope for increasing opportunities for people to venture out more often at weekends. The manager stated a commitment to continuing the develop this area of practice and a team leader explained that she intended to support people to venture out more places, more often, as the weather improves with the advent of spring. Staff explained that it is not currently possible to download photographs of activities, as the home does not have a computer. This is also slowing the development of picture boards in bedrooms and a picture menu, which was started at the time of the last inspection. Comments by staff and people living at the home confirmed that they are encouraged to take part in light domestic tasks to retain and develop their independence. One person makes his own breakfast and hot drinks and said that he occasionally shops for bread and milk for the home. Another person likes to put the bin bags out and to help with recycling paper. One person carried his laundry basket to the laundry room and a staff member explained People are encouraged to carry their laundry baskets to the laundry room (seen during the site visit) and to load the dishwasher. An assistant manager explained that people are supported to go shopping for their own clothes where they are happy to do so. A person who lives at the home verified this. In some cases where people do not enjoy shopping they are encouraged to choose from catalogues. Similarly people are supported to go the local hairdressers for their haircut, though one person said they preferred to have their haircut at home. The manager said that due to previous staff vacancies it has been difficult to assist people to attend church but expressed a commitment to providing this support again now that staffing at the home has improved. Entries in records and care reviews show that relatives are encouraged to maintain contact with people at the home and to contribute to plans for their care. The manager explained that since taking over the running of the home, the new providers, in conjunction with commissioners and the housing Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 15 association managers (responsible for the property), have met with relatives to enable them to comment on the service. This was verified in notes of meetings provided by the manager, which indicate that the provider is seeking to work in partnership with relatives and others to develop and improve the service. Each bungalow has a separate choice menu that has been developed to take account of the preferences of the people living there. People’s food preferences are recorded in their care plans. The menu in number 45 was observed to provide a varied and balanced menu. Comments by the assistant manager indicate that efforts are made to strike a fair balance between people’s choices and promoting healthy eating. The assistant manager explained that where possible this is addressed by buying healthier options low fat food products such as spreads and yoghurts, evidence of which was seen in the fridge. The assistant manager in bungalow 45 was also able to show a satisfactory awareness of the dietary needs of a person with diabetes, (controlled by diet). The manager said she would look out for other low sugar products, e.g. puddings and chocolate for the person concerned to try out. As previously noted the development of a picture menu has stalled, as the home does not currently have a computer for staff to use. Danzey Green DS0000070421.V353663.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. People are provided with appropriate support from care staff and health professionals so that their personal care and healthcare needs are met. EVIDENCE: Staff explained that people have age appropriate bedtimes and are able to sleep in if they wish to do so and this was verified in comments by a person at the home. People’s care plans contain details of their preferred bedtimes as well as summaries of their daily living routines so that staff can fit in with them. On the morning of the site visit staff were mindful of people’s privacy and dignity with all personal care tasks taking place behind closed doors. Everyone at the home was seen to be well groomed and wearing age appropriate, well laundered clothing, indicating they are supported to take a pride in their appearance and to maintain a good self-image. Entries in a person’s health records indicate that the home follows health concerns and supports access to health professionals where appropriate. As previously noted night staffing has been provided after a person at the home Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 17 fell and bumped their head during the night. An Assistant manager explained that tests have been carried out to identify the underlying cause for the fall, evidence of which was seen in health notes. One person needs an intimate examination to investigate some health concerns. The manager explained that the person concerned does not have the capacity to consent to the examination recommended by the GP. Consequently she is arranging a multidisciplinary meeting, in keeping with the requirements of the mental capacity act, so that an informed decision may be made by all concerned. People’s health records provide evidence that people are being supported to gain access to local health services, such as GP, dentist, optician and chiropody. The home used to visit another service for the use of scales to weigh a wheelchair user safely but explained that this is no longer a possibility. The manager said that the person’s weight issues were addressed and there are no longer any concerns in this regard but undertook to gain access to alternative venue with suitable weighing scales. Two medication cabinets were checked and found to be well ordered and not over stocked with medication. Staff explained that all unused medication is returned at the end of each week. This was verified by entries in the medication returns record. An assistant manager was able to give a good explanation of safe medication administration procedures for ensuring that people are given the correct medication. Photographs of people were seen on their medical records to reduce any confusion over the identity of the person for whom the medication had been prescribed Two staff giving out medication both said they had received medication training and confirmed that they are assessed by one of the management team before giving out medication alone. Currently this is not underpinned by a documented competency assessment for all staff. The manager explained that that she had just completed such an assessment herself (assessment seen) and stated that she would use the same assessment format as the basis for checking other staff have a good grasp of the procedures also. Protocols are in place for staff to follow when giving out medications to people that have been prescribed on an as needed basis. Written information related to the side effects of prescribed medications is also now on file as advice for staff to consider. The manager carries out a weekly check of the medication systems, copies of which were seen on file. Recording of controlled drugs has been improved and two signatures are routinely being recorded to properly account for the medication. Danzey Green DS0000070421.V353663.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 good. This judgement has been made using available evidence including a visit to this service. Procedures are in place and staff are trained to recognise and report suspicions of abuse so that people are protected from harm EVIDENCE: There have been no complaints to us about the home since the last inspection and the manager said there have been no complaints made directly to the home. The manager said that she intends to set up a new complaints log for tracking complaints as the home is run by a new care provider, (Care Tech community services). Copies of the complaints procedure are available in the hallways of the bungalows; these are available both in an easy read and audiotape version. Information on how to make a complaint is also included in the new service user guide. Personal inventories are recorded on care plan files to take account of new items purchased by people so that they can be properly accounted for. Two people’s recent money records were seen. In both cases the records contained two staff signatures, petty cash vouchers detailing the expenditure and receipts of purchases, to account for people’s money. The manager also checks the monies each month to ensure that money is properly accounted for. Following concerns regarding unexplained bruises on a person at the home, the manager has routinely met with staff from Social Services and day service Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 19 managers to closely monitor the causes. This has been reflected in notifications sent to us recently to keep us updated of events at the home. The health notes of the person concerned demonstrate that GP advice has been sought and most probably the result of a blood disorder that causes the person concerned to bruise very easily. The manager reports that this has resulted in better communication and day services and risk assessments have been reviewed where necessary for people at the home. The manager recently notified us that she had complained to an employment agency of concerns about one of their workers and has referred the matter to Social Services Department for their consideration. The manager said that she would continue to monitor the outcome with the agency and Solihull Social Services Department. Comments by staff on duty confirm that adult abuse training is provided so that staff are able to recognise and report suspicions of abuse. This was also verified in staff training records and planned training courses. Induction records also demonstrate that new staff are shown the Safeguarding procedures when they start work at the home. Whistleblowing procedures are on display in the hallways so that staff know with whom they should raise any concerns they might hold about the running of the home. Danzey Green DS0000070421.V353663.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 Overall the home is clean, well decorated and comfortably furnished so that people benefit from a homely environment. EVIDENCE: The home consists of three individual bungalows, each providing good wheelchair access. Access to the rear gardens and patio areas is good although the gardens are on a slope and do not provide a great deal of space for people to walk in. The lawns were tidy and one person has a small green house, which he uses to grow tomatoes. Overall the bungalows are well maintained and well furnished. The majority of the bedrooms and some communal areas have been decorated during the last year and a new kitchen has been fitted in Bungalow. Good work has taken place to coordinate the colours in the rooms to make them attractive for people. Staff confirmed that people at the home were able to choose their bedroom colours from paint colour charts, with advice and support where Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 21 necessary. Most bedrooms have been personalised with items pictures and photographs on display. This is still ongoing for some recently decorated rooms. The flooring has recently been replaced in two bedrooms improving these rooms for people. Bungalow 45 kitchen was refitted last year and the manager said that there are plans for the last remaining bungalow to be fitted with a kitchen during the coming year. Good work has taken place to purchase new dining chairs for every bungalow, as the old ones were not very stable and prone to breaking. The bathrooms are well equipped with handrails and equipment to support people with physical disabilities, such as specialist bath and accessible showers. The manager stated that there are plans to re plan and refurbish one of the bath / shower rooms to make better use of the space available. A cleaning schedule was seen detailing cleaning tasks. Staff sign the schedule to confirm that they have carried the necessary cleaning duties. Overall the home was clean and fresh. Aprons and gloves are available in various areas of the home to support good hygiene practices. Plastic bags and yellow bins are available for the disposal of continence products and each bungalow has modern laundry equipment in place. A new industrial washing machine has recently been purchased, equipped with settings for managing continence laundry at home. The laundry rooms are situated in the centre of each bungalow and have no windows. However they fitted with good extraction fans fitted to stop any build up of unpleasant odours in the home. Several staff spoken to confirmed that they have been provided with infection control training to support good hygiene practices at the home. Risk assessments in people’s care plan files also take account of any infection control issues, such as clothing to be worn when completing personal care tasks. A member of staff confirmed advice had been provided regarding the advisability and availability of hepatitis B vaccinations. Danzey Green DS0000070421.V353663.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): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are properly recruited and trained to ensure that they suitable and properly equipped to support the people at the home. EVIDENCE: The home currently employs a manager and three assistant managers to cover the three bungalows. The rota shows that there is typically two staff on duty in each bungalow, on each morning and evening shift when people are at home. Staffing provision is provided during the middle of the day during the week to support a small number of people who do not attend day centres. The manager said that she is in the process of recruiting extra staff with a view to providing seven staff across the three bungalows on each shift and throughout the day, including weekdays and weekends. This will be necessary as there are proposals for the home to provide day activities from home instead of people attending Social Services day services. In the annual quality assurance questionnaire completed by the manager she reports that 66 of staff have now completed National Vocational Qualifications at level 2 or above and that all staff are provided with mandatory Health and Safety related training courses, such as first aid, moving and Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 23 handling, fire safety and food hygiene. This was also verified in comments made by staff, who confirmed they are provided with access to regular supervision and ongoing training. Staff within the team are also provided with access to other care courses, examples include, autism, challenging behaviour, medication. The manager said that sensory training has also been arranged, (confirmed on training plan) and said that she would be arranging for staff to attend equality and diversity training and sexuality training. The staff recruitment checklists for two new staff were looked at. Both checklist contained dated evidence to indicate that correct recruitment procedures are followed, including taking up references and Criminal Record Bureau checks to ensure that staff are safe to work at the home. The manager explained that since new staff have been recruited there has been no recent use of agency staff. The manager has sought written verification that the agency used by the home correctly vet and train all their staff. A letter confirming these facts was seen in the office of the home. Discussions with staff confirmed that they are provided with regular planned supervision. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Excellent systems are in place for seeking the views of relevant people involved with the home to contribute to the ongoing monitoring and development of the service. Suitable arrangements are in place for maintaining a safe working and living environment for everyone at the home. EVIDENCE: The manager holds the Registered Managers Award and the National Vocational Qualification level 4 in Care. The manager previously worked as deputy manager at the home and has worked with people with learning difficulties for a number of years. There are a number of ways in which the home is monitoring the quality of the service. The manager said that questionnaires have recently been sent to people’s relatives from a central office as part of the organisations quality Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 25 assurance system. Resident’s meetings notes were checked and verify that regular meetings are being held so that people are included in discussing everyday living arrangements and plans e.g. activities and holidays. Staff confirmed that they have access to a senior manager each month when they carry out monitoring visits at the home. The reports of the visits were seen on file, contain evidence of ongoing monitoring of the home’s practices and progress to meet the requirements and recommendations of the last inspection report. Good work has taken place to arrange 3 monthly meetings involving senior managers of the organisation, commissioners and the landlord to meet and discuss ongoing improvements to the service. Similarly the area manager for the home has started monthly clinics to enable relatives to meet with her to raise any concerns or issues they would like to see addressed. The manager also carries regular medication audits in each bungalow to support safe medication storage and administration practices and routinely carries out checks of the environment to pick up any maintenance issues. As noted earlier in the report the home does not have a computer. Consequently this is slowing up the development a picture menu and photographs to help people to choose activities. A computer would also be of benefit when reviewing and updating the new care plans and save the need to re-write them in full. Health and Safety Checks were sampled. A monitoring record was seen confirming that hot water temperatures are checked to ensure that people are not placed at risk of being scalded. The electrical equipment has been tested and there is a record confirming that showerheads and water outlets are flushed regularly to stop the possibility of Legionellas developing in the water supply. The fire Safety log was checked and confirmed that testing of alarms and lights are being carried out at the correct frequencies and that fire drills are carried out so that people are prepared in the event of a fire at the home. Reports of maintenance checks were seen, demonstrating that a suitable contract is in place for keeping fire equipment in safe working order. The fire risk assessment has been dated to show that it has recently been reviewed, in keeping with the recommendations of the fire officer following his visit in July 2007. Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 2 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 4 x x 3 x Danzey Green DS0000070421.V353663.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations Promptly proceed with plans to write the Statement of Purpose to provide a clear description of the service provided at the home under Care Tech, so that this is made clear to all relevant people involved with the service, such as commissioners and social workers. The current fees for the service should be included in the service user guide in order everyone is clear about the charges for the service. Action should be taken to identify suitable weighing scales for monitoring the weight of wheelchair users safely, where necessary. Proceed with plans to introduce a written medication assessment to confirm that staff have a thorough grasp of safe handling of medication. The provision of a computer at the home is strongly recommended to enable the development of accessible information using photographs to help people to make choices, e.g. menu options and activities timetables. DS0000070421.V353663.R01.S.doc Version 5.2 Page 28 2 3 4 5 YA1 YA19 YA20 YA39 Danzey Green Commission for Social Care Inspection Birmingham Office 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. 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