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Inspection on 10/06/05 for Dawson Road, 5 & Whateley Road

Also see our care home review for Dawson Road, 5 & Whateley Road for more information

This inspection was carried out on 10th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a core group of staff who have worked at the home for a long period of time. They are well motivated; participate in the day-to-day operations of the home whilst maintaining a clear sense of direction. Observations revealed positive relationships between staff and service users even though some individuals have severe communication difficulties. Prospective new service users have the opportunity to have introductory visits to the home. There is a clear and consistent care planning system in place to provide staff with information they need to meet service user needs. Service users have the opportunity to participate in appropriate activities, some based in the home with others in the community. Staff at the home seek input from other health and social care professionals to assist in meeting individual need. Service user bedrooms are well maintained and personalised. 9 of the 14 care staff team are qualified to NVQ 2 or above, thereby exceeding the required standard of 50%. The home ensure all the required recruitment checks are completed before new members of staff start work in the home.

What has improved since the last inspection?

Some commendable work has been undertaken in recent months to present information about individuals` needs in an accessible and user-friendly way. Person centred plans have been developed for two service users. This should have a positive impact on future care planning. Service users are being provided with lockable cupboards in their bedrooms for the safe storage of their personal plan. A new sink for hand washing has been installed, as recommended by the Environmental Health Officer. There is evidence that the organisation has developed systems for quality assurance and monitoring of "customer satisfaction" and this is to be commended.

What the care home could do better:

The home needs to ensure that the views of existing service users are taken into account before a new service user is admitted to the home. The system of person centred planning needs to be extended to include all service users. Each risk assessment should be directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. A deficit in the design of the bungalows exists, as there is little space for storage. Items such as hoists and weighing scales are therefore stored in hallways. This detracts from providing a homely environment.Staff must receive formal supervision more frequently to ensure they are carrying out their responsibilities effectively and are receiving appropriate support.

CARE HOME ADULTS 18-65 Dawson Road, 5 / Whateley Road, 1 Handsworth Birmingham West Midlands B21 9HS Lead Inspector Kerry Coulter Announced 10 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dawson Road,5 / Whateley Road Address 5 Dawson Road / Whateley Road Handsworth Birmingham West Midlands B21 9HS 0121 554 4718 0121 554 4718 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Care Service Ltd Mr Andrew Robson Care Home 12 Category(ies) of Younger Adults, Learning Disability, Physical registration, with number Disability of places Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. 12 beds - Adults with Learning Difficulties and Physical Disability. Date of last inspection 28 February 2005 Brief Description of the Service: 5 Dawson and 1 Whateley Road are two six bedded bungalows situated on the corner of Dawson and Whateley Road, off Grove Lane, Handsworth and within walking distance of the Soho Road. They are close to local shopping centres, places of worship and bus routes to the city centre. They are purpose built bungalows providing accommodation and nursing care for 12 adults who have multiple physical and learning disabilities. Each bungalow comprises of a through dining area and lounge, open plan kitchen and utility room, bathroom and six bedrooms. The homes are accessible to each other through a hallway, which joins them. However, this is not accessible to people who have a physical impairment. At the rear of the bungalow is a large secluded garden, which is accessible to all service users. It has lawned areas, trees, shrubs and flowerbeds. Staff are employed by Milbury Care Services and have a multirole, which includes care work, cooking and cleaning. The homes are run as two separate units with two seperate staff teams during the day. At night there is one waking night staff and one sleep-in staff between the two homes. There is one manager for both homes. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over one day. Conversations with some of the clients were limited due to their complex needs and limited verbal communication abilities. However, the inspector met with all clients and time was spent observing care practices, interactions and support from staff. A tour of the building and garden was made. Clients care plans and risk assessments were inspected. Staff training and recruitment procedures were examined, and a number of Health and Safety records were inspected. The inspector had the opportunity to talk with the Manager, the Organisation’s Service Manager and several care and nursing staff. In addition, information was provided in response to the pre-inspection questionnaire. During this visit the inspector did not have opportunity to speak with relatives and other professionals. What the service does well: The home has a core group of staff who have worked at the home for a long period of time. They are well motivated; participate in the day-to-day operations of the home whilst maintaining a clear sense of direction. Observations revealed positive relationships between staff and service users even though some individuals have severe communication difficulties. Prospective new service users have the opportunity to have introductory visits to the home. There is a clear and consistent care planning system in place to provide staff with information they need to meet service user needs. Service users have the opportunity to participate in appropriate activities, some based in the home with others in the community. Staff at the home seek input from other health and social care professionals to assist in meeting individual need. Service user bedrooms are well maintained and personalised. 9 of the 14 care staff team are qualified to NVQ 2 or above, thereby exceeding the required standard of 50 . The home ensure all the required recruitment checks are completed before new members of staff start work in the home. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home needs to ensure that the views of existing service users are taken into account before a new service user is admitted to the home. The system of person centred planning needs to be extended to include all service users. Each risk assessment should be directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. A deficit in the design of the bungalows exists, as there is little space for storage. Items such as hoists and weighing scales are therefore stored in hallways. This detracts from providing a homely environment. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 7 Staff must receive formal supervision more frequently to ensure they are carrying out their responsibilities effectively and are receiving appropriate support. 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. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 4 Service users are provided with information on the home in which they live in a variety of formats. Adequate assessment of potential new service users is undertaken but further improvement is needed to take into account the views of individuals who already live at the home to ensure compatibility. EVIDENCE: The home’s statement of purpose and service user guide were assessed as meeting the required standard at the inspection in February 2005, therefore these documents were not sampled. However, it was observed that these documents are readily available in the home. The statement of purpose is on display in the hall and service users have a copy of the guide in their bedrooms and care plan. The process of the admission of one new service user was assessed. The manager had completed an assessment of this individual needs and this was generally satisfactory. However it did not take into account the views of service users already living at the home. Discussion with the manager indicates that Milbury does not have any admission assessment forms to guide staff on what to include when assessing prospective new service users. It is recommended that an assessment pro-forma is developed to ensure staff have appropriate guidance. Records and discussion with the manager evidenced that the new service user had visited the home on several occasions and also had an overnight stay before moving in to the home. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10 There is a clear and consistent care planning system in place to provide staff with information they need to meet service user needs. Development is needed to ensure the plans are person centred and include the goals and aspirations of individuals. Strategies for managing risks were generally clearly identified with only minor improvement required to ensure risk is effectively managed. EVIDENCE: Three service user files were sampled. A new care plan had been completed for the service user who recently moved into the home, this covered areas such as eating and drinking, pressure care, communication and maintaining a safe environment. Some information in the file related to the individuals previous care home and staff are working to further develop the plans in place to ensure they relate to the new environment. The care plans sampled had been reviewed on a regular basis with written evidence of evaluation. Care plans are developed from an ‘Activities of Daily Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 11 Living’ assessment and generally feature on the health needs of service users. At previous inspections the manager informed the inspector that person centred plans (PCP) are to be put in place for each service. This is due to the fact that is has previously been required that the goals and aspirations of service users require including in the care plan. Some commendable work has been undertaken in recent months to present information about individuals’ needs in an accessible and user-friendly way. It is positive that some progress has now been made and two person centred care plans are in the process of being completed. The manager was confident that at the home’s next inspection each service user would have a person centred plan. Members of staff actively encourage residents to take responsibility for as many things are they are able, within their individual capabilities. They seek to promote choice wherever possible, and respect the choices people make. Individuals’ communication difficulties place some restrictions on how this is put into practice. Where possible, attempts are made to overcome this, for example, through the use of pictorial aids. The inspection in February 2005 highlighted that service users had contributed towards staff accompanying them on leisure activities such as meals out. It was required that a higher proportion of the staff costs of regular leisure activities must be reimbursed to ensure that service users are able to access community and leisure activities. The manager stated that service users do now not pay staff costs and there is a set amount that Milbury will contribute towards a staff meal away from the home. A wide range of risk assessments were observed to be available for each individual. Assessments had been recently reviewed and were generally satisfactory. Unfortunately there was no risk assessment available for one service user who uses bedrails. Bedrail assessments were however available for other individuals. The manager stated that an assessment had been completed but he was unsure why it was not in the individual file. An immediate requirement was made to ensure a risk assessment was available. Each risk assessment should be directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. One of the outcomes for completing risk assessments and care plans should be that the finished article is a simple and effective working document, in which essential information can be easily found. Service users individual records are kept secured in the communal office. Staff were observed being mindful of issues discussed in the presence of service users. The manager stated that service users were being provided with lockable cupboards in their bedrooms for the safe storage of their personal plan. The home uses accident books that are compliant with the Data Protection Act. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 and 17 Intergration within the community and pursuit of appropriate activities are integral elements of the ethos of the home. Staff support service users to maintain and develop relationships with family and friends. Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: Service users have the opportunity to participate in appropriate activities, some based in the home with others in the community. Activity programmes form an integral part of individuals’ care packages. Each individual has a weekly timetable of activities, staff stated these were completed each week with as much input as possible from the individual. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 13 Service users continue to regularly attend the church lunch club on the Soho Road supported by staff. Service users participate in a variety of activities in the local community including shopping, walks, restaurants, colleges, cinema and pubs. Service users have sensory lighting in their bedrooms appropriate to their individual needs. Service users have their own music systems, TV’s and videos in their bedrooms. TV’s and music systems are also provided in communal areas. At the time of this inspection some service users went out for a meal supported by staff. The home has a minibus, which service users can access and they also use taxis. It is evident that where appropriate service users are supported by staff to maintain contact with their family. Service users are supported to visit their family where appropriate and visitors are welcome to the home. Direct observation confirmed that staff respect individuals’ rights to make choices and that they seek to involve people in the daily routines of the house. The food cupboards, fridges and freezers were well stocked, and meals and menus were seen to be satisfactory. Culturally appropriate foods are provided. Staff and service users generally eat together in a relaxed manner. Each service user has a food diary, which is detailed and includes food and drink offered and how much, what alternatives were offered if the service user refused the meal and if there were any signs of dysphasia i.e. coughing, watery eyes. Some service users are fed through a PEG. Care plans and guidelines are in place for these service users. Where appropriate the dietician and speech and language therapist are involved with service users. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Personal support is delivered in accordance with service users preferences and requirements. Health needs are generally appropriately met, and positive action is being taken to make further improvements. Practices relating to the storage and administration of medication are generally satisfactory with only minor improvement required. EVIDENCE: Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 15 Service users and staff appear to enjoy a good general rapport. Support is given in a warm and friendly manner, and staff were seen to be polite, considerate, patient and respectful, as appropriate. From sampling service users records and from observations made it is evident that staff provide sensitive and flexible personal support to service users. Times for getting up, going to bed and meals are flexible depending on the individual needs and activities of service users. The home provides nursing care and individual plans identify their health needs. Assessments have been completed to include pressure care, nutrition and risk of dysphasia. Some individuals require regular re-positioning at night time whilst another requires her fluid intake to be monitored. Whilst the home does have a system of recording for this, improvements need to be made to ensure that effective monitoring takes place. Currently staff record that service users have been turned on a night time chores list that consists mainly of cleaning chores, this is inappropriate. Fluid intake is recorded but the total is not recorded at the end of the day meaning that it in not monitored effectively. Generally when a service user is unwell the individuals records evidence what action has been taken by staff to include any medical intervention. However, on one entry sampled it recorded an individual as wheezing with medication then administered with instructions for the situation to be monitored. Unfortunately the records did not record if the medication was effective and the daily records for the individual had not been completed the following day. The manager must ensure that staff complete daily records detailing wellbeing, any care given and response to care so that staff can effectively monitor the health of service users. Each service user is registered with a local GP. Service users records sampled indicated that where appropriate referrals are made to other health professionals including speech and language therapist, occupational therapist, physiotherapist, psychiatrist and the dietician. The medication administration, recording and storage systems of the home were sampled. Boots supply the medication to the home using the monitored dosage system. Medication is stored in a locked cabinet. Requirements from the last inspection regarding the signing of the medication administration chart and availability of written protocols for ‘as required’ medication have been actioned. The majority of topical creams and ointments were observed to have been dated on opening and discarded after 28 days. Unfortunately a bathroom cabinet contained a tub of cream that was opened and dispensed in 1998. This cream did not appear on the medication chart. The manager was unaware of the cream and explained that the cream belonged to the new service user and she had brought it with her from her previous care home. The manager removed the cream to ensure it would not be administered. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 16 The qualified nurses oversee the administration of medication to the service users. However, sometimes medication is administered by care staff at meal times under the observation of the nurse. A clear written policy and procedure is required for this practice, this should also include why this practice is needed as usually it should be the nurse who administers the medication. The draft policy should be forwarded to the CSCI Pharmacy Inspector for approval. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The complaints system in the home is satisfactory. The arrangements in place to protect clients from the possible risk of harm or abuse are generally satisfactory. EVIDENCE: There have been no complaints made about the home since the last inspection. There are documents available within the organisation, designed to guide staff in seeking service user’ views. These are entitled “Let us know what you think” and “Questions about your house”. Individuals’ communication difficulties make it difficult to assess fully whether or not they feel that their concerns are listened to and acted upon. Service users are reliant on staff that know them well to pick up on cues and clues as to whether or not they are happy. The home has satisfactory adult protection procedures in place. Staff files sampled evidenced that Criminal Record Bureau checks are completed. The training matrix for the home indicates that staff receive adult protection and prevention of abuse training. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 29 and 30 The environment at the home is generally comfortable, homely and safe. There are concerns about the lack of storage and unsuitability of the bath. EVIDENCE: The premises are in keeping with the local community. Each of the homes is accessible to the six service users living in each home. The corridor joining the two homes is not accessible to service users but is accessible to staff as required. The home was clean and free from offensive odours. Generally the home is decorated and maintained to a high standard. Furnishings, fittings, adaptations and equipment are as domestic, unobtrusive and ordinary as is compatible with fulfilling their purpose. Minor repair was observed to be required at one kitchen sink as the sealant was quite mouldy and required removing and resealing. As previously required a new carpet has been fitted in the office. Each bungalow has an open plan lounge, dining room and kitchen. A separate laundry is provided in each bungalow. There is a rear garden for the use of Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 19 both bungalows, which is accessible to all service users. However the patio area in the rear garden is quite uneven and requires levelling. The manager stated that quotes for this work had already been obtained and work would start to level the slabs soon. A deficit in the design of the bungalows exists, as there is little space for storage. Items such as hoists and weighing scales are therefore stored in hallways. The contents of one bathroom highlighted the problem, it was observed to contain boxes of nutritional drink, plastic syringes, a moulded chair, part of a bed, a decorating table, hoist, step ladders, boxes of pads and a vacuum. The organisation must ensure that this is resolved, consideration could be given to providing secure storage in the garden area. Service users bedrooms were personalised and contained many appropriate personal effects and equipment. Where appropriate service users bedrooms reflected their cultural background. Service users bedrooms contain a chest of drawers, chair, bed appropriate to their individual needs, wardrobe, bedside table, wash hand basin, space for service users possessions, two double sockets and sensory lighting equipment. A range of sensory lighting equipment is provided in each bedroom, according to service users individual tastes and needs. The manager stated that the bedroom of the newly admitted service user was soon to be redecorated according to her own personal preferences. Each of the bungalows has a bathroom, which service users can access supported by staff. Assisted bathing facilities and shower trolleys are provided in the bathrooms. However one bathroom is not pleasant in appearance due to the clutter of all the items stored there. At previous inspections staff informed the inspector that the bath in Dawson Rd is not suitable for the needs of the current service users and therefore only the shower trolley is used. A referral has been made to the Occupational Therapist for advice on a suitable bath. Where appropriate service users have adjustable beds and pressure relief mattresses. Sensory lighting equipment, mobiles and mirrors are provided in service users bedrooms where appropriate. A hoist used to weigh service users is provided in the home. The inspector saw evidence that hoists, beds and equipment are regularly serviced and maintained. An Environmental Health Officer (EHO) visited the home in November 2004. One recommendation they made was regarding the sink in the kitchen. A new sink for hand washing has now been installed. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 A recent admission to the home means that staffing levels require review to ensure that the needs of all service users continue to be met. There is a continuous training programme in place for staff, and this should be developed further in accordance with service users’ assessed needs. Staff are generally well supported but supervision in accordance with required standards needs to be better established. EVIDENCE: It was noted that both staff and service users appear comfortable in each other’s company and enjoy a good general rapport. Information provided in response to the pre-inspection questionnaire confirms that 9 of the 14 care staff team are qualified to NVQ 2 or above, thereby exceeding the required standard of 50 . Members of staff demonstrate that they have a good personal knowledge of the individuals in their care. During the day the homes are staffed as two separate houses. There is one registered care manager for the two homes who is additional to the staffing numbers on the rota. At night the home is staffed as one home by one qualified nurse, a support worker and a support worker sleeping – in. At the Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 21 previous inspection the home had lost the post of one full time nurse but at the time this was not having a detrimental effect on the nursing care provided. At this inspection discussion with the manager indicated that staffing was under review as the needs of some service users had changed and the admission of a new service user has had an effect on the staffing requirements. Different options are under consideration, to include additional staffing hours specific to the new service user. The rota sampled evidenced that minimum staffing numbers are being adhered to. However, there is concern that on some occasions staff have worked lengthy hours, for example an early shift, followed by a late shift, a sleep in and then a morning shift. When staff spend such a long time at work without a break away from the home it is difficult for them to stay 100 focused and provide a quality service. The manager must therefore ensure staff do not work excessive shifts without an appropriate rest period. Three staff records were sampled. These included all the required records pertaining to the recruitment of staff. The manager has completed a training matrix, this details the training staff have received and the training required. Milbury employs a training coordinator and a rolling program of training is offered to staff. Some staff are due refresher training for first aid but dates for this have been booked. The manager stated staff had received training in PEG feeds, however this was not recorded on the matrix and will need to be added. Forthcoming training that is to be arranged includes tissue viability and infection control. Diabetes training also needs to be arranged for staff to ensure staff have the required knowledge to meet service user need. Supervision of staff is an area that requires improvement. Not all staff have received supervision on a regular basis, this should be at least six times a year. The manager stated that supervision had been an area that his previous deputy had responsibility for and due to the home having no deputy in post for some months this had been an area that he had struggled to find the time to meet with all staff. He said that a new deputy was nor in post and he hoped that the standard would be met in future. Staff records did however identify that where staff had not fulfilled their roles and responsibilities adequately, action had / was being taken to ensure the situation was rectified. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The organisation is making positive efforts to ensure that service user views underpin service development appropriately. Work practices in the Home generally promote and protect service user’ welfare, health and safety but attention is required to fire evacuation routes and the storage of COSHH items. EVIDENCE: There is evidence that the organisation has developed systems for quality assurance and monitoring of “customer satisfaction” and this is to be commended. It is recommended that the new annual review report (being implemented by the company) should be sent to CSCI as a matter of course. It was positive that the Service Manager attended the home to be present for the inspectors’ feedback. The manager was also inclusive in involving the Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 23 deputy manager for feedback of the inspection findings. The Service Manager visits and reports monthly, as required by regulation 26. The fire safety records were examined and all tests, checks, servicing of equipment, drills and training had been completed or scheduled as appropriate. However the fire evacuation route to the rear of the property was not satisfactory. The hedge in the garden were quite overgrown and had encroached over part of the pathway. The home accommodates wheelchair users and so the route needs to be free from obstruction. The manager agreed to ensure the hedge was cut back. It is recommended that the pathway be widened when the patio is levelled. Up to date risk assessments were available for the premises and staff. The COSHH cupboard was checked and found to be unlocked. The manager stated that it was usual not to lock the cupboard as service users due to their physical disability were unable to access the cupboard. However risk assessments were not available for this practice and an immediate requirement was made for the COSHH products to be stored securely. The manager locked the cupboard during the inspection. Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 x 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 2 x 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Dawson Road, 5 / Whateley Road, 1 Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 12(3) Requirement The views of existing service users must be taken into account when admitting new service users into the home. Evidence of how this process was undertaken and its outcome must be available in the home. There must be a person centred plan for each service user. Outstanding requirement from inspection of 14/6/04. All service users who have bed rails must have a risk assessment on their use. Each risk assessment should be directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa. Improvement is required to the systems for the recording and monitoring of- 1. Turning of service users at night. 2. Fluid intake ( to include a total intake at the end of each day). The manager must ensure that staff complete daily records detailing well-being, any care given and response to care so that staff can effectively monitor the health of service users. Timescale for action 30/7/05 2. 6 15 30/8/05 3. 9 13(4) 4. 9 12)1) 13(4) 12(1) 17/6/05 Immediate requiremen t 30/8/05 5. 19 30/7/05 6. 19 12(1) 30/7/05 Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 26 7. 20 13(2) All topical creams and ointments must be dated on opening and discarded after 28 days. 8. 20 13(2) Administration of medication to the service users by care staff- A clear written policy and procedure is required for this practice, this should also include why this practice is needed as usually it should be the nurse who administers the medication. The draft policy should be forwarded to the CSCI Pharmacy Inspector for approval. Premises- The kitchen worktop behind kitchen sink requires resealing. Proceed with plans to level paving slabs to rear of the home. Ensure the bathrooms are free from un-necessary clutter. The organisation must consider replacing the bath in Dawson Road with one recommended by an occupational therapist, which is accessible to all service users (referral to OT made). Original requirement from inspection in June 2004. Following the admission of a new service user the home must review staffing to ensure adequate numbers of staff are on duty to meet service user need. Staff must not work excessive shifts without an appropriate rest period. Ensure staff training records record all training received by 10/6/05 Immediate requiremen t. (Cream removed from cupboard at inspection) 30/8/05 9. 24 23(2) (b) 30/8/05 10. 11. 24 and 27 29 23 (2) (d,l) 23(2)(n) 30/7/05 30/8/05 12. 33 18(1)(a) 30/8/05 13. 14. 33 and Working Time Directive 35 12(1) & 18 18(1)(a) 30/7/05 30/8/05 Page 27 Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 15. 16. 36 42 18(2) 13(4) & 23 13(4) 17. 42 staff. Arrange for staff to receive training on diabetes. Ensure staff receive supervision at least six times a year with a record maintained in the home. The fire evacuation route to the rear of the property must be kept free from obstruction, hedge to be cut back. COSHH products must be stored securely when not in use. 30/8/05 30/6/05 Immediate requiremen t 10/6/05 Immediate requiremen t (COSHH cupboard locked by manager during the inspection) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 2 Good Practice Recommendations Milbury does not have any admission assessment forms to guide staff on what to include when assessing prospective new service users. It is recommended that an assessment pro-forma is developed to ensure staff have appropriate guidance. Extra storage space within the home should be provided. consideration could be given to providing secure storage in the garden area. It is recommended that the pathway to the rear of the home that is used as a fire evacuation route is widened. It is recommended that the new annual review report (being implemented by the company) should be sent to CSCI as a matter of course. 2. 3. 4. 24 42 39 Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Dawson Road, 5 / Whateley Road, 1 E54 S24836 5 Dawson Rd Whateley Rd V224002 100605 Stage 4.doc Version 1.30 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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