Inspection on 18/04/06 for Dawson Road, 5 & Whateley Road

This inspection was carried out on 18th April 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dawson Road, 5 & Whateley Road 25/06/08

Dawson Road, 5 & Whateley Road 25/06/07

Dawson Road, 5 & Whateley Road 27/10/05

Dawson Road, 5 & Whateley Road 10/06/05

Dawson Road, 5 & Whateley Road 28/02/05

Dawson Road, 5 & Whateley Road 14/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

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

CARE HOME ADULTS 18-65 Dawson Road, 5 / Whateley Road Handsworth Birmingham West Midlands B21 9HS Lead Inspector Kerry Coulter Unannounced Inspection 18th April 2006 10:00 Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dawson Road, 5 / Whateley Road Address Handsworth Birmingham West Midlands B21 9HS 0121 554 4718/5896 F/P 0121 554 4718 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) Milbury Care Services Limited Mr Andrew William George Robson Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 12 beds - Adults with Learning Difficulties and Physical Disability The home can continue to accommodate one named service user over 65 with a learning disability. Future admissions, and the statement of purpose are amended to reflect the age of service users accommodated. 27th October 2005 Date of last inspection 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. It has lawned areas, trees, shrubs and flowerbeds. Staff are employed by Milbury Care Services and have a multi-role, which includes care work, cooking and cleaning. The homes are run as two separate units with two separate staff teams during the day. There is one manager for both homes. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and reports from the provider. The unannounced fieldwork visit was carried out over seven and a half hours. This was the homes key inspection for the inspection year 2006 to 2007. The Deputy Manager and the staff on duty were spoken with. The Manager was not available for discussions as he was on annual leave but was spoken with by telephone after the fieldwork visit. Due to the communication difficulties of the service users they were not able to give their views of the home. Therefore observation of care practice was used to find out what their experiences of living at the home are. A tour of the premises took place. Care, staff and health and safety records were looked at. After the visit to the home took place the Inspector had the opportunity to speak with three relatives on the telephone. What the service does well: The home has a core group of staff that have worked at the home for a long period of time. Observations revealed positive relationships between staff and service users. It is good that there is a photographic record of the staff on duty on display in the hallway. This assists service users and visitors to the home to know who is on duty. Prospective new service users have the opportunity to visit the home and assessment is completed prior to moving in to ensure the home can meet their needs. Service users have the opportunity to participate in appropriate activities. 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. Relatives have been involved in the development of person centred plans. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Systems for care planning and risk assessment must improve to ensure that all service users needs are planned for and safely met. The system of person centred planning needs to be extended to include all service users. Service users must be provided with clear information about possible additional costs for transport provided by the home. 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. Ongoing issues with the provision of a suitable bath must now be resolved to ensure service users have a choice of bath or shower. The Manager must ensure that all staff practice recognises service users as individuals. Menu planning is currently done on an ad hoc basis. This needs to improve to ensure service users are provided with a healthy balanced diet. Shortfalls were identified in regards to the home’s ability to safeguard service users by ensuring the appropriate checks are undertaken before agency staff commence work in the home. Staffing arrangements need significant improvement. A full review of staffing is needed to ensure adequate numbers of competent staff are on duty, the staffing compliment for the home needs to be sufficient to cover for periods of annual leave. Staff training and supervision must be further developed. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 7 An effective quality assurance process needs to be developed that includes developing a plan for the home on how to move forward, thereby improving the overall quality of life for service users who live there. Records in the home must be maintained to ensure they are up to date, to ensure the protection of service users. 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 DS0000024836.V288977.R01.S.doc Version 5.1 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 Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 4 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Service users are fully assessed prior to admission to the home to ensure that their needs can be met by the service. EVIDENCE: It was observed that the Statement of Purpose and Service User Guide 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 care plan. At the last inspection in October 2005 it was evidenced that a prospective new service user had the opportunity to visit the home prior to moving in. This service user has now been living at the home for some months. The Deputy Manager said that the Manager had completed a full assessment that included visiting the previous home of this individual. Unfortunately a copy of the assessment could not be found. However the Manager forwarded a copy a few days after the visit. This was observed to be satisfactory. Discussion with a relative after the fieldwork visit took place confirmed that initial visits to the home had taken place, assessment was completed and the family were invited to a review of the placement. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 9, 10 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Some care plans need developing to ensure all care needs are being met, these need to be reviewed and evaluated appropriately. Service users are supported to make choices and decisions, but this is limited by their learning disabilities and communication support needs. Responsible risk taking is recognised as an essential component of promoting individual independence. However, risk assessing needs to be improved in order to support care planning more effectively. EVIDENCE: Some care plans are in need of significant development. The care files for three service users were sampled. Each service user had a care plan. Two of these were generally up to date. One plan had sections that did not evidence review since 2004. Some plans were quite basic in content but for the one service user who had a person centred plan there was additional useful guidance to include likes, dislikes and cultural needs. Discussion with the Deputy Manager indicates that the majority of service users now have a person centred plan. Due to the complex needs of some service users it has been difficult for staff to Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 11 fully involve them in the care planning process. Where this is the case then input from people who know them well has been used to include key-workers and relatives. Choices and decision-making are restricted to fairly mundane matters, (such as what to eat or whether to go out) because of people’s learning disabilities and limited communication. Staff were observed offering choices to service users, for example so that one service user could choose what he wanted to drink staff showed him the coffee jar and tea bags. He clearly pointed to the one he wanted. Staff have to use their knowledge of individuals’ mannerisms, body language and gestures to interpret their wishes. It is therefore important that every chance is taken to develop people’s capacity to communicate more effectively (both staff and service user) so as to enhance opportunities for making better choices. For those service users who have them, information in the Person Centred Plan (PCP) provides some good information on communication. However, as previously stated, not all service users have a completed PCP. Risk assessments were also sampled, and seen to be in need of development. For one service user, no risk assessments could be located in his file, and the register of risk assessments was blank. In some plans risks had been identified such as the occurrence of pressure ulcers but care plans had not been fully completed to guide staff as to what care was needed to prevent these occurring. Several sampled risk assessments required review and some were not signed or dated making it difficult to assess if they were current assessments. Service users individual records are kept secured in either the office or a locked cupboard in the hallway. Staff were observed being mindful of issues discussed in the presence of service users. The home uses accident books that are compliant with the Data Protection Act. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, 15, 16, 17 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The service users daily life and social activities are generally satisfactory but recent staffing difficulties have impacted on opportunities for activities away from the home. To ensure all service users receive a balanced and healthy diet planning of meals needs to improve. EVIDENCE: Service users have the opportunity to participate in varied activities, some based in the home and others based in the community. Since the last inspection the majority of service users have commenced activities as part of the Open College Network, in partnership with the Handsworth College. This has had good outcomes for service users as activities are varied and have the advantage that staff have to complete a record of evidence that shows the activities participated in, and whether or not the individual enjoyed it. Examples of activities on offer include shopping, walks, restaurants, colleges, cinema and pubs. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 13 Discussion with several members of staff indicate that recent staffing difficulties in the home have on occasions had a detrimental effect on the frequency that service users are able to do activities away from the home. However, staff said when a community activity is cancelled they always try and substitute an in-house activity. Two service users went out on activities with staff during the fieldwork visit. Other staff were seen to engage with service users doing activities such as drawing, jigsaws and exercise programs using standing frames. Service users have sensory lighting in their bedrooms, music systems, TV’s and videos. TV’s and music systems are also provided in communal areas. It is evident from discussion with staff and observation of records that where appropriate service users are supported by staff to maintain contact with their family. Service users are supported to visit their family and visitors are welcome to the home. The inspector did not meet any relatives at the visit but discussion with three relatives after the visit took place indicated that they are made welcome at the home. Service users have the use of a mini bus, for which they pay a contribution of their mobility allowance. Recently there has been a steep increase in the cost. Evidence was not available that service users or their families had been consulted prior to this increase or that satisfactory information had been provided informing them of the increase and the reasons it had occurred. Additionally, service users had not been provided with new contract agreements. Discussion with the Deputy Manager and subsequently with the Manager indicates that this increase has come from Milbury’s head office and that they too had received little information about the increase. They said they are giving consideration to stop having the use of a mini bus and instead rely on taxis and hiring mini buses as and when needed for holidays and day trips. Following this visit the CSCI requested further information from Milbury to clarify what information has been provided to service users and their relatives. Subsequent discussions with the Service Manager indicates that Milbury will now send further information explaining the price rise. Work is also to be undertaken to establish how frequently service users use the mini bus with a view to reviewing transport arrangements. Stocks of food were observed to be plentiful. Some foods in the fridge were dated on opening but items such as sauces, salad cream were not. Staff must date these on opening to ensure they can be discarded in line with the manufacturers guidelines. To continue using products beyond the recommended use by dates potentially puts service users at risk of food poisoning. It was not fully evidenced that service users are provided with a healthy diet. Adequate supplies of fresh vegetables and fruit were available but records of food provided to service users did not show that they had the recommended five daily portions of fruit and vegetables. For example, the food Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 14 records for one service user did not record any fruit being provided over a sampled one-week period. Discussions with the Deputy Manager and staff indicates that the home does not have a pre-planned menu. The meals cooked are generally decided on the day in an ad-hoc manner. To ensure all service users receive a balanced and healthy diet planning of meals needs to improve, taking into account the food preferences of service users. Mealtime practice was observed. Staff generally provided good support to service users and assisted individuals to eat at their own pace. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of how individuals are supported and health care promoted are in need of improvement. General practice in the handling and administration of medication affords protection to the service users. EVIDENCE: All of the people living at Dawson and Whateley require support in their personal care. Service users were all well dressed appropriately to their age, gender and the weather. Most care plans include detailed information on the support required for personal care but this needs development for service users who do not have Person Centred Plans. Each service user has a manual handling assessment that details the type of hoist and size of sling required but some of this required review. Staff practice was observed to see what the service users living at the home experienced. Some good practice was observed, for example one staff who hoisted a service user from her bed did so with patience and skill, communicating with the individual as she did so. Some areas of practice need to improve. Two members of staff were seen several times to move service users in their wheelchairs without first explaining this was going to happen. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 16 For most service users the sudden movement of their wheelchair must have come as a bit of a shock as staff usually approached from behind the chair and moved it with no verbal communication first. Records indicated that referrals have been made to a range of healthcare professionals and members of the multi-disciplinary team (including GP, dietician, speech and language therapist, occupational therapist, community nurse, etc.) as required in accordance with individual need. The home provides nursing care and individual plans identify most of their health needs. As stated earlier in this report not all service users who were assessed as at risk of developing pressure ulcers had a plan of care for this area. Risk assessments for pressure ulcers had also not been subject to regular review. Improved planning is needed for some of the more ‘regular’ health input such as medication reviews, dental and optician input. The home does have a system for health action planning ‘The OK health checklist’ but those sampled had not been updated for some time. Discussion with the Deputy Manager indicated that she was aware of the need for improvements and for one service user she had started to develop a health file. The accident book was seen, and complies with current data protection legislation. It was noted that reports are being filed with individual personal records, as appropriate, but that currently there is no way of tracking where reports are from the accident book itself. It is recommended that the counterfoil stub in the book be marked with the date of the report and the initials of the person to whom it relates. The systems for the safe handling and administration of medication were generally well managed. The home retains copies of prescriptions, and audits are undertaken of medication stocks. Medication stocks were also sampled, and found to be in order. All medicines were appropriately and securely stored. Requirements made at the time of the last inspection have been complied with, and general practice improved. The nurse usually administers medication but sometimes care staff give service users their medication if they are away from the home on activities. A policy has been developed for this practice. Only care staff who have completed medication training are allowed to administer medication. The medication folder contains a sheet for staff to sign when this has occurred. It is recommended that a list of staff authorised to administer medication be kept alongside the sign sheet. This will enable any nurse, to include agency nurses to be clear about who can undertake this task. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 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 the following standard(s): 22, 23 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Service users learning disabilities make it difficult to assess fully whether or not they consider that their views are listened to and acted upon but satisfactory procedures are in place. General practice within the Home offers protection from abuse, neglect and self-harm to the service users but checking of agency staff needs to improve. EVIDENCE: CSCI has not received any concerns, complaints or allegations about this home since the last inspection. The home’s complaint log did not record any new complaints. 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. Discussion with three relatives indicates that they have not had to make any complaints about the home. One said that she had raised an issue some time ago and was happy with how it had been dealt with. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 18 Adult protection procedures have previously been observed to be satisfactory. All staff, with the exception of new staff, are said to have received training in the Protection of Vulnerable Adults From Abuse, though the chart on the office wall did not show this (See Standard 35 also). Minutes of the Nurses meeting in January 2006 showed that the Manager intended to provide this training to staff. The financial records for one service user were sampled; receipts were available for all expenditure. It is good practice that the Service Manager audits these records on a regular basis; this increases the safeguards in place for service users. Sample checking of the personal file of the most recently appointed member of staff revealed that CRB and POVA checks had been completed satisfactorily. Agency staff sometimes work in the home. Discussion with the Deputy Manager indicates that evidence of CRB checks is not requested from the agency. The Manager needs to ensure this information is provided to ensure appropriate safeguards are in place for service users. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29, 30 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at the home is generally comfortable, homely and safe but there are ongoing issues about the lack of storage and unsuitability of the bath. EVIDENCE: The premises are in keeping with the local community. Each of the bungalows is accessible to the six service users living there. The corridor joining the two bungalows 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 satisfactory standard. Furnishings, fittings, adaptations and equipment are as domestic, unobtrusive and ordinary as is compatible with fulfilling their purpose. However in Whateley the lounge seating and net curtains were in a poor state of repair. Seating was very worn with ripped areas where the foam could be seen. Net curtains were sagging and were ripped. Discussion with the Manager after the fieldwork visit took place indicates that Milbury has agreed for these to be replaced. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 20 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. At the last inspection bathroom were observed to be very cluttered but the recent installation of additional cupboards has provided storage in these areas. Discussion with the Deputy Manager indicates that further improvements are planned to include sectioning off the entrance hall to provide a new office, the existing office will then be used to store equipment. Service users bedrooms were personalised and contained appropriate personal effects and equipment. Where appropriate service users bedrooms reflected their cultural background. Discussion with staff indicates that some service users have new curtains on order and those that were able chose their own. 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. Previous inspections have identified that the bath in Dawson bungalow is not suitable for the needs of the current service users and therefore only the shower trolley is used, thereby limiting the choice of service users to have a bath. Discussion with one of the Nurses at the last inspection indicated that this issue had been resolved and that quotes were being obtained for a new bath to be installed. However the Deputy and Manager said that there has since been a problem with funding. This issue must be resolved as it is not acceptable that it has been ongoing since June 2004. 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. Recent checking of the condition of service users mattresses have identified that three required replacement. At the time of the fieldwork visit the Deputy agreed to inform the CSCI of the date when this would be done. The home has a variety of hoists, sliding sheets, shower trolleys and other specialist equipment. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Current staffing arrangements in the home do not always ensure positive outcomes for service users. EVIDENCE: Support to service users is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Members of staff demonstrate that they have a good personal knowledge of the individuals in their care. Discussion with the Deputy Manager indicates that more than 50 of the staff has achieved the standard of having an NVQ in care. It is good that there is a photographic record of the staff on duty on display in the hallway. This assists service users and visitors to the home to know who is on duty. During the day the homes are staffed as two separate houses. It has previously been the practice for a Nurse to be on duty in each bungalow during the day. However discussion with staff and observation of the rota shows that recently it has been quite regular that only one nurse is on duty. The frequency of this has increased with the recent retirement of one nurse. With only one Nurse on duty this means they would have to leave their designated bungalow to administer medication and carry out other nursing tasks during their shift. This has the potential to leave one bungalow short of Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 22 staff during that period. It is also difficult for one Nurse to ensure that service users are receiving the care they need when they have to continually swap from one bungalow to the other. Under regulation 37 the CSCI must be informed of any occasion where the home is being staffed below the usual levels. Discussion with the Manager indicates that interviewing of new staff is underway and that the Manager also hopes to increase the nurse compliment by one additional full time nurse. One service user who is new to the home is assessed as requiring constant supervision. Whilst this was observed to be adhered to throughout the visit it undoubtedly had an impact on the time available staff have to support other service users and undertake other duties. Discussion with the Manager indicates that there has been some increase in staff hours to enable this, 42 hours per week. Given the support needs of this service user a full review is needed of the current staff hours is needed to ensure they are satisfactory to meet all service users needs. Current staff vacancies and maternity leave have meant staffing shortfalls of between 62hrs to 163hrs per week. Therefore some staff have done overtime and agency staff have been used to cover any shortfalls. Over a sampled tenday period agency staff had covered 18 shifts. Whilst agency use is currently necessary to cover the shortfalls it does not result in service users always being supported by consistent staff who know their needs well. Discussion with staff also indicate that current staffing difficulties have at times impacted on the frequency of service users being able to participate in activities outside of the home. Two relatives were spoken with about their views of the staffing arrangements. Both said that the staff were lovely and did a good job. One was concerned about the lack of staff, particularly at weekends. The recruitment records for two new staff contained all the required information to show that a robust recruitment procedure is followed, to ensure that service users are not put at risk. Staff new to working with individuals who have a learning disability have the opportunity to complete the Learning Disability Award Framework. Milbury also has a formal induction programme. The record of this was sampled for one member of staff. This had been part completed but had not met Milbury’s own timescale for full completion. The chart in the office mapping training was not fully up to date, and a requirement of this inspection is that the Manager completes a current training and development assessment for each member of staff. This should include details of all training completed by each person, and highlight any gaps, including where refreshers are required. Where training is shown as being outstanding or required, the assessment should show when Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 23 this is scheduled and who is to deliver it. Discussion with staff and sampling of records did not show that staff were up to date with training in areas such as first aid, fire and manual handling. Previous requirements have been made to ensure that staff receive appropriate support and supervision. It is disappointing that there was no evidence to show that any progress has been made. Sampling of records and discussion with staff show that formal supervision is infrequent. One staff had received supervision once in five months, and for another there was no record of supervision since June 2005. Staff meetings are useful in ensuring good communication between the team and to ensure staff can exchange views, ideas and be updated with what is happening in the home. Unfortunately since May 2005 there was only a record of two meetings taking place. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for the management of the home needs to improve to ensure good outcomes for service users across all of the National Minimum Standards. EVIDENCE: The Manager was on annual leave at the time of the visit. The Manager has demonstrated good knowledge of the needs of the service users at previous inspections. He has many years care experience and is a registered nurse in learning disabilities. Unfortunately there has been a lack of progress in ensuring good outcomes for service users. Some areas where the home has previously performed well have had shortfalls at this visit. Observation of the homes rota and discussion with the Manager show that due to staffing shortages the Manager has had to spend more time as the only Nurse on duty. Previously all of his shifts have been in addition to the nursing staff on duty. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 25 To ensure improvements are made the Manager must be given sufficient time to carry out his managerial responsibilities and ensure identified areas for improvement are actioned. There is evidence that the organisation has developed systems for quality assurance. Regular monthly visits required under Regulation 26 (Care Homes Regulations 2001) have been completed as necessary, and copies of reports submitted to the CSCI. However information provided on these reports do not indicate the current staffing difficulties at the home or areas where significant improvement is needed such as the systems for staff supervision. The organisation completes an annual quality audit of the home. This was sampled but it was not clear if views of relatives had contributed to the process. As already reported, some records in the home were not up to date such as some care plans and training records. Whilst it is acknowledged that the home is currently in the process of reorganising the office there was a large pile of paperwork waiting to be filed, this may have contributed to the Deputy Manager being unable to locate the pre admission assessment for one service user. Files are in need of a general “tidy up”: material that is old or has been superseded should be removed and disposed of, or archived, as appropriate. It is important that anyone seeking information from the file should be able to locate it quickly and easily, and not be put at risk of following guidance that is out of date. The fire safety records were examined and all tests, checks, servicing of equipment, drills had been completed or scheduled as appropriate. Records did not show that all staff had received six monthly fire training. Portable appliance testing has been carried out on electrical equipment, and the hard wiring certificate is in date, as is the Landlord’s Gas Safety Certificate. Staff test the fridge and freezer temperatures regularly to make sure that food is being stored at the correct temperature. Staff test water temperatures weekly. Records of these showed that these are safe. The COSHH cupboard was observed to be unlocked in Dawson bungalow. This cupboard must be kept locked when not in use, particularly as one service user is identified at being at risk of drinking unsafe substances. The Deputy Manager immediately locked the COSHH cupboard when it was brought to her attention. Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 3 LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X 2 2 X Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12(1)(a) 15 Timescale for action Care plans must set out in detail 30/06/06 the care required to be carried out by staff to ensure all aspects of the health, personal and social care needs of service users are being met. Care plans must be reviewed at least six monthly. The Manager must ensure all 18/06/06 risks to service users are identified and a risk assessment completed and reviewed at least six monthly. Outstanding from 17/06/05. Ensure service users have 30/06/06 adequate opportunities to participate in community activities. Review of the arrangements for 30/06/06 transport provision is needed to ensure the system is fair, equitable and value for money. Evidence of consultation with service users or their relatives is needed regarding the recent increase in fees for the use of the mini bus. Explanation is needed as to the increase in charges. Service users must also be provided with an up to DS0000024836.V288977.R01.S.doc Version 5.1 Page 28 Requirement 2. YA9 12(1) 13(4) 3. YA13 16(2)(m) 4. YA16 12(1) 13(6) Dawson Road, 5 / Whateley Road 5. YA17 16(2)(i) 6. YA18 12(1) 15 13(4) 12(1) 7. YA18 8. 9. YA19 YA19 12(1) 12(1) 15 13(6) 18(1) 10. YA23 11. YA24 23 (2)(d,l) 12. YA24 23(2)(b) 13. YA29 23(2)(n) 14. YA33 18(1)(a) date contract/agreement to cover this practice. Menu planning must be reviewed to ensure service users receive a balanced and healthy diet. The Manager must ensure that manual handling assessments are reviewed at least six monthly. The Manager must ensure that staff provide personal support to service users in a respectful manner at all times. The practice of staff moving service users in their wheelchairs without first informing them must cease. Health action plans require development and review. Risk assessment and care planning on the prevention of pressure ulcers requires improvement. Ensure appropriate information to include evidence of CRB checks is obtained from the Agency before new agency staff start work in the home. Adequate space for the storage of equipment must be provided. Outstanding from 30/12/05 but plans to address this is in place. Ensure all furnishings and fittings are in a satisfactory condition. Replace seating and curtains in Whateley lounge. The Manager must notify the CSCI of the intended date for the provision of baths that are accessible to service users. Outstanding requirement from 30/11/05. The Manager and Registered Provider must ensure the numbers of staff on duty are maintained at levels which reflect the needs of service DS0000024836.V288977.R01.S.doc 30/06/06 30/05/06 30/05/06 30/06/06 30/06/06 30/05/06 30/07/06 30/07/06 30/06/06 30/05/06 Dawson Road, 5 / Whateley Road Version 5.1 Page 29 15. YA41YA33 18(1) 37 18(1)(a) 16. YA35 17. YA35 18(1)(a) 18. YA36 18(2) 19. 20. YA36 YA37 18(2) 10(1) 12(1) 24 26 21. YA39 22. 23. YA41 YA42 17(3) 13(4) 24. YA42 13(4) 18(1)(c) 23(4) users in the home at all times. Vacant staff posts must be recruited to, to reduce the homes reliance on agency staff. The Manager must ensure the CSCI is informed of any occurrences where staffing has fell below minimum levels. The Manager and Registered Provider must ensure that staff are suitably skilled by ensuring appropriate training is provided. Training records must be up to date and record all training undertaken by staff. The Manager must ensure the induction programme for new staff is fully completed in line with the providers own time guidelines. The Manager must ensure that formal supervision for all staff is being carried out the minimum of six times per year. The Manager must ensure that staff meetings take place a minimum of six times per year. The Registered Provider must ensure that the Manager has sufficient time to carry out his managerial responsibilities. The Manager and Registered Provider must ensure that effective quality assurance and quality monitoring systems are in place. The Manager must ensure records held in the home are maintained and kept up to date. The Manager must ensure that all chemical products are stored in accordance with COSHH regulations 1988. The Manager and Registered Provider must ensure staff receive refresher fire training at least six monthly. DS0000024836.V288977.R01.S.doc 30/05/06 30/06/06 30/06/06 30/06/06 30/06/06 30/05/06 30/07/06 30/05/06 15/05/06 30/06/06 Dawson Road, 5 / Whateley Road Version 5.1 Page 30 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 YA19 Good Practice Recommendations Accident records. It is recommended that the counterfoil stub in the book be marked with the date of the report and the initials of the person to whom it relates to ensure it is easier to track accidents. It is recommended that a list of staff authorised to administer medication be kept alongside the sign sheet. This will enable any nurse, to include agency nurses to be clear about who can undertake this task. 2. YA20 Dawson Road, 5 / Whateley Road DS0000024836.V288977.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 DS0000024836.V288977.R01.S.doc Version 5.1 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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