Inspection on 25/06/07 for Dawson Road, 5 & Whateley Road

This inspection was carried out on 25th June 2007.

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 9 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 18/04/06

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 Key Unannounced Inspection 25th June 2007 09:30 Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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) londonroad@tiscali.co.uk Milbury Care Services Ltd 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.V340980.R01.S.doc Version 5.2 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 be amended to reflect the age of service users accommodated. 12th February 2007 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. Information about the fees to live at the home was provided by Milbury, this indicates that the contribution from people who live at the home is £63.95 per week. This does not include the use of the home’s vehicle. Copies of inspection reports are available to read at the home on request or as part of the service user guide on display in the home. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork visit was carried out over eight hours. This was the homes key inspection for the inspection year 2007 to 2008. A random inspection was undertaken in February 2007. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home, reports from the provider and a pre inspection questionnaire (AQAA). All people who live at the home were spoken to. Due to their communication needs most people who live at the home were not able to comment on their views. Therefore to establish what it is like to live at the home time was spent observing care practices, interactions and support from staff. Discussions with staff, the Manager and Operations Manager took place. 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 CSCI questionnaires were received from two health professionals and one relative. What the service does well: Support to people who live in the home is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Attention is paid to individual’s appearance and the people living in the home were well dressed in smart clothes. It is good that there is a photographic record of the staff on duty on display in the hallway. This assists people who live at the home and visitors to know who is on duty. The people who live there are supported to keep in contact with their family and friends. Staff at the home seek input from other health and social care professionals to assist in meeting individual need. People’s bedrooms are well maintained and contain their personal items. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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 peoples needs are planned for and safely met. The system of person centred planning needs to be extended to include all people at the home. Where health professionals recommend the introduction of health monitoring charts for specific individuals this should be done without delay to ensure their continued health. A full review of staffing is needed to ensure there are enough nurses on duty to meet the needs of people living in the home. Staff should receive the supervision and support they need to carry out their jobs and meet the needs of the people living there. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 7 All the required recruitment records must be in the home for all staff that work there. This would show that all the necessary checks had been done to make sure that suitable people are employed to work with the people living there. The systems for administering medication need some improvement to ensure people get the medication they need. Some health and safety issues need addressing so that people in the home are safe from risks such as fire. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to ensure they can make a choice about whether or not they want to live at the home. People’s individual needs 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. These documents had been updated and included all the relevant and required information. The service user guide was in an easy read format that included pictures. This gives the information about what the home provides to people who are looking to see if the home can meet their needs and whether or not they want to live there. There have been no admissions to the home since the last inspection. A new admission tool is in place to assist staff undertaking assessment of the needs of a potential new person. The new tool was seen to have been part completed for someone who had undertaken a trial visit to the home, however it had not been fully completed as they decided they did not want to move into the home. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff generally have the information they need so they know how to support the people living in the home. Risk assessments need to be kept under regular review to ensure that risks to people living in the home are managed in a safe and responsible manner. EVIDENCE: The care provided to three people was case tracked to include their care plans and risk assessments. Each person had a care plan. Two of these were up to date. They detailed how staff are to support people to meet their communication, social, cultural, spiritual, health, personal care, dietary and mobility needs. They also stated what the person’s preferences, likes and dislikes were. For one person the plans were dated August 2006 and so were overdue for review. The Manager said that there were new plans in place but that one of the Nurses had these at home as they were updating them. Copies of the up to date plans need to be available in the home so that staff have the information they need to meet people’s needs. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 11 One person spends a lot of time sleeping. Their care plan states that when they are asleep on the settee staff need to ensure their safety by monitoring them. The plan does not specify the frequency or level of monitoring required. However, a risk assessment reviewed in June said that staff were always to observe. The care plan needs to clearly guide staff as to how to support the person as during the visit they were observed asleep on the settee. Whilst staff were close by in the kitchen they did not have actual sight of them for a period of ten minutes. Discussion with staff indicates that the majority of people who live at the home have a person centred plan. Due to the complex needs of some people it has been difficult for staff to 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. For those people who have them, information in the Person Centred Plan (PCP) provides some good information on communication. On the questionnaire (AQAA) the Manager said that it is hoped to improve 1:1 engagement with people at the home. It is hoped to have a residents meeting on Whateley but this has not yet happened. The Manager said this was because the advocacy group they were trying to access could not visit on the planned day. Each person’s records included individual risk assessments. Some manual handling and pressure care assessments had not been reviewed within the last six months. This needs to be done to make sure the information is up to date and that the control measures in place protect people from harm. Some assessments have been observed to need review at previous inspections and it is disappointing that this area still needs to be improved. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that people living in the home experience a meaningful lifestyle. The people living in the home are offered a healthy diet to ensure their well being. EVIDENCE: People who live at the home have the opportunity to participate in varied activities, some based in the home and others based in the community. Some people undertake activities as part of the Open College Network, in partnership with the Handsworth College. This has had good outcomes for people 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. Records and discussions with staff show that activities on offer include walks, watching videos, shopping, sensory activities, music, meals out, cinema and watering plants. Since the last inspection recording of activities has improved Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 13 so that staff evaluate more effectively if the activities offered have been enjoyed. Records show that the cultural and religious needs of people are considered when undertaking activities, this includes watching culturally appropriate films, going to Church or visiting restaurants. A new activity has been recently introduced of a weekly music activity by a visiting ‘music man’. Records show this has been greatly enjoyed by people living at the home. For people who are well enough to have a holiday an activity holiday to Devon has been booked and an animal or music related holiday is also being considered. The questionnaire (AQAA) completed by the Manager states that it is intended to develop raised beds in the garden in the next twelve months so that people who live in the home can become more involved in gardening activities. The home has the use of a vehicle. Previous inspections have indicated there is sometimes a lack of drivers for the vehicle so not everyone had full use of it. Discussion with the Manager indicates the lease for the vehicle is near to the end and it is anticipated that the new one will be smaller. The Manager said this will be beneficial to people living at the home as more staff have indicated they would feel confident in driving a smaller vehicle. It is evident from discussion with staff and observation of records that where appropriate people are supported by staff to maintain contact with their family. Notices in the home state that visitors are welcome to the home. Staff said that people’s relatives are invited to take part in their birthday parties. Food records showed that a variety of food is offered that included fresh fruit and vegetables. This is an improvement from the random inspection where it was not clear that a varied, nutritious and healthy diet was being offered. Lunchtime practice was observed in one of the bungalows. Appropriate support was given. Staff told people what was for lunch, sat at their level whilst supporting them to eat at their own pace. Some people have special diets such as blended food because of swallowing difficulties. Other diets are catered for that meet people’s cultural or religious needs. The fridge was observed to be well stocked with food, fresh fruit was available. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People generally receive personal support in the way they prefer and require. Arrangements are not always sufficient to ensure that individual’s health needs are met or the medication prescribed for them is given. This could put at risk the health and well being of individual’s. EVIDENCE: Care plans included how staff are to support individuals to ensure their personal care and health needs are met. Plans were seen to respect individual religious beliefs such as not washing hair on a particular day of the week. Attention had been paid to individual’s appearance and the people living in the home were well dressed in clothes that were appropriate to their age, the weather and the activities they were doing. Staff try to ensure same gender personal care for people but due to the ratio of male staff there are not always enough male staff on duty to provide personal care to males who live at the home. During the mealtime one person was coughing and in distress, they were appropriately supported by staff, supported to lean forward, their back patted and spoke to encouragingly until they were well. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 15 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. One person who lives at the home is due to commence hydrotherapy. Tracking of healthcare has improved since the last inspection with a new system of recording having been introduced. It is good that that staff have also commenced work on updating health action plans. This is a personal plan about what support a person needs to stay healthy and what healthcare services they need to use. Where needed, staff had appropriately monitored people’s weight and people who were at risk of constipation. Staff also monitor individuals fluid intake where needed. For one person who had not been drinking much staff had taken the appropriate action to consult with the Speech and Language Therapist and intend to consult with relatives about how the person can be supported to stay healthy. Some healthcare issues needed improvement. As identified earlier in this report some risk assessments needed review to include the risk of some individuals developing pressure sores. Some people have eating or swallowing difficulties. For one person who has been coughing staff have kept a record of this. However, recently the Speech and Language Therapist had also requested that a record was kept of when the person did not cough, this had not yet been done by staff. One health professional commented that specific recommendations are not always followed through by staff. Medication is stored in locked cabinets and administered by nurses. The home retains copies of prescriptions, and audits are undertaken of medication stocks. Protocols were in place for people who were prescribed PRN (as required) medication. These stated when, why and how much of the medication should be given. However, for one person who is prescribed an inhaler this did not appear on the protocol so that staff did not have guidance on its use. Medication Administration Records (MARS) were sampled for June. There were several gaps on the MARs where staff should have signed to say the medication had been given or not. This included five days out of twelve when medication for epilepsy had not been signed for. If the individual does not get this medication it potentially increases their risk of having a seizure. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for making complaints ensure that the views of the people living in the home are listened to and acted on. Arrangements are sufficient to ensure that the people living in the home are protected from abuse, neglect and self-harm. 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 people’s views. These are entitled “Let us know what you think” and “Questions about your house”. People who live at the home are reliant on staff that know them well to pick up on cues and clues as to whether or not they are happy. To facilitate this staff have information in care plans on how to recognise when individuals are upset. Information about the complaint procedure is included in the service user guide. One relative who returned a CSCI questionnaire said they did not know what the complaints procedure was. Consideration should be given to making sure relatives are aware of the procedure. The training matrix showed that staff have had training in adult protection and the prevention of abuse, some having had recent refresher training so that they know how to protect people from abuse. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 17 The financial records for one person who lives at the home were sampled; receipts were available for all expenditure. Staff check monies at the handover of each shift to ensure that the money is still there and any money taken out for people to spend had been calculated properly. It is good practice that the Service Manager audits these records on a regular basis; this increases the safeguards in place for people. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable, safe and clean environment that generally meets their individual needs. EVIDENCE: 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. Communal areas are homely with pictures, photographs of people who live at the home and birthdays cards on display. Unfortunately this was spoilt a little in Dawson by a ripped tablecloth on the dining table which detracted from the homely appearance of the room. Generally the garden was well maintained but there were some overgrown areas that would benefit form some attention. The Manager said it was intended to further develop the garden in the next twelve months to provide raised beds. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 19 At the last Key Inspection the lounge seating and net curtains in Whateley were in a poor state of repair. New seating, furniture and net curtains have now been provided which makes the lounge and dining area look nicer. Since the last Key Inspection sectioning off the entrance hall to provide a new office has been completed in Dawson, the existing office will be used for meetings and to store equipment. Some areas of the home have previously observed to be very cluttered, in particular the bathroom and spare room in Whateley. The majority of clutter has now been removed making these areas more homely and nicer to use. Previous inspections have identified that the bath in Dawson bungalow is not suitable for the needs of the current people who live there and therefore only the shower trolley is used, thereby limiting the choice of people to have a bath. A new bath is on order and the Manager said it will be installed once new flooring has been fitted in the bathroom. Bedrooms seen were well decorated according to individual’s tastes, interests, culture, age and gender. They contained many personal possessions. One person who lives at the home nodded his head when asked if he liked his bedroom. The home has a variety of hoists, sliding sheets, shower trolleys and other specialist equipment. Staff spoken with said that there was enough equipment available to meet people’s needs. The home was clean and free from offensive odours. Satisfactory hand washing facilities were observed in the bathroom, laundry and kitchen. Colour coded mops and buckets are used to prevent the spread of infection. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing the home their support and development are variable and do not always ensure that staff are able to meet the needs of the people living in the home. People living there are not always sufficiently protected by the home’s recruitment practices. EVIDENCE: Support to people who live in the home 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. The AQAA completed by the home Manager records that 64 of staff have achieved 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 people who live at the home and visitors to the home to know who is on duty. One relative said that staff at the home were friendly. During the day the homes are staffed as two separate houses. It has historically 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. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 21 The Manager has completed a brief assessment of the impact that having only one nurse on duty has on the running of the home, this does not indicate that one nurse is adequate. If nurse levels are to be decreased then a full written assessment of the staffing needs of the service needs to be completed to evidence that people’s needs can be safely met by one nurse. One relative commented that the home would be improved if there were more qualified staff. Discussion with the Manager and the staff rota shows that the home currently has three staff on maternity leave. This means that bank staff are being used and permanent staff are also working extra hours to cover the absences. The Manager said it is hoped to recruit some additional staff on temporary contracts to cover these absences. The recruitment records for five staff were sampled. Records were generally more ordered than at previous visits with work done to section off the records making information easier to locate. For three established staff the records included all the required information to show that a robust recruitment procedure had been followed. For a new bank staff a copy of their application form and two written references were available. A criminal record bureau (CRB)number was provided to show that a CRB check had been done but the actual disclosure was not available to evidence the outcome of the check. For a recently employed nurse only a copy of the application form and proof of identity was available, the Manager said that the other documents were at headquarters. During the inspection visit a copy of written references, proof of checking of the nurses registration and the CRB number were faxed to the home from Milbury headquarters. The Manager needs to ensure staff files contain all the required recruitment information to show that a robust procedure is always followed. Staff new to working with individuals who have a learning disability have the opportunity to complete the Learning Disability Award Framework, six staff at the home have completed this. Since the last inspection the Manager has updated the training records for staff so that they show what training each person has done, what they need to do and what has been booked. The last key inspection identified that some staff were not up to date with first aid, fire and manual handling training. The majority of staff have now done this training, several staff were having manual handling training on the day of the inspection. Training undertaken by staff in 2007 has included tissue viability, epilepsy and protection of vulnerable adults. The Manager and some of the nurses have attended recent training on the new ‘Mental Capacity Act’. At previous inspections some staff have been observed to carry out care practices without communicating this effectively to the people who live in the home. To try and improve staff’s practice training has been undertaken by nineteen about ‘attitudes and values’. This appears to have been effective as staff practice was observed to be improved. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 22 Previous requirements have been made to ensure that staff receive appropriate support and supervision. The Manager has now completed a supervision matrix to assist in planning supervisions. Some staff have had fairly regular supervision but the frequency for others has been variable. Staff should have at least six supervision sessions each year to monitor their performance and identify their training and development needs to ensure they can meet the needs of the people living there. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are sufficient to ensure that the people living there can be confident that their views underpin all self-monitoring, review and development by the home. Arrangements are not sufficient to ensure that the health, safety and welfare of the people living in the home are always promoted and protected. EVIDENCE: The Manager has demonstrated good knowledge of the needs of the people who live at the home. He is registered with the CSCI and has many years care experience and is a registered nurse in learning disabilities. 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. A full audit of the home was undertaken in January Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 24 over a four day period. The actions identified from the audit were very detailed and consistent with the findings from the previous Key and Random inspections by the CSCI. The Manager is now completing weekly update reports to the Operations Manager regarding progress towards meeting CSCI requirements. An electrician completed the annual test of the portable electrical appliances in November 2006 to make sure they are safe to use. An electrician completed the five yearly test of the electrical wiring in June 2002 and stated that it was in a satisfactory condition, however this now needs to be rechecked. The Manager said that the electric engineers had rang that day to arrange to come and do the electrical installations check. In February 2007 a Corgi registered engineer tested the gas equipment as required annually to make sure it is safe. Certificates were available to evidence that the moving and handling equipment such as the hoist and bath had been regularly serviced. Opened food in the fridge had been dated on opening so that staff know when it needs to be thrown away so that people are not put at risk of eating out of date foods. Fridge temperatures are monitored by staff but the records in Dawson showed that the temperature was often too high at 10°C. It was not clear that any action had been taken to reduce the temperature so that people who live in the home are not put at risk from food poisoning. Staff test water temperatures weekly. Records of these showed that these are safe. Staff have received fire training and staff spoken with were aware of the fire procedure. Fire records showed the last fire drill was in November 2006 but the Manager said a drill had been done on the day of the fire training in May and updated the record. The fire risk assessment was dated May 2006, the Manager said a more up to date assessment had been done but could not find it. Certificates show the fire alarms and lights serviced had been serviced in May 2007. Records for testing of the fire alarms did not show that they had been tested weekly, sometimes there were gaps of three weeks in duration. The alarms must be tested weekly to ensure they are working properly and people are not put at risk in the event of a fire. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 25 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 2 3 X 3 X X 1 X Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 15 Requirement Up to date care plans must be available in the home so that staff have the information they need to meet individual’s needs in a safe manner. All risks to people living in the home must be fully assessed and reviewed at least six monthly so that people are protected from harm. Previous requirement. Medication must be signed for as it is given to ensure that people are receiving their medication as prescribed. Where people are prescribed medication on an ‘as required’ basis a protocol on its use needs to be available so that people get the medication when they need it. A full review of the staffing levels must be carried out to ensure there are enough nurses on duty at all times to meet the needs of the people living in the home. Staff recruitment records must be available in the home and evidence that suitable people DS0000024836.V340980.R01.S.doc Timescale for action 30/08/07 2. YA9 13(4) 30/08/07 3. YA20 13(2) 30/07/07 4. YA20 13(2) 30/08/07 5. YA33 18(1)(a) 30/08/07 6. YA34 19 30/07/07 Dawson Road, 5 & Whateley Road Version 5.2 Page 27 7. YA42 13(4) (a, c) 23(4) 8. YA42 9. YA42 23(4) had been employed to work with the people living there. The fridge must be maintained 30/07/07 within safe temperatures to ensure people are not at risk from food poisoning. The fire risk assessment must 30/07/07 be kept under regular review to ensure that people are protected from the risk of fire. The fire alarms must be tested 30/07/07 weekly and a record kept to ensure that people are protected from the risk of fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA6 YA19 YA20 YA27 YA36 YA42 Good Practice Recommendations Ensure that each person at the home has a person centred care plan so that staff have the information to meet individuals needs and preferences. Where health professionals recommend the introduction of health monitoring charts for specific individuals this should be done without delay to ensure their continued health. The medication audit should be expanded so that a monitoring system is in place to ensure staff are signing medication administration records appropriately. Proceed without delay with the plan to install a new bath suitable to the needs of people who live in the home. Staff should receive the supervision and support they need to carry out their jobs and meet the needs of the people living there. Records of all fire drills must be kept to ensure that staff and the people living there regularly practice what they would do if there were a fire to ensure their safety. Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dawson Road, 5 & Whateley Road DS0000024836.V340980.R01.S.doc Version 5.2 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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