Inspection on 25/06/08 for Dawson Road, 5 & Whateley Road

This inspection was carried out on 25th June 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

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 27/09/2008.

CARE HOME ADULTS 18-65 Dawson Road, 5 & Whateley Road Handsworth Birmingham West Midlands B21 9HS Lead Inspector Kerry Coulter Unannounced Inspection 25th June 2008 09:10 Dawson Road, 5 & Whateley Road DS0000024836.V367230.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.V367230.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.V367230.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) Voyage.com Milbury Care Services Ltd 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.V367230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category/ies of service only: Care home with nursing – Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD (12) Physical disability – Code PD (12) 2 The maximum number of service users who can be accommodated is: 12 25th June 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. A copy of the service user guide is available in each bungalow, which provides information about the facilities. The range of fees was not stated in the service users guide and these should be included. 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.V367230.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment (AQAA) completed by the manager. Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. People who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The manager and staff on duty were spoken to. A tour of the premises took place. Care, staff and health and safety records were looked at. ‘Have your say’ Surveys were received from three members of staff and two health professionals, their views of the home are included within this report. What the service does well: Before people move into the home their needs are assessed to ensure they can be met. People who live at the home have the opportunity to participate in varied activities. 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. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 6 Attention is paid to individual’s appearance and the people living in the home were well dressed in smart clothes. 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. A healthy and nutritious diet is offered to the people living there to help meet their health needs. Staff have training to make sure they can meet the needs of people who live in the home. What has improved since the last inspection? What they could do better: Care plans need to make clear the exact type of support an individual needs to make sure they get the care they need. Risk assessments need to be available for any people who use bed rails to ensure they are not put at risk by the use of the rails. The systems for administering medication need some improvement to ensure people get the medication they need. Some areas of healthcare monitoring needed to improve so that people get the care they need to stay healthy. Work is needed to the home to ensure it is well decorated and maintained for the people who live there. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 7 Staff should receive the supervision and support they need to carry out their jobs and meet the needs of the people living there. Fridges should be maintained at safe temperatures so that people are not put at risk of food poisoning. The format of the service user guide should be reviewed to try and make it more accessible to potential new 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. The summary of this inspection report can be made available in other formats on request. Dawson Road, 5 & Whateley Road DS0000024836.V367230.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.V367230.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 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have most of the information they need so they can make a choice about whether or not they want to live there. Before people move into the home their needs are assessed to ensure they can be met. 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 most of the relevant and required information except information about how much it costs to live at the home. This needs to be included in the guide so that people have all the information they need about the home. 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. However one person who had moved into the home had not visited prior to moving in. Due to the persons needs the guide may not have been in an easy to understand format, the addition of photographs of the home may have given the person an idea of what the home looks like. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 10 One new person had been admitted to the home since the last inspection. Their records showed that the home had completed a full assessment of their needs prior to them being admitted, this covered areas such as staffing needs, background information, communication, personal care needs, dressing, social needs, psychological, mental health, and health. Copies of assessments completed by the person’s social worker, the hospital and their former care home had also been obtained. A meeting was then held with other care professionals to decide if the home could meet this persons needs. As the individual themselves had difficulties in communicating their views and they also had no relative involvement it was good that an independent advocate was involved in the process. It was agreed by the professionals involved in the review meeting that due to the person moving to the home from hospital a visit to the home prior to the person moving in would not be in their best interests. To make the move less traumatic the home ensured that the person’s new bedroom had all their personal effects unpacked before their arrival. This meant that the person would have been surrounded by familiar things in their new room. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have most of the information they need so they know how to support individual’s to meet their needs and make choices about their day-to-day lives. EVIDENCE: The care provided to two people was looked at, to include their care plans and risk assessments. Each person had a care plan. The home has been working on completing a new format for the plans and these were generally more person centred than some of the previous plans. Care plans detailed how staff are to support individuals to meet their needs and achieve their goals. 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. Care plans cross referenced with guidelines and recommendations made by professionals so that staff had all the information they needed together to know how to support the person. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 12 One person sometimes gets distressed when being hoisted by staff and can scream, hit out or scratch staff. A care plan was in place for this behaviour but it needed some improvement as it had little guidance for staff on how they should prevent the behaviour occurring. If the behaviour did occur the plan guided staff to ‘be firm’. This needs expanding so that it is clear what staff should do as staff may have a different understanding of what this means. Most of the people living there are not able to communicate verbally because of their learning disability. Their care plans included information about how they communicate. Choices and decision-making are often restricted to what people would like to eat, if they want to go out or what activities they would like to do. During the visit staff were observed offering people a choice of meals by putting different foods in front of them to choose from. People were also consulted about if they wanted to sit in the garden as it was a sunny day. A review meeting had been held recently for one person who had moved into the home to see if the trial stay had been successful. As the person was unable to communicate their views about this an independent advocate acted on their behalf in the meeting. Records included individual risk assessments that stated how staff are to support the person to take risks whilst maintaining their independence as much as possible. These are reviewed regularly and updated if the person’s needs have changed. Some improvement was needed to assess the risks to people who had bed rails. One person had an assessment that was quite vague regarding the actual risks and the control measures in place. For one person, there was no assessment of the risks in their file. The manager said that an assessment had been completed but that he was not sure where it was. The manager was advised that the assessment needs to be available in the file so that staff are aware of how to protect the person from possible risks. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 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 Handsworth College. Each person has their own activity planner. Records and discussions with staff show that activities on offer include walks, watching videos, looking at magazines, aromatherapy, shopping, going to the park, sensory activities, music, meals out, church and pet interaction. It was identified in last years annual quality assurance assessment (AQAA) that it was planned to have new Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 14 raised beds in the garden. It is good that this has now been done, the manager said that this would help people to get involved in gardening activities. Most staff spoken with felt that people got to go on enough community activities although one staff did comment that sometimes it was difficult to get people out but now that it was the summer people were going out more. Notices in the home state that visitors are welcome to the home. 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. One of the people living there does not have contact with relatives. Staff have involved an advocate so that the person has someone independent to speak up for them if needed. Food records sampled showed that people were offered a varied and healthy diet that reflected their likes and cultural background. Individuals’ diet included fresh fruit and vegetables and these were available in the home. Mealtime practice was observed in both of the bungalows. Appropriate support was given. Staff offered choices and sat next to people whilst supporting them to eat at their own pace. Where the person had a poor appetite the Dietician was involved. Where necessary supplements had been prescribed for the individual and records showed that these had been given to ensure the person was adequately nourished. Some people have special diets such as blended food because of swallowing difficulties and staff spoken with were aware of individual needs. Some people are fed through a PEG tube, which has been surgically inserted into the person following assessment and discussion with health professionals. This may be because they have had difficulty swallowing and are at risk of choking. It ensures that the person receives the nutrition they need but are not at risk of choking whilst eating. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not always sufficient to ensure that the health needs of the people living there are met so ensuring their well being. EVIDENCE: Care plans included how staff are to support individuals to ensure their personal care and health needs are met. 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. Some people were sitting in the garden in the morning, it was a sunny day and staff were observed supporting people to wear sun cream so that they were not at risk of being burnt. One person cried out whilst sitting in the lounge area, staff quickly came over to the person to give them reassurance and to try and find out what had upset them. Records included individual health action plans. This is a personal plan about what a person needs to be healthy and what healthcare services they need to access. People had regular check ups with the dentist and optician to ensure their teeth and eyes were healthy. Records indicated that referrals have been Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 16 made to a range of healthcare professionals dietician, speech and language therapist, occupational therapist, community nurse, etc as required in accordance with individual need. One person had a record of their weight being monitored, as sudden weight loss or weight gain can be a sign of being unwell. However the person’s record had not been recorded for the last three months. Discussion with the manager indicates that staff should have been monitoring weight monthly, although this was not recorded in the persons care plan. One person who lives at the home sometimes suffers from constipation, they have medication prescribed that staff can give to relive this. Their bowel monitoring records showed a period of six days when they had not opened their bowels. Their care records did not record that staff had taken any action to alleviate the constipation. However, by looking at the persons medication records it was possible to establish that staff had taken action and given medication to help the person open their bowels. Surveys were received from two health professionals who were generally positive about the healthcare provided. However one commented that ‘continuity of recommendations by health care professionals sometimes a problem as some staff much more ready to follow through procedures than others’. The medication was looked at in Dawson bungalow. The qualified nurses give the medication. At the front of each person’s Medication Administration Record (MAR) there was a photograph of the individual so that unfamiliar staff would know who to give it to. There was also information about how the person likes to take their medication. Some people are prescribed as required (PRN) medication. Protocols were in place that stated when the person needed to take it and how much to ensure that it is effective and not given when the person does not need it. Some of these had been completed in 2006 so it would be a good idea if these were reviewed to make sure the guidance was still appropriate. Copies of prescriptions were kept to ensure that staff know what medication is prescribed for the person so that they can ensure that this is what is stated on their MAR. The commission were notified of a medication error that occurred in the home where one person was given a double dose of medication. Discussion with staff and observation of records shows that appropriate action was taken after the error occurred to make sure the person was not at risk and to reduce the risk of further errors. One staff was observed administering medication, the procedures followed were safe and ensured the person got the medication they were prescribed. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 17 The home has a separate cupboard for the storage of controlled medication. It took staff a while to gain access to this cupboard as they said it was not accessed very often and they were unsure of the right key. Observation of the controlled medication book indicated that one person had two tablets that were classed as controlled medication. However these tablets were not in the cupboard. From looking at medication administration records it was possible to establish that the tablets had been administered to the person. The home has a system for checking the stock of medication held but this had not picked up this error as controlled medication was not included on the stock checks completed by staff. Arrangements for the recording and checking of controlled medication needs to improve to ensure any errors or missing medication would be quickly spotted by staff. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on. The people living there are protected from abuse, neglect and self-harm. EVIDENCE: 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 healthcare professional who returned a survey said that the home usually responds well to any concerns. The commission has not received any concerns, complaints or allegations about this home since the last inspection. The home’s complaint log showed that the home had received two complaints in the last twelve months. One complaint was from a visitor who had been refused access to the home. The log indicated that the complaint had been fully investigated and that staff were found to have acted appropriately to safeguard people. The second complaint received by the home was in the form of an anonymous letter that made allegations including some staff were sleeping on duty. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 19 Records showed that this allegation had been fully investigated and was not upheld. Some improvement was needed to the records with regards to contact made and the advice received from social services. Staff training records sampled showed that all staff have regular training in adult protection and discussion with staff show they are aware of the procedure to be followed. This ensures that staff know how to safeguard the people living there from harm. Staff records sampled showed that before staff start working at the home a Criminal Records Bureau (CRB) check is completed to ensure they are ‘suitable’ to work with the people living there. The financial records for one person who lives at the home were sampled; receipts were available for all expenditure. It is good practice that the area manager audits these records on a regular basis; this increases the safeguards in place for people. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some refurbishment of the home is needed to ensure people live in a homely, comfortable, safe and clean environment that meets their individual needs. EVIDENCE: The home was clean and free from offensive odours. Generally the home is decorated and maintained to an adequate standard. Communal areas are made homely with pictures, photographs of people who live at the home and birthdays cards on display. Some communal areas were worn in appearance and would benefit from being redecorated. Hallway carpets and the dining area carpet in Dawson bungalow were quite stained and need deep cleaning to remove the stains or new carpets fitted. Some paintwork in the home needed attention where it had been chipped. Kitchen units in both bungalows need attention as several have areas that are chipped or where the laminate is starting to peel. In Dawson bungalow the underside of some of the kitchen worktops was chipped and this Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 21 did not make cleaning of the worktop to prevent infection effective. The kitchen blind in Dawson was quite stained and needed to be replaced. In both bathrooms the laminate units underneath the sinks were very chipped and the exposed wood could harbour germs and be difficult to clean effectively. These need to be repaired or replaced. The manager said that the estates surveyor had been to the home three weeks prior to the inspection visit and completed a list of everything that needed doing, however the finances for the work needed had to be agreed. Two bedrooms seen were well decorated according to individual’s tastes, interests, culture, age and gender. They contained many personal possessions. 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 has now been installed and staff said that it was being used so that people have a choice of bath or shower. The garden was well maintained and as identified earlier in this report has been made more accessible to people who live at the home by the addition of raised flower beds. The annual quality assurance assessment completed by the manager prior to the inspection visit stated that it was planned to improve the garden by having a summer house. At the visit the manager said this may now not happen as they have been advised by the council that they will need planning permission. 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.V367230.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. 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 sufficient to ensure that the needs of people living in the home are met. There is a robust recruitment system in place, which protects people from harm. 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 stated that over 50 of staff have achieved a National Vocational Qualification level 2 or above in Care. Another two members of staff are close to achieving this. This meets the standard to ensure staff have the skills and knowledge to meet the needs of the people living there. During the day the homes are staffed as two separate houses with care staff being allocated to each bungalow. Depending on how many nurses are on duty they either cover both bungalows or work in one. As required at the last inspection a review has been completed of the nursing hours needed in the home, this has concluded that there needs to be a minimum of 230 nursing Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 23 hours per week and this equates to a minimum of one nurse, but often there are two on duty. All but one staff who were spoken with said that the staffing levels were sufficient to meet peoples needs but one staff felt that staffing levels had ‘gone downhill’. Other staff said ‘there are enough staff on duty to meet peoples needs’, ‘our shifts are mostly well staffed’ and ‘most of the time staff ratio is good’. The recruitment records for four staff were sampled. Two records had some information missing but the missing information was quickly obtained by the manager from Milbury headquarters. Records showed that a robust recruitment procedure had been followed so that people are not put at risk of having unsuitable people working with them. It is recommended that the manager completes an audit of all the staff files to make sure they all contain the required information regarding staff recruitment. Staff who are new to the home complete an induction. Staff said , ‘I worked alongside someone throughout my induction period’ and ‘there is an induction booklet to follow’. Staff were positive about the training on offer at the home, they said ‘training is good’, ‘the training is very up to date, we are going on mental capacity act training’ and ‘there is always training going on’. The organisation of records made it time consuming to track the training completed by staff, this was in part due to the fact that the training matrix was not up to date. However, from looking at a variety of records it was possible to establish that staff receive training in areas such as first aid, manual handling, prevention of abuse, health and safety, food hygiene, tissue viability (skin care) and fire. Most staff spoken with said that supervision was fairly regular, ‘had supervision two months ago, it is usually every other month’, ‘supervision is regular, but was more regular in the past’, ‘we have appraisals and supervisions regularly’ and ‘frequency of supervision is now and then, they seem to focus on the new staff’. Records showed that some staff had supervision regularly whilst others had not. Staff need regular supervision to monitor their performance and identify their training and development needs to ensure they can meet the needs of the people living there. The manager has meetings with the nurses and also with the full staff team. A full staff meeting was being held on the day of the inspection but there had been a gap of four months since the last full staff meeting. As the home has a large staff team meetings should be more regular so that staff can be kept up to date about important issues. The annual quality assurance assessment completed by the manager recognised that the frequency of meeting could be improved. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements ensure that the people living there benefit from a well run home. The people living there can be confident that their views underpin the self- monitoring, review and development of the home. The health, safety and welfare of the people living there is generally promoted and protected so ensuring their well being. EVIDENCE: The manager has demonstrated good knowledge of the needs of the people who live at the home. He is registered with the commission and has many years care experience and is a registered nurse in learning disabilities. The annual quality assurance assessment was sent to the manager to be completed before the inspection, this was completed and returned within the set timescale. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 25 A representative of the provider visits the home monthly to ensure that it is meeting the needs of the people living there and is well run. Reports of these visits are written and were available. The provider completed a review of the service in 2007, this covered areas such as staffing, the environment, resident satisfaction, activities and food. Due to the communication needs of people living at the home it is difficult to get their views, therefore relatives had the opportunity to contribute to the review. It is good that a copy of the review is on display in the hallway so that visitors to the home can read it. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Fire drills take place regularly to ensure that staff and the people living there know what to do if there is a fire. Individual fire risk assessments that state how each person is to be supported if there is a fire are in place. Staff test the water temperatures weekly to make sure that the water is not too hot or cold. The electrical installations in the home were tested in August 2007 and found to be unsatisfactory, the manager was able to provide evidence to show that remedial work had been undertaken so that the electrics were now safe. A Corgi registered engineer had completed the annual test of the gas equipment and stated that it was in a safe condition. The temperatures of the fridges are monitored daily, however records show that the temperature of both fridges in the home is usually at 10°C, this has been the case since January 2008. This is too warm and does not ensure that food is being stored at a safe temperature. It is disappointing that the temperatures were monitored but no action taken to ensure the fridges were at the right temperatures as this could people at risk of food poisoning. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 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 3 2 2 X 3 X 3 X X 2 X Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13(4) Requirement Detailed risk assessments need to be available for any people who use bed rails to ensure they are not put at risk by the use of the rails. The arrangements for monitoring stocks of controlled medication need to be reviewed to ensure any errors or missing medication would be quickly spotted by staff. Timescale for action 30/08/08 2 YA20 13(2) 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The service users guide should state the fees charged to live there so that prospective service users have the information they need so they can make a choice as to whether or not they want to live there. The format of the service user guide should be reviewed to try and make it more accessible to potential new service users. Care plans need to make clear the exact type of support DS0000024836.V367230.R01.S.doc Version 5.2 Page 28 2 3 YA1 YA6 Dawson Road, 5 & Whateley Road 4 5 6 7 8 9 YA19 YA19 YA20 YA22 YA24 YA30 10 11 YA34 YA36 12 YA42 an individual needs to make sure they get the care they need. Care plans should detail the frequency that people should have their weight monitored so that peoples weight is monitored regularly to make sure they are in good health. Care records need to be improved to ensure they reflect people’s well being and show any action taken regarding peoples health needs. Peoples individual guidance on the use of ‘as required’ medication should be regularly reviewed to make sure the guidance is still appropriate. Records of complaint need to be improved to include where contact has been made and advice received from social services Work is needed to the home to ensure it is well decorated and maintained for the people who live there. Some repair / replacement of worktops and sink units in the kitchen and bathrooms is needed to ensure staff can effectively clean these areas and maintain good infection control procedures. The manager should complete an audit of all the staff files to make sure they all contain the required information regarding staff recruitment. Staff should receive the supervision and support they need to carry out their jobs and meet the needs of the people living there. Previous recommendation. Fridges should be maintained at safe temperatures so that people are not put at risk of food poisoning. Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dawson Road, 5 & Whateley Road DS0000024836.V367230.R01.S.doc Version 5.2 Page 30 - 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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