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Inspection on 30/10/07 for FCH - 39 & 41 Derwent Road

Also see our care home review for FCH - 39 & 41 Derwent Road for more information

This inspection was carried out on 30th October 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

Staff are friendly and welcoming and were seen to greet the people at the home with respect, being mindful of their privacy and dignity. Care plans are in place containing helpful information to help staff to meet people`s needs. Staff were able to demonstrate a good understanding of people`s needs and their likes and dislikes. People are provided with opportunities to do things that interest them. For example one person is supported to go to watch cricket matches and another is supported to attend motor racing meetings and a rock festival. The home tries to make information accessible to people at the home. The service user guide is being out into a video format and white boards in the hallways show the staff on duty. House meetings are illustrated with photographs and a photographic menu plan is being devised to help people to make choices about what they want to eat. The home makes good use of support from healthcare professionals, such as GP, consultants and nurses to plan for and provide appropriate care. People are assisted to gain access to routine check ups and treatment from dentists, opticians and chiropodists where appropriate. The home has a complaints policy and the manager follows up complaints appropriately. Staff are trained to recognise and report any suspicions of abuse in that people are properly protected from harm. New staff are properly recruited and vetted to make sure they are suitable to work at the home. Staff are provided with training to properly equip them to carry out their work in a safe manner. A number of checks are carried out by the manager and senior managers of the organisation to make sure the home is running properly, e.g. checks of money and medication.

What has improved since the last inspection?

The Statement of Purpose has been reviewed and updated to keep abreast of changes, such as staff qualifications and the manager said that the service user guide is being made in a video version to make it easier for new people to see what the home has to offer. Care plans are being regularly reviewed to ensure that they are to date to take account of changes in needs. People have been provided with their own cabinets for their personal toiletries to reduce any potential risks to other people who might gain access to them when they were stored in the bathroom. Staff now record the reason for giving "as necessary" medications on the back of the medication sheets and protocols are in place to let staff know when to give these medications.

What the care home could do better:

There is a need to arrange for training and protocols to be out in place by the diabetes nurse to back up staff taking blood tests and giving insulin, to ensure that staff fully understand the procedures they are to follow. The electrical equipment has not been tested for several years. Hence there is a need to arrange for the equipment to be checked to ensure it is safe to use. Testing of fire alarms has stopped in the last month. The manager said that she would make sure that testing is resumed straight away. The manager has agreed to devise some extra risk assessment, where these may be necessary to support safe care practices e.g. skin care and swimming. The GP service that serves the home does not include access to well person checks. The manager has agreed to write to the local Health Authority to check out entitlements to this service. One of the bathrooms allows limited space to use the hoist and the bath seat. It is recommended that consideration be given to converting this to a bathroom for people assuming they would prefer this.

CARE HOME ADULTS 18-65 Fch - Derwent Road, 39 & 41 39 & 41 Derwent Road Bedworth Warwickshire CV12 8RT Lead Inspector Kevin Ward Unannounced Inspection 30th October 2007 07:45 Fch - Derwent Road, 39 & 41 DS0000004327.V353772.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 Fch - Derwent Road, 39 & 41 DS0000004327.V353772.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. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fch - Derwent Road, 39 & 41 Address 39 & 41 Derwent Road Bedworth Warwickshire CV12 8RT 02476 314504 F/P 02476 314504 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) FCH - Housing and Care Mrs Claire-Louise Groom Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Claire Louise Groom must achieve the Registered Managers Award Level 4 by 30th June 2006. Claire Louise Groom must have opportunity to manage a New Admission Referral to a Care Home by 30th August 2006. 26th April 2006 Date of last inspection Brief Description of the Service: 39 and 41 Derwent Road is a registered care home for six adults with a learning disability. FCH Housing and Care, (FCH), provides personal support on a 24 hour basis for the people living in the home. The service is located in Bedworth, and is within walking distance of the small town. It is situated in a quiet lay by, with its own parking area. It has been designed and adapted for people with profound physical disabilities. The two bungalows, 39 and 41, are each home to three people; staff are employed to work across the service. Service users each have their own bedroom. Shared space consists of a bathroom, toilet, a lounge and kitchen. There is a dining area in the kitchen at number 41, and in the lounge at number 39. Each bungalow has a separate laundry room. The link between the two bungalows houses the office/sleeping room for staff. There are well presented gardens to the rear of each property, which can be accessed by service users from the lounge. There is wheelchair access to the garden areas. Parking is available at the front of the property. The fees for the service recorded in the service user guide range between 333.00 and 337.41 per week. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. Questionnaires were returned by 4 people who live at the home prior to the inspection. These were completed with assistance from staff. Due to the high communication needs of the people at the home it was not possible to get their views of the home. 4 people’s relatives, and a consultant psychiatrist also completed questionnaires, giving their views of the service. An annual quality assurance questionnaire was completed and returned by the manager in time for the inspection, providing information about the home. The inspection included seeing the people who live at the home and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how the person’s needs are met in practice. The file of a third person, recently assessed by the home was also examined to check the home’s admission procedures. Discussions took place with four staff on duty during the morning as well as the home manager. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Staff are friendly and welcoming and were seen to greet the people at the home with respect, being mindful of their privacy and dignity. Care plans are in place containing helpful information to help staff to meet people’s needs. Staff were able to demonstrate a good understanding of people’s needs and their likes and dislikes. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 6 People are provided with opportunities to do things that interest them. For example one person is supported to go to watch cricket matches and another is supported to attend motor racing meetings and a rock festival. The home tries to make information accessible to people at the home. The service user guide is being out into a video format and white boards in the hallways show the staff on duty. House meetings are illustrated with photographs and a photographic menu plan is being devised to help people to make choices about what they want to eat. The home makes good use of support from healthcare professionals, such as GP, consultants and nurses to plan for and provide appropriate care. People are assisted to gain access to routine check ups and treatment from dentists, opticians and chiropodists where appropriate. The home has a complaints policy and the manager follows up complaints appropriately. Staff are trained to recognise and report any suspicions of abuse in that people are properly protected from harm. New staff are properly recruited and vetted to make sure they are suitable to work at the home. Staff are provided with training to properly equip them to carry out their work in a safe manner. A number of checks are carried out by the manager and senior managers of the organisation to make sure the home is running properly, e.g. checks of money and medication. What has improved since the last inspection? What they could do better: Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 7 There is a need to arrange for training and protocols to be out in place by the diabetes nurse to back up staff taking blood tests and giving insulin, to ensure that staff fully understand the procedures they are to follow. The electrical equipment has not been tested for several years. Hence there is a need to arrange for the equipment to be checked to ensure it is safe to use. Testing of fire alarms has stopped in the last month. The manager said that she would make sure that testing is resumed straight away. The manager has agreed to devise some extra risk assessment, where these may be necessary to support safe care practices e.g. skin care and swimming. The GP service that serves the home does not include access to well person checks. The manager has agreed to write to the local Health Authority to check out entitlements to this service. One of the bathrooms allows limited space to use the hoist and the bath seat. It is recommended that consideration be given to converting this to a bathroom for people assuming they would prefer this. 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. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.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 Fch - Derwent Road, 39 & 41 DS0000004327.V353772.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides people with information about the home in a format they understand. This is undermined by a shortage of information extra charges, necessary for people to be clear about their financial commitments to the home. People’s needs are properly assessed and they are supported to move into the home in a manner that considers the needs of all concerned. EVIDENCE: The home’s Statement of Purpose has been reviewed to provide up to date information about the home. A service user guide is also in place summarising the service that people can expect from the home. The manager explained that a the service user guide had been devised in a video format but following the recent sad death of a person at the home, involved in the video, it was not felt sensitive to use this material. Consequently a new video version has been filmed and is currently being edited. The manager also stated that she plans to produce a pictorial version of the service user guide as well to aid understanding of this information. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 10 When checking a person’s expenditure records it was noted that a charge of 40p per mile is being levied for trips out during the week. The manager explained that this is charged against the person’s DLA mobility allowance. However there is not a written agreement in place with the person concerned and there is no mention of this charge in the service user guide. The manager agreed to amend the service user guide to show any extra charges, e.g. transport, chiropody, holidays etc. The manager also agreed to seek support for the person concerned (from a relative, advocate or social worker) to help represent their interests when agreeing the extra transport charges. People have been informed by Social Services about the charges for their care. Letters were seen on people’s files from social services detailing the amount that they are required to pay towards these costs. The manager explained that a new person has been referred to the home and that their needs have been properly assessed. This was verified by written referral information and assessments on the person’s file. This included a social worker assessment and records of visiting demonstrating that the person concerned and their relatives have been involved in meeting with staff and visiting the home. Comments by the manager demonstrated that a high regard is being placed on ensuring that the pace of the person’s admission is managed sensitively, dictated by their personal needs as well as the needs of others at the home. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are planned for and reviewed so that staff have information to enable them to meet their needs effectively. People are being encouraged to take part in decisions that affect them so that they have greater control over their daily lives. EVIDENCE: Two people’s care plans and records were checked and items of information in several other files were also examined to check how the home plans and meets people’s needs. Overall the care plans (tenant profiles) contain satisfactory levels of information about people’s needs to enable staff to support them effectively. Good levels of information are in place about personal care needs and the way in which they like their care provided. This is particularly important as the people at the home are unable to easily make their preferences known verbally to staff. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 12 The tenant profiles include information about people’s communication needs and the manager said that she intends to review this information to take account of work that is taking place with speech and language therapist involvement. This has recently led to setting up systems, using a box objects to help a person to choose activities, e.g. choosing a shoe illustrates the person would like to go for a walk. The home has also worked with the speech therapist and the day service to devise a communication book to help day service staff to better understand the communication needs of a person at the home. White boards are in place in the two hallways of the home advising who is on duty and giving information about planned activities. House meetings are also held and the outcomes recorded. Photographs are used to help people to see what has taken place to address issues raised at previous meetings, e.g. pictures of improvements to their rooms and photos of activities. Review meetings are held every 6 months to ensure that people’s needs are properly considered and planned for. Comments by staff and the notes of these meetings demonstrate that relatives are encouraged to contribute to these meetings. Three monthly key worker meetings are also carried out between reviews to monitor people’s care. The notes of a social worker review meeting were seen as evidence of a closer focus being maintained on the progress of a person presenting occasional challenges at the home. Risk assessments were seen covering such matters as risks associated with health needs, e.g. diabetes as well as personal care and everyday living issues, e.g. assistance with moving and handling and fire safety. The risk assessments examined contained satisfactory levels of information to help staff reduce the risks identified. The manager agreed to write some new risk assessments to address hazards that are not currently in place on a person’s file, including swimming and skin care. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s preferences are taken into account when planning activities and meals so that they are provided with a suitable range of activities and meals they enjoy. EVIDENCE: The people at the home either attend a day service during the week or receive extra staffing support to go out places and engage in individualised activities. Comments by staff and an examination of the day activity plans of a person receiving a personal support from home, confirmed a good range of activities are provided in keeping with the person’s known preferences (which are also recorded in their care plan), e.g. gym, Mallory park race track and walks. Other activities and leisure opportunities are provided, taking account of personal preferences and interests. Examples include, concerts to see pop stars and tribute bands, such as Lilly Allen, Charlie Longborough and the four tops. One person also camped at the V festival (Rock festival) with support Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 14 from staff. One person who likes cricket and motor racing has been assisted to attended Edgbaston cricket ground and motor racing meetings Common everyday activities also include cinema, bowling, shopping cafes and walks. Staff confirmed that all except one person who prefers short breaks has been away on an annual holiday to Clacton or Cornwall this year. Staff explained that two people are supported to attend church on Sundays, which they enjoy. This was also verified in their daily diary records. Comments by staff and the manager confirm that relatives are encouraged to stay in contact and to visit the home. Entries in care review notes demonstrate that relatives are encouraged to contribute to ongoing care planning at the home. This is verified by comments in relative’s questionnaires, e.g. on relative states: we visit the home every week and our daughter visits us. We also have six monthly meetings with staff. One person’s relative visits to assist with a massage / pamper session. Good support has been provided by staff to develop life histories, to help people to maintain their identity and to recognise important personal memories. Staff were seen to address people in a friendly and respectful manner and to take time to talk to them. On the afternoon of the inspection a member of staff took time to make a pumpkin lantern with a person at the home in preparation for Halloween night. Comments by staff indicate that people are encouraged to take part in everyday household tasks where they are happy to do so, e.g. one person like to take part in gardening and another will do some light dusting. Several people like to go shopping for food and other items. This was verified in dairy notes. As noted previously, the manager agreed to seek to identify a relative, advocate or social worker to represent person’s interests when agreeing transport charges for day activities. In a questionnaire completed by a nurse she states the home is “very good at communicating and very good at advocating for the people in their care”. Staff explained that menus are developed each week, based on the preferences of the people at the home. All the staff spoken to said that they have had healthy eating training and that this effects menu planning and food purchase. Comments by staff and the manager confirmed that this has included a consideration of the dietary needs of people with diabetes. A member of staff was able to give a good account of individual preferences, including favourite drinks, cakes and snack foods, which were reflected in the items stored in the kitchen cupboards. The fridge contained low sugar products for a person with diabetes. An assessment has been carried out by a speech Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 15 therapist for a person with dysphagia (swallowing difficulties) to enable staff to provide support to eat safely. Discussions with staff demonstrated an awareness of the need to blend this person’s food and to provide close support, in keeping with their risk assessment. Staff explained that they are in the process of photographing all the meals on the menu to help people to make choices about the food they want on a day to day basis Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people’s needs are well planned for and monitored with the involvement of health professionals and safe medication procedures are in place so that they receive the appropriate support and healthcare they require. EVIDENCE: Staff were observed to be friendly and approachable and the people at the home looked at ease in their company, indicating they like them and feel secure in their presence. On the morning of the site visit staff were seen to support people to rise in a friendly and unhurried fashion. All personal care take took place behind closed doors. Staff were observed to knock bedroom doors before entering and were mindful to close doors behind them showing a suitable regard for people’s privacy and dignity. Comments by staff demonstrated a good understanding of people’s needs as well as their body language and other means by which they communicate. Information on people’s records indicates that advice is appropriately sought from a range of health professionals, where required. Support has been Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 17 provided from a psychologist to devise guidelines for appropriately responding to a person’s challenges. Staff confirmed that they had read the guidelines and their comments demonstrated a good understanding of the actions required of them to effectively support the person concerned. Staff are currently taking the blood sugar levels of a person with diabetes to help the nurse to monitor the condition Staff support is also provided to enable the person to take insulin via an insulin pen. A staff member on duty explained that she had been taught how to do this by senior staff but had not received any formal training from a nurse. The manager confirmed that some staff including herself have received training from the diabetes nurse and explained this learning has been passed on to more staff. There are currently no protocols in place for taking blood tests or giving insulin. The manager agreed to seek training from the diabetes nurse, with a view to her assessing staff competency and developing the necessary protocols to underpin safe practice. Safe practice epilepsy protocols were seen for people who require the administration of diazepam in the event of a seizure. A consultant psychiatrist has appropriately signed the protocols. Entries in health records indicate that people are being supported to access local health professionals, such as GP, dentists, opticians and chiropodists for routine checks and treatment. In a questionnaire, a consultant psychiatrist involved in monitoring the health of some people at the service comments “staff promptly contact me if they have any concerns.” The manager reports that the GP continues to refuse to offer well person health checks but agreed to write to the local Health Authority to clarify people’s entitlement to this service. The manager described how purposeful use has been made of the community dental service to provide people with individual advice on oral hygiene and teeth cleaning techniques. Current medication records were sampled for two people and highlighted no anomalies. Where people take, “as necessary” medications (PRN medication), the reason for this is recorded on the back of the medication sheet. Two staff spoken with were able to demonstrate a good understanding of safe medication procedures and the circumstances under which “as necessary” medications should be given out, as recorded in medication protocols. The cabinets were tidy and not overstocked. The manager explained that the home has recently changed pharmacists and all unused medication is now returned at the end of four weeks so medication does not accumulate at the home. Staff confirmed that the home does not used homely remedies and people are only given medication that is prescribed for their personal use. The manager explained that regular medication audits are carried out to support safe practices, copies of which were seen in the office. Staff confirmed Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 18 that they have been provided with medication training and are subject to periodic assessments to ensure that they understand safe medication practices. Completed assessments and training certificates were seen on two randomly sampled staff files as verification of this. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 19 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. Suitable arrangements are in place for investigating concerns and complaints and staff are being trained to report suspicions of abuse so that people are protected form harm. EVIDENCE: There have been no complaints to us about the home since the last inspection. The manager explained that she had looked into concerns raised by a relative regarding the length of time a person had spent in their wheelchair when holidaying from the home. The relative’s concerns were resolved by an occupational therapist’s assessment of the situation, which confirmed that satisfactory care and support has been given. A complaints policy is available in the home and a copy of the procedure was seen in the service user guide. The manager confirmed that relatives have previously been issued with a copy of the procedure. This was verified in letters at the home. Currently there is not a log for recording complaints. The manager agreed to set up a log so that actions taken to address complaints issues may be more easily tracked. There have been no allegations of abuse at the home since the last inspection. Comments by staff demonstrated a good understanding of the adult protection and whistleblowing procedures that are in the office. The manager explained that these policies are shared with staff at their induction. Staff also confirmed that this is covered in the Learning Disability Award Framework training that all Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 20 staff attend. The manager reports that one relative acts as appointee for a person at the home and everyone else has their own named accounts. Records are in place to account for cash withdrawn from the bank and expenditure on personal items and receipts are retained on file. The manager explained that all withdrawals from people’s personal accounts are based on her written authorisation by letter to the bank. A record was seen that the manager uses to audit withdrawals against bank statements to accurately account for people’s monies. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the home is maintained in a comfortable, clean and tidy condition so that people benefit from a homely environment. EVIDENCE: In both houses the living environments are clean and comfortable. Efforts have been made to make both houses homely with domestic style furniture in place in lounges and dining areas. Positive work has taken place to personalise people’s bedrooms based on their known likes and interests, e.g. pictures of favourite rock stars and football clubs, sensory lights etc. The manager explained that plans are in place to decorate the hallway, kitchen in number 39 and to decorate the hallway and two bedrooms in number 41. New lounge suites and dining furniture are also being purchased shortly for both houses. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 22 One bathroom has a specialist bath, suitable to meet the needs of people at the home. The other has a bath with a bath seat. There is limited space available in this bathroom to use the hoist that is required for one person. Comments by staff and the manager confirmed that whilst the situation is manageable and not unsafe it less than ideal and rather cramped. The toilet seat, in number 39 is working loose, due to poor fittings. This is potentially a hazard that could cause someone to fall. The manager said that she would promptly arrange for the toilet seat to be replaced. The gardens looked tidy and well maintained. The manager explained that one of the people at the home likes to take part in some light gardening with staff and the lawns are cut by a contractor. This was also confirmed by staff. Overall the home looked clean and tidy and was free from any offensive odours. Staff confirmed that they had access to protective gloves and aprons and were seen to make use of them on the morning of the site visit. Comments by staff confirmed that suitable arrangements are in place for the safe disposal of continence waste products, Disposable bags are available and a clinical waste contract is in place at the home. The laundry rooms are suitably equipped and are situated away from kitchens so they do not present infection control hazards. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff appropriately recruited and provided with access to relevant training so that the people at the home benefit from a suitable, well trained workforce. EVIDENCE: Comments by staff and the manager and information on the staff rota confirmed that the home continues to maintain four staff on duty most of the time. The home also provides a waking member of night staff as well as a sleep in person. Comments by staff indicate that this is satisfactory to meet the needs of the people currently at the home and confirmed that management support is available at nights if required. The manager reports that are currently no vacancies at the home and plans are in place for a member of staff to cover a team leader starting maternity leave shortly, to ensure management support is always available at the home. The manager explained that the home seeks to provide gender sensitive care where possible. There are sufficient female staff to ensure that women always receive personal care from female staff. The home also employs two male staff Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 24 which enables male support to be offered to the men at the home some of the time, as well as providing them with some male conversation. The files of two new staff were checked and found to contain records to confirm that appropriate recruitment and vetting procedures are followed, including taking up references and Criminal Record Bureau checks before staff start work at the home. The records demonstrate that staff are subject to an interview process before starting at the home and have completed Learning Disability Award Framework (LDAF) induction training which includes a range of health and safety related courses as well as care related subjects. Comments by staff indicate that they are being provided with access to a range of training opportunities, necessary to deliver safe care at the home. This was verified in training records and viewing two staff files containing a sample of certificates. The training records indicate that the majority of staff have been trained in subjects that support safe practice, such as first aid, fire safety, food handling and moving and handling, medication and safeguarding from abuse. Staff explained that infection control training was covered in the Health and Safety course they have attended. Staff have also received healthy eating training to help people to have a healthy diet. As noted earlier this has included consideration of the dietary implications for people with diabetes. In the annual quality assurance assessment completed by the manager she reports that 70 of staff have completed National Vocational Qualifications (NVQ’s at level 2 or above and more staff are currently training. This represents as a positive achievement and indicates a commitment to ensuring that staff are given the training they require to meet people’s needs properly. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the home is well managed. Suitable arrangements are in place for ensuring a quality service and systems are in place for maintaining a safe living environment for people. EVIDENCE: The manager holds the National Vocational Qualification (NVQ) in Care, level 4 and stated that she is in the process of completing the Registered Managers Award. These qualifications are necessary to equip managers to carry out their role effectively. The manager also has 13 years experience of working with people with learning disabilities. The manager carries out a number of checks and audits to support the good running of the home, e.g. Health and Safety audits to check that the Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 26 environment and equipment is safe, medication checks and savings account checks. A cleaning schedule is also in place to structure cleaning tasks for night staff to carry out. Comments by staff confirmed that they receive regular planned supervision and that they attend team meetings at the home. This was verified in staff files and records of team meetings. As previously noted regular house meetings are held to share developments at the home with the people that live there and to show them photographs to demonstrate that matters previously agreed have been followed up, e.g. photos of changes to bedrooms and outings. The manager said that relatives and professionals have not recently been surveyed for their views of the home but stated a commitment to doing this shortly, so that their opinions may be considered in the homes development plan. The manager explained that the new development plan will be discussed with staff in staff meetings so that they can contribute to the ongoing achievement of the home’s goals. Monthly visits have taken place at the home most months. These reports indicate that senior managers monitor the effective running of the home. The manager was unable to confirm the date of the last time the portable equipment was tested at the home and no records could be found, although records verify that visual checks are routinely carried out. Since the inspection the line manager for the home has taken steps to ensure that equipment is also checked by an appropriately trained electrical contractor. A landlord gas safety certificate was seen confirming that the home’s gas appliances have been checked this year. Records were seen demonstrating that a suitable maintenance contract is in place for ensuring the fire safety equipment is maintained in good working order. The fire safety log demonstrates that fire drills take place and that emergency lighting has been tested. The fire alarm records indicate that the home has been maintaining a consistent record of alarm tests over a long period of time but this has ceased during the last month. The manager said that she would address this shortfall to make sure that tests are properly resumed straight away. Cleaning fluids are locked away under kitchen cupboards to prevent any risks to the people at the home and a file of product risk assessments were seen in an office file providing guidance on the safe use of cleaning products. Maintenance labels on the hoist and bath chair demonstrate that this equipment has been checked to ensure it is in good working order. Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 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 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 x 2 x x 3 x Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 28 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 YA19 Regulation 18(1) (a) Requirement Staff must be trained and their competency assessed by an appropriate healthcare professional, to enable them to carry out blood tests and use the insulin pen safely. Protocols must be put in place and signed by an appropriate health professional to underpin blood tests and administration of insulin, to ensure safe practice is followed. Electrical equipment must be checked to ensure it is safe and does not present a fire safety risk. Timescale for action 14/12/07 2 YA19 13 (c) 14/12/07 3 YA42 13 (c) 07/12/07 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 user guide should be amended to include the home’s fees and the extra charges, e.g. transport, chiropody and holidays. DS0000004327.V353772.R01.S.doc Version 5.2 Page 29 Fch - Derwent Road, 39 & 41 2 YA9 Action should be taken to write risk assessments where necessary to ensure people are supported in a safe manner e.g. swimming and skin care. A written agreement should be put in place for the person who pays for day service transport from their Disability Living Allowance, with support from a social worker, relative or advocate. Write to the Local Health Authority to clarify people’s entitlement to regular health checks to support their continued good health. A complaints log should be set up at the home to make it easier to record and track complaints outcomes. Consideration should be given to improving the space available in the bathroom in no. 41, e.g. convert to a wet room. This would enable personal care to be carried out in a more comfortable manner. Relatives and professionals should be surveyed for their opinions so that their views may contribute the home’s development plan Proceed with plans to ensure that fire alarms tests are reestablished on a weekly basis. 3 YA16 4 5 6 YA19 YA22 YA24 7 8 YA39 YA42 Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 30 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 Fch - Derwent Road, 39 & 41 DS0000004327.V353772.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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