Inspection on 03/07/08 for Ferndale Crescent, 10

This inspection was carried out on 3rd July 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ferndale Crescent, 10 30/06/09

Ferndale Crescent, 10 14/02/07

Ferndale Crescent, 10 10/11/05

Ferndale Crescent, 10 04/05/05

Ferndale Crescent, 10 23/09/04

Ferndale Crescent, 10 26/04/04

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 Ferndale Crescent, 10 Moseley Birmingham West Midlands B12 0HF Lead Inspector Kerry Coulter Unannounced Inspection 3rd July 2008 09:40 Ferndale Crescent, 10 DS0000016880.V367914.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 Ferndale Crescent, 10 DS0000016880.V367914.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. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ferndale Crescent, 10 Address Moseley Birmingham West Midlands B12 0HF 0121 772 1885 0121 766 6856 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) joannesp@trident-ha.org.uk Trident Housing Association Manager post vacant Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 14th February 2007 Brief Description of the Service: 10 Ferndale Crescent is located in a residential area of Highgate on the outskirts of the city centre. Therefore the city centre is easily accessed by public transport. The home is registered to provide support to eight adults who have a physical and learning disability. At the time of this inspection there were six residents living in the home. The home caters for adults of mixed gender. All bedrooms are single and have an ensuite facility. There are six bedrooms on the ground floor and two on the first floor, which can be accessed by a chairlift if required. Three of the bedrooms have an overhead hoist. The communal areas comprise of an open plan lounge and dining room, kitchen and sensory room on the ground floor. The laundry is situated on the first floor. The home is staffed 24 hours a day and at night there is one waking night staff and one member of staff sleeping -in. A copy of the service user guide is available in the home, which provides information about the facilities. The actual range of fees was not stated in the service users guide, it stated ‘fees are dependent upon the level of care required based on assessment of need’. The latest CSCI inspection report is available in the home for visitors if they wish to read it. Ferndale Crescent, 10 DS0000016880.V367914.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 deputy manager. Three 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. Some of the 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 staff on duty were spoken to. A tour of the premises took place. Care, staff and health and safety records were looked at. Surveys were sent to six people who live at the home and two were returned, four surveys were received from staff, their views are included in this report. What the service does well: Staff spend time sitting talking to the people living in the home so that they feel valued. The people who live there are supported to keep in contact with their family and friends. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 6 Each person has a care plan so that staff know how to help the people living there to meet their needs and keep them safe. Staff are good at helping people do the things they want to do. People go out often in the community and to places they like going to. People go on holiday every year with staff if they want to. They go to places that they would enjoy and have a good break. People are offered a healthy and nutritious diet that ensures their well being. When needed health professionals get involved to give advice and support so that individual’s health needs can be met. Each person has their own bedroom with a number of personal belongings in them. This gives them their personal and private space. Records show that the fire equipment is tested to make sure it is working. This will make sure that the people living there and staff are able to get out in an emergency. There is equipment that is in good order to help people be moved safely. What has improved since the last inspection? What they could do better: The service users guide should state the fees charged to live there so that prospective service users can make a choice as to whether or not they want to live there. Care plans and risk assessments need improvement to make sure people get the care they need. The people living there need to be weighed when needed. This will help to make sure their health needs are met. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 7 Staff need to follow the guidelines from the speech and language therapist regarding dysphagia so that people are not given meals that could pose a risk of choking. The systems for administering medication need some improvement to ensure people get the medication they need safely. Some redecoration needs to be done to make sure the home is comfortable to live in. Staffing vacancies must be recruited to so to make sure that staff know the people living there and how to meet their needs. Staff recruitment records must be available in the home and show that suitable people had been employed to work with the people living there. Staff need some refresher training in fire and manual handling so that they can keep the people living in the home safe and meet their individual needs. Staff need to have regular formal recorded supervision with their manager so that they are fully supported in their role. The home needs to have a permanent manager who knows how to run the home so it can benefit the people living there. 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. Ferndale Crescent, 10 DS0000016880.V367914.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 Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 and they have an opportunity to visit to see what it is like. EVIDENCE: The home has a service user guide that tells people about the home to help them decide if they would like to live there. The guide had most of the information but needed to be updated to reflect the current management arrangements for the home. Information about the range of fees was not clear, the guide said ‘fees are dependent upon the level of care required based on assessment of need’. The guide was in a written format with symbols called ‘widget’. Discussion with the temporary manager indicates that people who live at the home are not able to fully understand the symbols. The temporary manager said that it was intended to update the guide soon so that it was in a more suitable format for people to understand. No new people were living at the home. At the time of the visit the home had two vacancies but the temporary manager said that due to the location of the bedrooms being on the first floor these were unlikely to be filled. The annual Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 10 quality assurance assessment completed by the deputy manager said ‘A full assessment is received by all prospective tenants in order to ensure that the facilities and staffing are appropriate for the needs of the individual. They are invited to come and have tea with us and also they can spend the weekend here, to get a feel of the place meet and talk with the other tenants, and to ask questions.’ ‘Over the next 12 months we plan to produce a service user guide on video incorporating the service users veiws of the home’. Ferndale Crescent, 10 DS0000016880.V367914.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 do not have all of the information they need so they know how to support individual’s to meet all of their needs. People make decisions about their lives with assistance from staff where needed and are consulted on all aspects of life in the life. EVIDENCE: The care records for three people who live at the home were looked at. These included an individual care plan that detailed how staff are to support individuals to meet their needs and achieve their goals. Care plans reflected the cultural background of the individual and how staff are to support the person to continue to practise their religious and cultural background. Plans covered areas of needs such as health, communication, mobility, eating and drinking, personal care, finances, activities, relationships and likes and dislikes. Plans sampled were not dated so it was not possible to establish when they had been written so that staff would know if the information in them was up to date. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 12 . Review meetings had taken place with each person and these showed that people had been consulted about the care they receive. Some of the plans seen needed to be improved. One plan for personal care repeatedly said that the person needed ‘support’. Detail about what type of support was needed so that staff have all the information they need to meet peoples needs. One person had a care plan about the support they needed at night. This said they needed to be checked ‘regularly’. The plan should detail what the frequency of checking should be as staff may have different ideas of what regularly means. Most people at the home use wheelchairs for most of the time and are at risk of developing pressure sores. Care plans need to be put in place so that staff have the information they need about each persons pressure care needs, to include any pressure relieving equipment they need to use. This will help to ensure people do not develop any pressure sores. Discussion with the temporary manager and sampling of records shows that person centred planning meetings are being arranged for each person at the home. The temporary manager said that people’s views would be sought at the meetings to make sure they were still happy living at the home. Staff were observed throughout the visit giving people choices about what they wanted to do, eat, drink or where they wanted to spend their time. People said that they could make decisions about what they do each day and in the evenings, although one person said this was not always the case at weekends. One person spoken with said that staff held meetings with people every month. Minutes of meetings were available in the home but these did not show the meetings were monthly. Topics discussed include meals, activities, things people are not happy about, holidays and décor of the home. Discussion with people show they have also been consulted about new seating for the lounge and recruitment of new staff. Previously the meetings have been chaired by someone external to the home, the Tenant Participation Officer. However the temporary manager said this has now stopped and staff chair the meetings. A representative of people who live at the home also attends monthly ‘service sector’ meetings with people from other Trident homes where wider issues can be discussed. People’s records included individual risk assessments. These generally stated what action staff need to take to ensure that the risks to the individual are minimised as much as possible. Areas that had been assessed included manual handling, night support, epilepsy, responding to fire alarms, finances and pressure care. Most of the assessments were detailed and had been regularly Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 13 evaluated and reviewed, however some assessments lacked detail and would benefit from improvement. One person had a pressure care assessment that concluded they were not at risk of pressure sores. However the scoring on the assessment was inaccurate and when totalled correctly they were in fact at low risk of developing pressure sores. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that the people living in the home experience a meaningful lifestyle. People are offered a healthy diet and enjoy their meals. EVIDENCE: Most of the people at the home go to day centres and some attend college courses during the week. Records and discussions with people and staff show that activities on offer include food shopping, pub visits, knitting, gardening, Irish club, church, cinema, meals out, parks and going to concerts. Staff offered one person the opportunity to take part in a karaoke activity during the visit, she obviously enjoyed it due to all the smiling and laughing during the activity. Staff said this was her favourite activity. Another staff was seen teaching one person how to tell the time. Staff chatted with people and sat with them whilst they watched the television, people were generally included in conversations. One person was excluded from some of the general Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 15 conversations and from watching the television due to the positioning of his wheelchair and where other people were sitting. Staff need to be mindful how people are positioned in the lounge so that they are not excluded from the social interactions that are taking place. One person who lives at the home said they were happy living there. They said they were starting a college course in September after telling staff they would like to go. They said they had recently been to Paris for a few days with staff and were hoping to go to Tenerife for a longer holiday. One person said they enjoyed gardening and showed the beans they had planted in the garden. They said that it would be easier to do gardening if they could be provided with some raised beds as they used a wheelchair and this sometimes made it difficult to reach things at ground level. Some people at the home are involved in the ‘mobile gym’ to help them stay healthy. The temporary manager explained that this is part of a Government initiative where people can get access to their own trainer who visits them in their home. People spoken with said they enjoyed this activity. Information about contact with family and friends was available in people’s care plans. People said they were supported to maintain contact with their relatives. One person said that before he died their Father had been in a care home and that staff from Ferndale often took them to visit. Staff have assisted people to broaden their social networks, one person has a be-friender from the ‘SHARE’ scheme who visits them and accompanies them on some social activities. Most meals at the home are nutritious and varied, unless people have chosen otherwise. Records showed that one person frequently had chicken and chips but her care plan was clear that this was her favourite food and something she enjoyed having. One person said ‘we have a choice’. Staff said that people get a choice and help with planning the menus in advance. One staff said that the quality of the food was always good. Lots of fruit and fruit juice was available in the kitchen. The fridge was well stocked with food. It was good that there was lots of choice, for example skimmed, semi skimmed or full fat milk. It is good that people know what meals are on offer, staff tell people but there is also a menu board in the kitchen. This shows what meals are planned in picture format. Ferndale Crescent, 10 DS0000016880.V367914.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 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: The balance of gender and culture of the staff matched the backgrounds of people to ensure they are supported by staff who can meet their needs. Care plans included how staff are to support individuals to ensure their personal care and health needs are met. Staff were observed to knock on people’s bedroom doors before entering, to respect their privacy. 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. 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. These showed that people had regular check ups with the dentist, chiropodist and optician. Two people went out with staff support to attend a dental appointment on the afternoon of the inspection visit. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 17 Records showed that where appropriate other health professionals were involved in their care to ensure their health needs were met. All changing health care needs are followed up regularly with appropriate appointments and input via other health professionals. The annual quality assurance assessment stated ‘Health professionals are involved with each service user dependant on their individual needs, these include speech and language therapist, occupational therapists, psychiatrist, dietician, opticians, dentist to name but a few. The chiropodist visits on a six weekly basis’. Some people have input from the dietician. One person is overweight but does not like to visit the dietician and be weighed, the home have completed a risk assessment regarding this. Another person’s plan says they need to go and be weighed ‘about every three months’ but it had been over four months since they had been. It is important to monitor people’s weight as sudden weight loss or weight gain can be a sign of being unwell. Staff said that two people at the home were at risk of choking due to swallowing difficulties. The care file for one person was looked at and showed the speech and language therapist had completed an assessment and said they were at risk from dysphagia (a swallowing problem). The speech and language therapist had given the home guidelines to follow to make sure the person was not at risk when eating and drinking. These said that they needed to have thickener in their drinks and to have foods that were a mashed consistency. The evening meal was observed and staff gave the person a drink that had been thickened but the meal was not of a mashed consistency and had food that had been cut into small pieces. This was raised with the services co-ordinator at the time of the visit who has taken swift action to improve care practice. Within two days of the inspection visit the temporary manager had forwarded a plan to the commission of the action they are taking to make sure all staff are following the guidelines from the speech and language therapist. In May 2008 we received an anonymous complaint that included some concerns about medication practice at the home. This was passed to Trident to investigate who found that two staff had not followed the correct procedures in reporting medication errors. This involved an incident where one person who lived at the home had received too much medication over a period of several days. Following the complaint Trident has done a lot of work to make sure things are improved and people get their medication safely. The medication procedures have been rewritten so that they are clear on the procedures staff need to follow. Each person has their own guidelines that inform staff how they like to take their medication. Staff are undergoing medication competence assessments and medication training to ensure they are safe to administer medication. The home is also changing to a different pharmacist who will be able to undertake monitoring visits to check that medication systems are Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 18 satisfactory, the pharmacist will also be supplying the home with a report of their visits. Medication is stored in a locked cabinet. The cabinet was clean and organised into sections for each person to help ensure that it is clear which medication belongs to whom. There is a photograph of the individual at the front of their Medication Administration Records (MARS) to ensure that it is clear who to give the medication to. MARS cross-referenced with the blister packs indicating that medication had been administered as prescribed. Staff had signed the MARS appropriately when medication had been given. Some MAR’s had handwritten amendments made to them, the person who had made the amendment had not signed these. These should be checked and signed by two staff to make sure any changes are accurate and in line with the prescription. One person was prescribed two types of topical cream on an as required basis. There was no information available to guide staff as to where to apply the cream or what cream should be used. One person was prescribed paracetamol ‘as required’ but there was no guidance for staff on when this should be used. Staff need guidance from the GP if this is safe to use with the aspirin that the person is also prescribed. Detailed guidance was in place for one person who is prescribed medication as required for constipation. The guidance has been updated and staff have taken a copy to the persons GP for their agreement that it is suitable. One person is prescribed medication that is ‘controlled’, this was seen to be stored in a separate locked cupboard. The amount held matched what was recorded in the controlled drug book. However improvement is needed to the recording as when new medication is received staff have recorded ‘new pack’ without actually stating the amount. Ferndale Crescent, 10 DS0000016880.V367914.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. 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: The home has not received any complaints in the last twelve months. We received one anonymous complaint about the home in May 2008, the complaint was about medication, staffing levels and manual handling. This was passed to Trident to investigate who found that staffing levels and manual handling practices were satisfactory. As previously stated in this report Trident found there were issues regarding medication practices in the home and have acted on their findings to try and put things right. The complaint procedure is clearly on display in the home and is in a format that includes pictures to try and make it easier for people to understand. People said that they knew who to speak to if they were unhappy about something. One person said ‘staff ask us if we are not happy about anything’. Records of meetings with people at the home show they are asked at these meetings if there is anything they are unhappy about. The temporary manager said it was intended to add a feedback and suggestions sheet to the visitors book so that people could make general comments about things if they wanted to, without having to make a formal complaint if they did not want to. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 20 The home has polices and procedures on safeguarding people at the home, these are available to staff. Since the last key inspection the home has made one safeguarding referral to social services when one person who lives at the home bit another. To protect people from this behaviour staff now have guidelines to follow from the community nurse and the person is not left alone with other people who live at the home. Staff training records sampled showed that all staff have training in adult protection and are aware of the procedure to be followed. The whistle blowing policy has also been discussed with staff at their last staff meeting. 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. Most of the records had been signed by two members of staff, but some had been signed by only one. It is the home’s procedure that two staff should sign the records. It is good practice that the care co-ordinator audits these records on a regular basis as part of their monthly visits to the home; this increases the safeguards in place for people. Records sampled included a list of the person’s belongings. All but one of these had been updated in the last few months. One had not been updated since August 2007. They should be updated regularly when people buy new things or dispose of any belongings. If something should go missing it would then be easier to track when the person last had it or when they bought it. Ferndale Crescent, 10 DS0000016880.V367914.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, 26, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable, safe and clean environment that meets most of their individual needs. EVIDENCE: The home has an open plan lounge and dining room that are homely in style. It was nice that there were fresh flowers on the dining table. Since the last key inspection new carpet has been fitted and new seating is on order. People who live at the home have been involved in choosing the new furniture. Some areas of the décor is becoming a little worn and some paintwork in the home is quite chipped. The temporary manager said that quotes are being obtained for some redecoration work so that the home will be in good decorative order and remain a nice place to live. People’s bedrooms contained many personal possessions. Bedrooms were at a comfortable temperature and were clean. Everyone has there own en-suite shower room attached to their bedroom. At previous inspections requirements Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 22 have been made for the shower in one person’ en suite to drain away efficiently as there was an offensive odour in this room. At this visit there was no offensive odour and staff spoken with said there were no problems with the shower draining away. One person said they were generally happy with their bedroom and were very pleased that they had recently had a new bed. However they pointed out that several knobs on the wardrobe and drawer units were missing. They said this meant they had difficulty in opening them and had to ask staff to do it, they said they had been like this for quite a while. This home is intended to specifically meet the needs of people who have a physical disability however the laundry is located on the first floor and can only be accessed by people who are able to use the stairs of the stair lift. The temporary manager said that currently no one who lives at the home is able to access the laundry. At the last inspection to the home one person commented that they wished there was a downstairs laundry as they were quite capable of doing their own laundry and access upstairs is difficult. The annual quality assurance assessment and discussion with the temporary manager indicates that Trident is looking at this issue and how best to use the first floor of the home. Discussion with staff and the completed annual quality assurance assessment (AQAA) indicates that people have the equipment they need. The AQQA states ‘each room has an en-suite bathroom with equipment suitable to their needs, overhead tracking hoists are available in some bedrooms, appropriate to individual service users needs as are adjustable beds and pressure mattresses. Each room is also fitted with a call alarm in the bedroom and the bathroom’. Ferndale Crescent, 10 DS0000016880.V367914.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, 33, 34, 35 and 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The arrangements for staffing the home, their recruitment, support and development are variable and may not ensure that the needs of people living in the home are met. 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 annual quality assurance assessment stated that all of the care staff have achieved a National Vocational Qualification in Care. This is excellent and means that people are supported by well qualified staff. The home has some staff vacancies and have had to use some agency staff to cover these. The staff rota and discussion with staff shows that regular agency staff are used who know the people at the home. One agency staff spoken with had been working in the home regularly for the last four months. There were enough staff on duty at time of the visit to meet service people’s needs, there were three support staff in the morning and four in the afternoon, plus the Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 24 temporary manager. However two of the three staff on the morning shift were agency staff and so outnumbered the permanent staff. Discussion with the care co-ordinator showed that recruitment was underway to fill the current vacancies so that the use of agency staff can be reduced. Staff spoken with said ‘staffing levels meet peoples needs, if need more due to activities they put extra staff on, use regular agency staff that know people well’. ‘Home has enough staff’. ‘Agency staff are used but they understand people’s needs’. One person who lives at the home said ‘happy with the staff’. It is good that people who live at the home are involved in the recruitment of staff and have had training to do this. One person has recently been involved in the interviews for a new manager for the home. The recruitment records for three members of staff were looked at. These showed that references and a criminal record bureau check had been undertaken prior to staff working in the home. For one member of staff recruited since the last inspection there was no application form available. The temporary manager contacted Trident’s human resources department but they did not know where it was. Without the application form it was not possible to confirm that a robust recruitment procedure had been followed. Most staff were positive about the training on offer at the home, they said ‘ I get all the mandatory training I need’ and ‘get all the mandatory training’. However one staff said that the training was not always relevant. Records showed that staff had received training in manual handling, fire, first aid, food hygiene, challenging behaviour, medication and adult protection. Some staff have recently done training in the Mental Capacity Act and healthy eating. Staff training records had not been brought up to date with all the training that staff had done so it was not possible to fully establish that staff had received refresher training in fire and manual handling. Minutes of staff meetings sampled showed that these were held regularly. Staff talked about how to meet the needs of the people living there, training, staff conduct and holidays for people living there. Discussions with staff and sampling of records showed that since the registered manager had left the home the frequency of staff supervision had reduced. One staff said they had not had supervision for three months. Discussion with the temporary manager indicates that scheduling supervisions for all of the staff team was being undertaken so that staff will get the support they need to do their jobs. Ferndale Crescent, 10 DS0000016880.V367914.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): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not been effectively managed but the new manager is enthusiastic about making changes to improve outcomes for people. People can generally be confident that their views underpin all self-monitoring, review and development by the home. EVIDENCE: The home has been without a permanent manager in post since September 2007. Comments received in staff surveys included ‘home needs a permanent manager’ and ‘manager needed’. Some outcomes for people who live at the home that were previously good when the home had a permanent manager have now become adequate. Trident have tried to recruit a permanent manager for the home but have so far been unsuccessful. The services coordinator said that the position had again been advertised and short listing of applicants was due to take place the following week. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 26 Following the recent complaint received, Trident has put a new temporary manager in charge of the home. It is good that the temporary manager is experienced and had worked at the home several years ago, this means that they know most of the people who live at the home already. At the time of the visit the temporary manager had been working at the home for a couple of weeks. In that time she has identified most of the improvements that are needed and has started working towards implementing them. The services co-ordinator visits the home monthly to undertake an audit of the home. Reports were available of the visits and showed that people who live at the home were consulted. Minutes of meetings held with people show that the home seeks and listens to their views. The services co-ordinator said that Trident is trying to improve people’s involvement in quality assurance process and are putting together new ‘customer satisfaction surveys’. Health and safety in the home is adequately managed. Water temperatures are checked regularly, these were observed to be within safe levels so that people are not at risk of scalding. The fire procedure was on display, this is in an easy read format that includes pictures so that it is easier for people to understand. Fire records showed that there had been a gap in staff testing the fire equipment to make sure it is working. However since March it has been tested weekly. An engineer regularly services the fire equipment. Regular fire drills are held but staff training records did not show that all staff have had regular updated training in fire safety so they know how to keep the people living there safe. A Corgi registered engineer had completed the annual test of the gas equipment and stated that it was in a satisfactory condition. An electrician had completed a test of portable electrical appliances to make sure they are safe to use. The certificate for the five yearly electrical wiring test showed this was completed in 2002 and was therefore overdue. The temporary manager said that it had been redone since but that the home had not yet received the certificate. She agreed to forward the certificate to the commission to show that the electrical installations were safe. Certificates were available to show that the hoists had been serviced and were safe for people to use. The home has the facilities of call bells in people’s bedrooms and en-suite bathrooms. Previously staff have done weekly checks to make sure they are working but the records show that staff stopped doing the checks in September 2007 when the permanent manager left. The temporary manager had discovered staff were not doing these and a check had been done the day before this inspection visit. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 27 An environmental health officer visited the home in May 2008 and made several recommendations, some of which have now been actioned by the home. The home needs to ensure that all of the recommendations are actioned so that the health and safety of people is promoted and protected. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 28 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 X Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15 Requirement Where people are at risk of developing pressure sores a care plan needs to be in place so that people get the care they need to stop pressure sores developing. Ensure staff follow the guidelines from the speech and language therapist regarding dysphagia so that people are not given meals that could pose a risk of choking. Staff recruitment files must include evidence that the necessary checks have been done to ensure people who live at the home do not have unsuitable staff working with them. A copy of the certificate for the electrical installations in the home must be sent to the commission to show that electrical installations in the home are safe for the people who live there. Timescale for action 30/08/08 2 YA19 12(1) 30/07/08 3 YA34 19 30/08/08 4 YA42 13(4) 30/08/08 Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The format of the service users guide should be reviewed and 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. Care plans need to be dated and make clear the exact type of support an individual needs to make sure they get the care they need. Risk assessments should be further developed to ensure they are clear about what the actual risk to the person is and the control measures that are in place. Where people are prescribed topical creams, guidance is needed on when and where this is to be used so that people receive prescribed treatments safely. Improvement is needed to the recording of received medication in the controlled medication book so this is accurately reflects the amount of medication received. Written guidance is needed, following consultation with the GP about the use of paracetamol prescribed ‘as required’ so that people receive prescribed medication safely. Where handwritten amendments to the directions on medication administration records, these should be signed by two staff to ensure the amendments are accurate. Records of peoples personal possessions should be updated regularly when people buy new things or dispose of any belongings. If something should go missing it would then be easier to track when the person last had it or when they bought it. Work is needed to the home to ensure it is well decorated and maintained for the people who live there. An accessible laundry area needs to be provided for people so that they can be as independent as possible. More permanent staff need to be recruited so that the use of agency staff is reduced and people are supported by staff who know them well. Staff should receive annual manual handling refresher training so that they know how to move people safely. A permanent manager needs to be recruited so that the home is well run for the benefit of people living there. DS0000016880.V367914.R01.S.doc Version 5.2 Page 31 2 3 4 5 6 7 8 YA6 YA9 YA20 YA20 YA20 YA20 YA23 9 10 11 12 13 YA24 YA24 YA33 YA35 YA37 Ferndale Crescent, 10 14 YA42 Records should indicate that all staff have had regular updated training in fire safety so they know how to keep the people living there safe. Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands 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 Ferndale Crescent, 10 DS0000016880.V367914.R01.S.doc Version 5.2 Page 33 - 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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