Inspection on 25/07/07 for Florrie Robbins

This inspection was carried out on 25th July 2007.

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

The inspector found 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.

Other inspections for this house

Florrie Robbins 17/08/06

Florrie Robbins 09/02/06

Florrie Robbins 30/08/05

Florrie Robbins 17/02/05

Florrie Robbins 05/08/04

Florrie Robbins 28/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Florrie Robbins Penshurst Avenue Handsworth Birmingham West Midlands B20 3DQ Lead Inspector Kerry Coulter Key Unannounced Inspection 25th July 2007 10:40 Florrie Robbins DS0000016728.V341288.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 Florrie Robbins DS0000016728.V341288.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. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Florrie Robbins Address Penshurst Avenue Handsworth Birmingham West Midlands B20 3DQ 0121 331 1817 F/P 0121 331 1817 alphonsusservices@hotmail.co.uk 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) Mr Roger Murray Mr Paul Murray James White Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Florrie Robbins DS0000016728.V341288.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 17th August 2006 Brief Description of the Service: Florrie Robbins is registered to provide accommodation, care and support for up to five adults with learning disabilities. The Home is owned and run by Alphonsus Care. The property is a purpose built detached house lying to the rear of one of the Organisations other homes (Charles House, Birchfield Road). The ground floor of the house is suitable for people with mobility problems. The Home has its own front entrance on Penshurst Avenue, but the rear of the property can be accessed through the back garden of Charles House. The house is within walking distance of the centre of Perry Barr, and there is a wide range of community facilities in the area, including shops, pubs, restaurants and places of worship. Public transport links are particularly good, with a choice of several buses, and also a train station. All of the single bedrooms have ensuite shower facilities and wash hand basins. Downstairs are two bedrooms, a lounge, dining room, and kitchen. There is also a bathroom and separate w.c. Upstairs there are three more bedrooms, another bathroom, shower room , and w.c., the laundry, and the office. There is limited off road parking at the front of the house, and a private small lawned garden to the rear of the property. The manager said the current range of fees is £880 - £1100 per week. Copies of previous CSCI inspection reports are on display in the home for people who wish to read them. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over six hours, the home did not know we were coming. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) 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 provisions 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 a questionnaire about the home (AQAA). 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. All people who live at the home were spoken to. Due to their communication needs most people who live at the home were not able to comment on their views. Discussions with staff and the Manager took place. CSCI survey forms were received from one relative and a friend of people who live at the home. Their comments are included in the report. What the service does well: Staff were observed to give support with warmth, friendliness and patience and treat people respectfully. The home was clean and there were no unpleasant smells making it a nice place to live. People who live at the home all have their own bedrooms that are individual in style and contain their personal things. People are supported to keep in touch with their family so they do not lose relationships that are important to them. People are provided with meals that they like. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 6 Robust recruitment practices are undertaken so that staff employed are suitable to work with vulnerable people. Regular health and safety checks are done to make sure that equipment is well maintained and does not put the people living there at risk of harm. What has improved since the last inspection? What they could do better: Information should be provided to people who live at the home in formats that are easier for them to understand and assist them in making choices for themselves. Some care plans need improvement so that staff have more information on how to support people’s health needs and manage behaviour so that people who live at the home get the care they need. Risk assessments need further development to ensure that risks to people are managed in a safe and responsible manner and staff have sufficient information to manage these risks. The opportunities for people to take part in activities need to be reviewed so they can do the things they enjoy in the evenings and weekends. Staff must have all the training they need so they have the skills and knowledge to meet the needs of each person who lives there. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 7 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. Florrie Robbins DS0000016728.V341288.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 Florrie Robbins DS0000016728.V341288.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, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have most of the information they need to ensure they can make a choice about whether or not they want to live at the home. People have the opportunity to visit and to try out what the Home has to offer, to support decisions about placement. EVIDENCE: The statement of purpose for the home was on display and people who live at the home have a copy of the service user guide in their care plan file. The information is in a standard written format. It is recommended that consideration is given to making the guide easier to understand, perhaps by including some pictures or photographs so that people who are considering moving to the home will have all the information they need to make a decision about moving there. The AQAA recorded that in the next twelve months the home intends to produce a brochure for people considering moving to the home. There have been no admissions since the time of the last inspection and there is currently one vacancy. As previously reported, there are systems in place within the Organisation to ensure that individual’s needs can be assessed appropriately, and that people have the opportunity to visit and stay over prior to making any decisions about placement. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 10 At the last inspection it was identified that peoples terms and conditions were dated 2003 and were unsigned. A requirement was made for them to be developed and updated. This has now been done, however it is recommended that the fees payable on behalf of the person are included in the document. Florrie Robbins DS0000016728.V341288.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. Although there is a clear care planning system, with personal profiles and risk assessments, these are not always adequate to provide staff with the information they need to satisfactorily meet peoples needs. EVIDENCE: Previous inspections have identified that care plans should be developed so that they contain sufficient detail so that staff know what support to offer people. Some of the plans still do not give staff enough information some improvement has been made with some of the care plans having been rewritten. The care plans for two people were sampled, both were generally up to date. Care plans provided some information about how staff are to support people to meet their communication, social, spiritual, health, personal care, dietary and mobility needs but further detail was needed. One person had guidelines about taking food from other people at mealtimes. These were dated January 2006 and will need to be reviewed to ensure the guidance is still appropriate. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 12 Information in the care plans would benefit from being more person centred for example to include more details about peoples food likes and dislikes, what size of incontinence pads people need, what time they prefer to go to bed at night and get up in the morning. This will help to ensure staff provide support in the way people prefer and need. Some plans referred to people’s behaviours such as eating faeces, lashing out or using inappropriate language. There was little information in the care plans about triggers for these behaviours or how staff can effectively manage it if it occurs. One person had been diagnosed with early signs of dementia, their care plan did not detail any additional support they may need from staff because of this. People who live at the home all have significant communication support needs, so choices tend to be restricted to fairly simple things. Weekly meetings are held but these are somewhat repetitive in content and do not appear to be fully participated in by everyone due to their communication needs. It is recommended that the format and frequency of the meetings are reviewed. Perhaps concentrating on only a couple of topics at each meeting would be less confusing for some people or 1:1 key worker meetings could be introduced. Consideration should be given to developing the use of alternative methods of communicating such as pictorial aides and objects of reference, so as to improve individuals’ capacities to make choices. Previous inspection reports have highlighted the importance of appropriate communication guidelines for working with people with high communication support needs. The Manager said that since the last inspection people had received some input from the Speech and Language Therapist who was helping in the development of ‘Communication Passports’ for people who live at the home. The home completes risk assessments for people so that consideration is given to supporting them to take responsible risks and also promote independence. Risk assessments sampled had been regularly reviewed. It was a requirement of the last two inspections that a risk assessment was needed for the person who has bed rails due to the risk of them falling out of bed. A risk assessment has now been completed but it is recommended this would be further improved if it included if the person had previously tried to climb over the rails or not. Previous inspections have identified that there should be clear links between care plans and risk assessments – simple indexing and cross-referencing is one of the easiest ways of achieving this. This remains a recommendation. Florrie Robbins DS0000016728.V341288.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 adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home would benefit from the range of activities available being developed so that they take part in activities at times similar to others of the same age, gender and culture. The people living in the home are offered a healthy diet to ensure their well being. EVIDENCE: People living in the home continue to access activities outside the home on a daily basis during the week. Some attend local centres, and the organisation has its own day service “arm”. Daily records tend to be confined to things like watching TV, getting drinks, and assistance with personal care. Separate activity records are kept and these were sampled for three people. For one person their care plan recorded they enjoyed pub, shopping, crafts and bowling and enjoyed the community. Their activity record showed that since January they had been shopping only once Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 14 and to the pub and meals out four times. There was no record of them going bowling. One person who enjoys the cinema had been three times in 2007 but had not been since April. For another person the only community activity recorded since January was a walk. The AQAA recorded that in house activities on offer included beauty, arts and crafts, games and cooking but there was little evidence of this happening in people’s records. For one person a letter from their Community Nurse refers to staff needing to provide appropriate sensory activities, perhaps incorporating a multi sensory room into their weeks activities. The Manager said this person goes to a sensory room once a week with their daycentre and really enjoys it. Perhaps this could be extended by utilising the vacant bedroom for sensory activities and providing more sensory equipment in the home. There are few references to other activities undertaken at weekends. Consideration needs to be given to increasing the number of opportunities for evening activities in keeping with other people of a similar age, gender and culture. The activity records sampled did not record if people had enjoyed the activity or not. Discussion with staff indicates that two people have been on holiday this year to Minehead. Staff said that one person does not like to go on holiday and that the other persons holiday had to be postponed. It was hoped this person would have a holiday later in the year. The home is good at supporting people to maintain contact with their families. One person spends time at their parents home most weekends. Records show that when people who live at the home have a birthday party their relatives are invited to attend. Food stocks were examined and supplies were ample, including fresh fruit and vegetables. The record of meals taken indicates that people have access to a balanced diet that is sufficiently varied and nutritious. Part of the evening meal time practice was observed. Staff were observed to appropriately support people. Two people who live at the home confirmed that the meal was nice. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care records do not always clearly state how people’s needs are to be met and so their needs may not always be consistently met by staff. People who live at the home receive their medication safely and as prescribed by the GP. EVIDENCE: People’s attire and personal grooming provided evidence that a good basic standard of care is given. Staff were directly observed interacting with people who live at the home: their manner was warm and friendly, and support is given in an appropriately respectful manner. Care plans generally indicated the degree of assistance people required for personal care but could be improved by including their preferences such as what time they like to get up in the morning and the gender of the staff they prefer to support them. One person‘s plan recorded they were incontinent and wore pads but there was no information about the type and size of pads worn and the frequency they needed changing. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 16 Personal records provide evidence of involvement of members of the multidisciplinary team including GP, Consultant Psychiatrist, Dentist, Community Nurse, Speech and Language Therapist and Optician. One person who lives at the home has epilepsy. Whilst there was a basic risk assessment in place that guided staff what to do in the event of a seizure there care plan did not detail the type of seizures they have, usual frequency and duration. Staff need this information so they know what is normal for this person and are aware if a seizure is outside of the normal pattern. Health action plans have been completed since the last inspection as required. These documents are basic in content and would benefit from further development such as information about the frequency needed for general health checks such as dentist and optician. One person is assessed as having dysphasia (eating problem) by the Speech and Language Therapist , this information needs incorporating into their main care plan. One person’s care plan records they have oedema. Their care plan needs to detail what support they need from staff to ensure their needs regarding this are met. Records showed that people have regular medication reviews and their weight is monitored regularly. Staff who administer medication have been trained so that people receive their medication safely. Medication is stored securely within a locked cupboard in the office. At the time of this visit medication administration was well managed. The home retains copies of prescriptions so that staff can check the correct medication has been received from the chemist. Medication administration records were sampled and found to be in good order. As required at the last visit topical creams are now dated on opening so that staff know when they need discarding. Where people are prescribed medication on an ‘as required’ basis written protocols are available to guide staff as to when they should be given. Since the last visit a protocol has been written for one person who has medication for their behaviour, this has been signed by the Consultant Psychiatrist. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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. Appropriate complaints procedures are in place and staff generally have the knowledge and skills they require to protect people from the risk of harm in the event an allegation was made. EVIDENCE: The CSCI has not received any complaints about this service since the last visit. The home has not received any complaints directly. People have a copy of the complaints procedure, this is generally not in an accessible format as it is a written document. To ensure people are consulted weekly meetings are held and people are asked if they have any complaints. As stated earlier in this report the home is currently working with the Speech and Language Therapist to develop communication systems for people. As part of this, consideration should be given to developing other formats for the complaints procedure. The complaints procedure is on display in the office and the CSCI surveys received from a relative and friend said they were generally aware of the procedure and the home responds appropriately to complaints. It may be better if a copy of the complaints procedure was on the notice board in the hallway, this would ensure that new visitors to the home would have access to the procedure. Staff have completed training in the protection of vulnerable adults and policies and procedures to include whistle blowing are readily available to them. The Manager was aware of the new Mental Capacity Act. This Act provides a Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 18 statutory framework to empower and protect vulnerable people who may not be able to make their own decisions. The Manager said that training for staff was to be discussed at next the management meeting. An up to date inventory of people’s belongings is maintained so that staff can track if anything has gone missing and people’s property is looked after. The home holds people’s personal money on their behalf. Receipts are available to evidence any expenditure. On the day of the visit the records of money held were accurate. People’s finances are checked by the Service Manager as part of their monthly visits to the home. Recruitment records sampled showed that a robust procedure is followed for the protection of people living in the home. Since the last visit to the home there has been one incident that has been dealt with under adult protection procedures. This incident did not involve any allegation of misconduct by staff at the home. This was appropriately reported to the CSCI and the investigation process was led by social services. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 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 their individual needs EVIDENCE: A full tour of the building was completed. The house is maintained to a high standard, and kept clean, tidy and hygienic. Satisfactory hand washing facilities were observed in the bathrooms, laundry and kitchen. All areas of the home were observed to be in good decorative order and homely in style. Since the last visit some new carpets have been fitted in the hallways making them look very well maintained. The kitchen has been refurbished with new units and worktops making this not only a hygienic place to cook but it also looks nice. During the visit there were some workman at the home fitting a new boiler, the Manager explained that there had been some problems with the old one. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 20 People’s rooms are individual in style and include personal belongings and ornaments reflecting peoples age, gender and culture. Individuals benefit from the provision of en-suite facilities in their rooms, enhancing their privacy and independence according to individual needs. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. 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. Staff are generally competent and have access to a good range of training opportunities, but identified gaps in training should now be addressed so as to improve the quality of support to people living in the house. People are supported and protected by the organisations recruitment processes. Arrangements are generally sufficient to ensure that there is enough staff to ensure people’s needs can be met. EVIDENCE: Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. It is good that all of the staff team have completed the Learning Disability awards Framework (LDAF) training. To ensure people are supported by a fully qualified staff team at least 50 of staff need to achieve an NVQ in care, currently only three staff have completed an NVQ. Discussion with the Manager and staff shows that progress towards completing NVQ’s has been slow. Some staff were registered for four years without completing their NVQ. One staff said they had recently been re enrolled on an NVQ. The organisation must support the Manager with a strategy to achieve the required level of staff training and members of staff Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 22 also have a personal responsibility to ensure that they continually update their skills and learning. Current staffing levels in the home are generally three staff in the morning Monday to Friday and two in the afternoons and at weekends. The Manager said that three staff are generally not needed at the weekend as one person goes home most weekends to stay with their parents. Discussion with the Manager indicates that the home is currently only receiving funding for two staff in the morning but that the funding for the third member of staff has recently been agreed with social services. Staff levels generally appear to meet peoples needs. The Manager said that no new staff had started work at the home since the last visit. Recruitment procedures were checked. A number of checks are done to make sure that staff are suitable to work with vulnerable people to include obtaining written references and Criminal Record Bureau checks. Copies of recruitment records are available in the home where they are kept on the individual member of staffs file. Files sampled showed that robust procedures had been followed so that people are not put at risk by having unsuitable staff working with them. Staff meetings are generally held monthly and formal supervision for staff is regularly scheduled. Checking of files provided evidence that this is up to the required standard so that staff receive the support they need to carry out the job and receive feedback on their performance. It was noted at the time of the last inspection that no one on the staff team apart from the Manager had done any training in supporting people with Autistic Spectrum Disorders. Since then seven staff have received training, the Manager said that a second day of training would be arranged for staff who missed the original training. The training matrix for the home shows that all staff have been trained in first aid, adult protection, fire, equal opportunities and medication. Eight of the eleven staff have done training in epilepsy, four have recently done infection control and seven have done manual handling. There is some training outstanding for some staff and this needs to be scheduled, one staff needs to do food hygiene and two have not done manual handling. One staff needs refresher training in first aid. As highlighted earlier in this report one person has recently been diagnosed with early dementia, as a result the Manager will need to plan to provide training in this area for staff so that they can continue to meet this persons needs. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a home that is generally well run. General practice promotes the health, safety and welfare of people living in the home. EVIDENCE: The Manager is qualified to NVQ level 4 and holds the Registered Manager’s Award. He is also a qualified Assessor for NVQ students. Discussion with the Manager indicates he has kept himself up to date about developments in the care sector, for example the new ‘Mental Capacity Act’ . Surveys received from a relative and a friend indicated the home was well managed one said the home ‘provides a happy and safe environment’. Quality assurance systems are in place. The Service Manager visits the home and writes a report of their visit as required under Regulation 26 to ensure the home is being well managed. Reports provided showed these visits are generally done monthly. Audits are also completed twice a year. The Manager Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 24 said that a full audit was planned for the coming Friday. The last audit was completed in March for which a brief report was available in the home. As part of the quality assurance system questionnaires are sent to relatives/ friends of people at the home seeking their views of the service. Other internal audits are completed this includes areas such as medication, wheelchair checks and a check of the home to include people’s bedrooms. Quality assurance would be further improved if the information from the audits was used to develop an annual development plan for the home. This is something that the home intends to do, as indicated on their AQAA form. A number of checks are undertaken regularly by the home to make sure that the health and safety of people living there is maintained. A number of these were sampled. Systems are in place to monitor the temperature of the fridge, these records showed that food is stored at safe temperatures to reduce the risk of food poisoning. The temperature of the water is usually monitored weekly to ensure it will not pose a risk of scalding to people. The West Midlands Fire Service visited the home in September 2006 and said that the fire precautions were satisfactory. Fire records showed that a risk assessment is in place so that the risks of there being a fire are minimised as much as possible. Staff had fire safety training in February so that they know what to do in the event of a fire. Staff regularly test the fire equipment to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 2 X X 3 X Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 Care plans must include specific guidance for staff on how to manage individual’s behaviours to ensure behaviours are effectively managed and people get the support they need in a consistent way. Care plans must clearly detail peoples health needs to include: Epilepsy Oedema Dementia Dysphasia to ensure people who live at the home get the support they need to stay healthy. Make arrangements for members of the care team who need training in areas of epilepsy, manual handling, dementia and autism to receive the training they need to ensure they can meet the needs of people who live at the home. Timescale for action 30/09/07 2. YA19 12(1)(a) 30/09/07 3. YA35 18(1a,c) 30/09/07 Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 27 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 further developed so that it is available in formats that are easier for people who live at the home, or people who are thinking of moving there to understand. Copies of people’s terms and conditions should include the fees payable on behalf of the person. Care plans should be further developed so that they contain sufficient detail and information about people’s preferences so that staff know what support to offer people who live at the home. Review the format of meetings held with people at the home so that their participation in the meeting is increased. Consideration should be given to developing the use of alternative methods of communicating such as pictorial aides and objects of reference, so as to improve individuals’ capacities to make choices. The bed rails risk assessment would be further improved if it included if the person had previously tried to climb over the rails or not to ensure they are not put at risk from the use of the rails. There should be clear links between people’s care plans and risk assessments – simple indexing and crossreferencing is one of the easiest ways of achieving this. People should have more opportunities to take part in activities at times valued by others of a similar, age, gender and culture to ensure they have a good lifestyle. The range of activities available to people to participate in within the community should be expanded and reflect individuals taste and interests. More information about people’s personal care preferences should be included in their care plan to ensure they receive personal support in the way they prefer and need. Health action plans would benefit from further development to include information about the frequency needed for general health checks such as dentist and optician to ensure people receive the healthcare they DS0000016728.V341288.R01.S.doc Version 5.2 Page 28 2. 3. YA5 YA6 4. 5. YA7 YA7 6. YA9 7. 8. 9. 10. 11. YA9 YA12 YA13 YA18 YA19 Florrie Robbins 12. 13. 14. YA32 YA22 YA39 need. Devise and implement a strategy to achieve at least a 50 ratio of care staff qualified to NVQ2 to ensure people are supported by a fully qualified staff team. Improve the format of the complaints procedure so that it is easier for people who live at the home to understand. Produce an up to date annual development plan for the home as part of an effective quality assurance system. Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 29 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 Florrie Robbins DS0000016728.V341288.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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