Inspection on 28/05/08 for Glebelands

This inspection was carried out on 28th May 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glebelands 05/06/07

Glebelands 25/07/06

Glebelands 09/02/06

Glebelands 21/09/05

Glebelands 02/02/05

Glebelands 17/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Glebelands Kempton Way Off Heath Farm Road Norton, Stourbridge West Midlands DY8 3AZ Lead Inspector Lesley Webb Unannounced Inspection 28th May 2008 09:00 Glebelands DS0000024984.V364831.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 Glebelands DS0000024984.V364831.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. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glebelands Address Kempton Way Off Heath Farm Road Norton, Stourbridge West Midlands DY8 3AZ 01384 813590 01384 813591 Mandy.A.Jones@dudley.gov.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) Chadd Housing Association Mrs Lynda Hazel Morgan Care Home 18 Category(ies) of Learning disability (17), Learning disability over registration, with number 65 years of age (1) of places Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Three services users in the category Learning Disability (LD) may also have a physical disability (PD). One service user in the category of learning disability (LD) may also have a mental disorder (MD). 5th June 2007 Date of last inspection Brief Description of the Service: Glebelands is an 18-bedded care establishment, which is provided through a partnership of the Churches Housing Association of Dudley District (CHADD) and Dudley Metropolitan Borough Council (MBC) Social Services Department. The property is owned and managed by CHADD who are the Registered Providers. Dudley MBC provides staffing to support service users. The Home was originally built in 1970 but was totally refurbished in 2000. The unit is a two-storey property, which is separated into four flats: two with five beds and two with four beds. All bedrooms are single occupancy. Each flat has its own laundry, lounge and dining room with adjoining kitchen and an additional area for making snacks. There are bathing and toilet facilities on both floors, which include level access showers. There is 1 assisted bath on the ground floor in flat 2. Each flat has its own private entrance with a secure entry phone system. There is a large meeting room on the ground floor, which also acts as an activities room for service users with a television and pool table. A shaft lift and stairway give access to both floors There is a garden with an enclosed courtyard. Glebelands has a large car park to the side of the premises. The Home is situated in a residential area of Stourbridge, the town centre being within easy access. The Home provides care for 18 adults who have a learning disability. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this inspection over one day, with the home being given no prior notice of the visit. Time was spent examining records, talking to residents, staff and observing care practices, before giving feed back on the findings of the inspection to the registered manager and a practice supervisor. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI) in the form of its Annual Quality Assurance Assessment (AQAA). Also twelve residents surveys were completed and returned to the CSCI. Information from both these sources was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example the people chosen consisted of both male and female and have differing communication and care needs. An Expert by Experience accompanied us during part of the inspection. This is someone who receives a care service themselves and also has a disability. Their findings are also included in this report and used as evidence when deciding on the quality of service provided at the home. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: People lead stimulating and interesting lifestyles. Residents attend various day centres and are supported to learn independent living skills. The home should be congratulated for the efforts it makes with regards to residents holidays. These vary in destinations depending on the wishes of residents. As the Expert by Experience states “I’m really pleased the home is listening to people’s individuals needs when planning holidays”. As at the previous inspection we saw lots of evidence where residents are encouraged to make friendships and maintain links with their families. It was pleasing to see different meals being prepared at lunchtime on all of the 4 flats, evidencing residents individual preferences are catered for. All the residents that we spoke to complimented the choice of meals and confirmed they are involved in menu planning. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 6 All of the resident’s bedrooms that we viewed were decorated and furnished to a good standard with lots of personal possessions and equipment. All staff we spoke to were positive about the management of the home, praising the registered managers style for running the home. What has improved since the last inspection? What they could do better: Local authority safeguarding guidelines must be followed at all times and for all incidents of alleged or potential abuse to reduce the risk of harm to residents. There have been incidents of aggression between residents. It is crucial that Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 7 the local safeguarding procedures are followed when these take place to ensure residents’ rights to protection are maintained The practice of residents paying for meals from their personal allowance must cease and an audit take place with monies reimbursed. Staffing levels must be reviewed based on the dependency levels of residents. Staffing levels must meet the needs of residents in order that they can access activities they have requested in the community. Priority should now be given to ensuring staff receive training on the values and principles of person centred approaches to care. A full list of recommendations is located at the back of this report. 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. Glebelands DS0000024984.V364831.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 Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to prospective residents about the home. Information is not available in alternative formats. This means people who may have difficulty reading may not understand what services the home offers. Assessments are completed for new residents so that the home can meet the needs of individuals. EVIDENCE: We looked at the statement of purpose and found that this contained a range of information including details of admission procedures. Its Mission Statement reads as ‘to provide good quality homes integrated into the local community, with support from caring professional staff, enabling people with learning disability to live as independently as they wish and are able as part of that community’. Through talking to residents, staff and the manager and by examining records we found that in the main the home is complying with the contents of its Statement of Purpose. At the time of inspection there was no Service User Guide available for us to look at. The registered manager informed us this has been incorporated into the Statement of Purpose and that this is not available in alternative formats such as easy read or pictorial. This means people who may have difficulty reading may not understand what services the home offers. We received twelve residents’ surveys before the Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 10 inspection, 4 that state they not receive enough information about the home before moving in (some of these residents moved into the home several years ago when information as previously described was not systematically given out). Providing information in different formats would help stop any potential discrimination with regard to people who cannot read. Since the last inspection there has been one new admission to the home. We examined this persons records and found evidence that their needs had been identified before they were offered a place at the home and that the homes admissions procedures have been followed. For example the registered manager considered the ability of the home to meet the needs of the potential resident and also the compatibility of the person with people already residing at the home. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to be involved in making decisions about their lives. Improvements have been made to care planning processes, promoting a person centred approach to support for individuals. EVIDENCE: Through examination of three residents files, discussions with the registered manager, residents and by observations made by the Expert by Experience we found that good improvements have been made with regards to care planning, involving residents in decision making and risk management. For example a new person centred care planning system has been implemented with documentation in formats that encourage involvement of residents and risk assessments have been expanded to ensure risks are identified and where possible reduced. Development of care plans and risk assessments should continue to ensure needs are appropriately managed. For example none of the residents’ plans that we viewed had been signed by the resident or key worker Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 12 and although staff have recorded that plans are reviewed monthly in the main staff have recorded ‘no changes’. The people who live at this home have varying abilities and the homes Statement of Purpose states as one of its aims ‘To manage the home and the care service in such a way as to enable residents to fulfil themselves to their maximum potential’. With this in mind it is therefore surprising that according to review notes people are not developing in any areas of their lives. We also noted that the new person centred risk assessments state to be reviewed every 6 months or as required. We found no evidence of this despite some being completed August 2007. We also found that further training for staff in person centred planning should take place. The Expert by Experience reports ‘Staff said all people in the home had recently had a person centred plan done by an independent organisation. I was really pleased to hear that the home had asked an independent organisation to come in a facilitate person centred plans. Plans needs to be active and clear about who, when and how it will proceed’. The registered manager informed us that there have been no new staff employed at the home since the last inspection. However, in order to involve residents in the day-to-day running of the home a new recruitment procedure has been developed. This includes a large print, pictorial format procedure where the views of residents are sought after potential employees have attended an open night to meet residents. This is a good initiative and we hope to see evidence of its use at the next inspection. The home is divided into 4 flats, each having its own residents meetings. We examined records of these and found the frequency of these varied for each unit. For example records were in place for 2 meetings for flat 1, 3 for flat 3 and 4 for flat 4. Records for flat 2 show 2 meetings but these were for 2 individual residents and the views of the other 2 residents have not been obtained. The varying frequency of residents meetings if further evidenced in the residents surveys received by the CSCI. 8 state they are ‘always’ given opportunities to make decisions, 3 ‘sometimes’ and 1 ‘hardly ever’. It is acknowledged the abilities of people vary on each of the unit however the home must ensure everyone is given equal opportunity to participate in regular meetings so that no one is excluded from decision making processes. Topics discussed in the residents meetings include residents’ well-being, day trips, holidays, menus, furniture and household tasks. We found evidence of action taken to address requests made by residents such as changes to menus, however further work needs to be undertaken in this area as the current recording format does not include recording when requests have been met. Glebelands DS0000024984.V364831.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): 12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices about their life style and supported to develop like skills. Recreational activities generally meet individuals expectations however staffing levels have the potential to reduce activities outside of the home. EVIDENCE: We talked to residents, staff and examined records and found people lead stimulating and interesting lifestyles. We looked at activity record sheets and these demonstrate that residents attend various day centres, undertake independent living skills and therapeutic activities. At the last inspection the home was advised to improve record keeping with regard to activities undertaken, monitoring and evaluation. The registered manager informed us that they have changed recording systems for activities a couple of times, with books used to record progress and sheets for jotting any activities declined. We found that further work should be undertaken in order that the home can Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 14 evidence activities requested in residents meetings are undertaken. For example residents residing in one flat have requested to go to car boots on a weekend and to Blackpool but no evidence of these taking place could be found. We found little evidence of activities taking place outside of the home of an evening and weekend. We discussed this with the registered manager as we felt this maybe due to staffing levels. She said that additional staff are allocated for this but rotas that we examined did not demonstrate this. We were given 2 separate activity folders for computer use and games. It was disappointing to find only one recording in both (14/04/07 for skittles and netball and 16/04/07 for use of the computer). The home should be congratulated for the efforts it makes with regards to residents holidays. These vary in destinations depending on the wishes of residents. For example this year some residents are going to Cornwall, another Wales and at the time of our visit another resident was holidaying in London. Residents expressed enjoyment with regard to their holidays, as one resident stated, “me and X and 2 staff are going to have smashing time in Cornwall”. The efforts made by the home with regard to holidays was reenforced by the Expert by Experience. As they state ‘Two people I met were planning to go on holiday this week together, to Cornwall, and we’re really looking forward to it. These people said they have chosen to go together as they get on very well. These 2 people have also requested to move into a bungalow together and staff said they were supporting them to make this happen. I was really please to hear this. Whilst we were talking about holidays I asked how people choose who and where they’d like to go. The manager said people choose who and where they’d like to go. The manager gave me an example of 2 people going to Spain last year and another who wanted to go on his own is currently in London for the week. One lady I was sat with said she didn’t like to go away on holidays but likes to go on day trips instead. I’m really pleased the home is listening to people’s individuals needs when planning holidays’. As at the previous inspection we saw lots of evidence where residents are encouraged to make friendships and maintain links with their families. Residents can enter into personal relationships and staff have received training. Some residents have their own mobile phones to keep in touch with friends and relatives. Since the last inspection an audit has taken place for providing bedroom door keys with the majority of people now having not only a key to their bedroom but also to the individual flat front doors. This is a positive step forward as it allows residents control over their personal space. One resident proudly showed us his keys explaining, “I got me key to door and window”. Residents are supported to cook meals, with agreed schedules in place in 3 of the 4 flats that detail named residents responsibility to cook the main meal for each day. It was pleasing to see different meals being prepared at lunchtime Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 15 on all of the 4 flats, evidencing residents individual preferences are catered for. All the residents that we spoke to complimented the choice of meals and confirmed they are involved in menu planning. At the last inspection the home was advised to re-introduce a recognised nutritional screening tool for assessment and reviewing of nutritional needs. The registered manager informed us that the home is currently looking at healthy eating options but that a screening tool has not yet been put in place. As we explained this should take place in order that effective monitoring of nutritional needs takes place. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of dignity and privacy are put into practice. EVIDENCE: As at the previous inspection male and female staff are employed so that residents can have a choice regarding who to support them. One flat has been fitted with a range of aids and equipment to support the residents who live there and who have a physical disability. There is a bath hoist, level access shower and handgrips in bathrooms. It was pleasing to find that since the last inspection preferences with regard to preferred bed times, bath times and opposite or same gender care are now recorded in residents plans. This helps ensure personal care is received as per residents wishes. We saw that there are some good systems in place to monitor and record individual residents’ health care appointments and treatments through out the year. The registered manager informed us that the ‘Priority for Healthcare Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 17 Screening’ booklets remain not fully completed due to still waiting for assistance from the community learning disability nurse. Medication systems have been much improved, ensuring greater protection to residents. For example policies and procedures have been reviewed, all staff that administer medication have received training, an audit system for medication has been introduced and advice has been sought from the pharmacist with regards to medication records. The home uses a monitored dosage (MDS) system for the administration of medication. All records for medication entering, being administered and returned were found to be in good order with no discrepancies. Medication competency assessments have been completed for staff responsible for administering medication to ensure their practices are maintained to a good standard, the temperature is monitored in the medication cabinet to ensure medication is stored in line with manufactures guidelines and sample signatures are in place to ensure easy auditing of medication administration records. Only minor recommendations were made. These being to identify ‘as and when’ (PRN) medication on medication administration records, to clarify with the general practitioner ‘use as directed’ instructions for prescribed creams and to ensure a stock of PRN medication is in the home for a named resident or request that this is taken off the medication administration record if no longer required. There is a senior member of staff allocated the responsibility of medication. Evidence indicates this person has improved systems greatly and should be congratulated. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have access to complaints procedures that they can understand and are supported to express concerns. Financial practices must improve to ensure residents are not placed at risk. EVIDENCE: We received twelve residents’ surveys prior to the inspection. 6 state they know who to talk to if unhappy and how to make a complaint. 2 state they don’t know who to speak to or how to complain. 4 state they know who to speak to but do not know how to complain. Due to the varying responses received we examined in detail complaints systems. The registered manager informed us that the complaints procedure has been reproduced in 3 formats pictorial (which we saw on display in the foyer of home), in the form of a complaints game that has been discussed in residents meeting and an electronic version (we were informed this is not yet operational). We examined the minuites of a residents meeting dated 07/05/08 where the new complaints game had been used. This states ‘X went on to show the residents a game that she has made up called the complaints game. Residents had a go but were a little confused by what is a comment and what is a complaint. They feel that ‘having no jam’ is a cause for complaint but X explained that would be a comment. Complaints are about bigger things, which can hurt your feelings or hurt yourself. Residents wanted to think about this. X showed them the comments/compliments and complaints book and said we could all talk about it next time’. As we explained to the registered manager it is a positive that Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 19 different ways are being explored in which to support residents to complain but that any concern regardless of how it is viewed as serious by staff should be treated as a complaint. This is to ensure issues are dealt with fairly and residents gain confidence that what they view as important is taken seriously. We also looked at the homes complaints/comments and compliments log. This details 2 comments raised by residents since the last inspection along with outcomes, 2 compliments and 2 complaints (again with recorded outcomes). We viewed the minuites of individual flat meetings and daily records completed for individual residents. On occasions issues have been recorded in both of these but not recorded in the complaints log. We could find no evidence of action taken to resolve issues identified in residents meetings and daily records. This issue was identified at the previous inspection and remains outstanding. We discussed this with the registered manager explaining that the inconsistencies identified evidence the various responses in the surveys we received. She acknowledged that recording needs improving and explained that training has been agreed in principle for staff but as yet a date has not been agreed. The inconsistencies with regards to residents feeling confident their concerns will be acted upon were re-enforced by the Expert by Experience who found ‘I asked people if they knew how to complain and people were not really sure what a complaint is but they have a staff member who is helping them to understand what a complaint is and how to complain. The manager said the staff member was going to introduce role-plays to give people ideas and examples of complaints. I thought this was a really good idea; role-plays are a great creative way to help people to understand. When I asked people what they do when they are upset, people said they talk to the staff, ‘sometimes they listen sometimes they don’t, half the time they don’t want to know’ I was told’. Staff that we spoke to demonstrated a good understanding of protecting residents from abuse. As one member of staff explained, “because some are quiet able need to remember they are just as at risk as less able from harm, reminding them of dangers and explaining, treat as adults, report any concerns to the office”. All staff have received training in safeguarding and all but 2 in positive approaches and low arousal techniques. This ensures staff are suitably trained in protection of adults. When looking at accidents records we found that on 4 occasions between October 2007 and February 2008 displays of aggression have taken place between residents. Safeguarding referrals have not been made for any of these. It is crucial that these take place to ensure residents’ rights to protection are maintained. We asked staff what systems are in place with regard to the management of residents’ finances. The senior on duty explained, “we manage for everyone, there is a safe in managers office for storage, all residents have their benefits managed by the appointiship unit. All residents have separate personal allowance sheets and balances are checked daily”. We sampled the records for 3 residents and found the above information to be accurate. When looking at the individual personal allowance sheets we found that on occasions residents Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 20 have funded meals for themselves and staff taken outside of the home. For example on states ‘21/05/08 lunch 7.68 (receipt shows 2 meals of veg lasagne and 2 drinks) and another ‘17.20 for 2 meals and drinks’. We asked the senior what the procedure was for funding meals residents have outside of the home. She said, “normally we give £5 each for staff and resident, anything over residents pay themselves”. We explained records viewed do not demonstrate evidence of the home contributing. We then viewed the residents’ contracts of residency (known as licence agreement) and the homes statement of purpose. Both of these state the home will pay for food and do not include any items not covered by fees charged for living there. Due to concerns with financial practices we issued an immediate requirement form instructing that the practice of residents paying for meals from their personal allowance cease with immediate effect and that an audit takes place with monies reimbursed. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: We looked around the building with a number of residents inviting us to view their rooms. As at the last inspection each flat was pleasantly decorated and reflected the different needs and tastes of the residents. There were various aids and adaptations in one of the flats in order to meet the needs of the people some of whom have a physical disability. All of the resident’s bedrooms that we viewed were decorated and furnished to a good standard with lots of personal possessions and equipment. The Expert by Experience also looked around the home. They reported ‘Glebelands is currently home to 16 people. The home has been divided into 4 parts, where 4 people live in each and have their own kitchen, lounge and dining area. A member of staff showed us Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 22 around the home and in some flats we were shown around people’s bedrooms. Being in the flats the landings and hallways felt quite spacious and having open planned kitchen dining area was good. The new shower room looked very nice and other flats were hoping to have one. I went into 2 bedrooms and I was pleased to see so many personal items in the rooms. One room was a bit messy as she was getting ready to go on her holiday- I liked seeing this lady feeling so comfortable in her home. People said they choose the decorations in their bedrooms and staff help with the bathrooms. One staff said in one flat people wanted to have a kingfisher painted on the wall, as staff was unsure what one was they researched it and had a talented member of staff to paint one. I’m really pleased staff listened to what people wanted and acted on it’. Since the last inspection all requirements and recommendations relating to the environment have been met. For example stained carpets and furniture in communal areas has been replaced, a carpet cleaner has been purchased and air conditioning units have been purchased for first floor flats. The communal lounge located on the ground floor is spacious with sufficient seating for large groups to meet. There is a television, computers and a snooker table for residents to use. The home has recently purchased a budgie, which is also kept in this area, and it was pleasing to observe 2 residents giving the homes pet attention. As well as an enclosed patio area at the centre of the building there is a garden area to the rear of the home. This includes raised flowerbeds, a green house used by residents and a recently purchased wooden cabin known as the ‘the retreat’. The registered manager explained this is going to be used for activities and sensory stimulation once fully operational. In the main infection control standards are good, promoting the wellbeing of residents. Each flat has its own laundry. These are domestic in style with washing and drying facilities that residents are encouraged to use. All were seen to be clean, tidy and dust free. At the last inspection the home was instructed to cease using communal plastic jugs for rinsing of residents’ hair. At this inspection the registered manager informed us each individual jugs are now in place. We suggested purchasing shower attachments that could be fitted to the bath taps to ensure clean running water. The registered manager agreed this was a good idea. Each of the 4 flats have their own toilets and bathing facilities. One of these was seen to have mould at the side of the bath, around some of the tiles in the shower and at the bottom of the shower curtain. We advised the registered manager to seek advice from the Health Protection Agency regarding this, as they would be able to advise best products and cleaning routines for elimination. We also noted that in another of the laundry’s 2 items of underwear were in place that appeared damaged due to washing at the wrong temperature. We asked the registered manager if the resident they belonged to undertook their own washing to which she said, “the colours run, staff are responsible for washing”. We instructed that Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 23 the named resident should be reimbursed due to the error by staff. Throughout all areas of the home personal protective equipment such as disposable gloves and aprons were seen to be in place as is good practice. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally staff in the home are trained, skilled and in sufficient numbers to support the people who live there. Further specialist training and increasing numbers of staff so that residents can participate in more activities in the community will enhance the quality of service residents receive. EVIDENCE: Prior to this visit we received twelve residents surveys. 5 state staff ‘always’ treat them well and ‘always’ listen and act on what say. 3 state staff ‘always’ treat them well and ‘sometimes’ listen and act and 2 state staff ‘sometimes’ treat them well and ‘never’ listen and act on what say. Throughout the inspection we observed interactions between residents and staff and found relationships to be friendly and relaxed. A member of staff did comment to us that they thought the amount of paperwork they are required to complete impacts on time they can spend with residents and the comments made in the residents’ surveys indicate improvements should be made in this area. The Expert by Experience also spoke to residents about staff and reports ‘The people I spoke with said they like the staff they have. During my visit I did notice staff knocking on people’s flat doors before entering but one person said Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 25 some of the staff do and others do not knock. All staff should be knocking on people’s doors. Another issue people brought up with me was how they never know what staff is coming on shift next and they would like to. The home should work with people to let them know what staff are working, other homes have boards with photographs of which staff and times they are working that day. People also said they do like the staff but key workers are often getting moved around and people were not sure when it happens. People need to know if their key workers are being moved around and why’. We viewed the National Vocational Qualification (NVQ) training matrix. This details twenty-four staff, 8 who hold this qualification, 5 who are in the process of completing either level 2 or 3 and 3 who are planned to start July 2008. As we explained to the registered manager arrangements should be made to enrol the remaining 8 staff (as recommended at the last inspection). Twenty-three of the staff have now received epilepsy training and nineteen communication training which is a positive as it ensure staff have the appropriate knowledge to meet residents needs. Priority should now be given to ensuring staff receive training on the values and principles of person centred approaches to care as some staff that were spoken to did not understand what these are. Other areas that would improve staffs’ knowledge include cerebral palsy and diabetes, tissue viability and Makaton (all of which were identified at the previous inspection). The need for further training was re-enforced by the Expert by Experience who reports ‘One person uses Makaton signing but the staff do not know Makaton. Staff said they do understand what this person wants as they have worked with him for a while and they have requested for some Makaton training. I feel it’s really important for the staff to be trained in Makaton before this person loses the skills he has learnt to communicate in Makaton. I really feel the staff need some training on values and the true meaning of being part of a person centred’. On previous occasions we have asked for the staffing levels to be reviewed as we felt there were insufficient staff to meet all of residents’ needs. The staffing levels remain the same (1 senior and either 4 or 5 support staff per day time shift). In addition to this a domestic position is available Monday to Friday 9am to 12pm. This position is currently vacant and rotas do not demonstrate all the hours are being covered. This has the potential to impact on direct time spent with residents if staff are undertaking additional domestic duties. We discussed staffing levels with the registered manager as these do not demonstrate additional staff are put on shift in order that residents can undertake activities outside the home (as requested in residents meetings). We asked how staffing levels are calculated and the registered manager said on numbers of residents residing at the home. As we explained, staffing levels must be based on dependency levels of residents and not numbers as the needs of individuals can alter with age, behaviour, health etc. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 26 Staff meetings take place but the frequency of these should improve to ensure staff are fully informed and supported in a consistent manor. For example no minuites were available for 2008 for flat 1, minuites of 1 meeting for flat 2, 3 for flat 3 and 2 for flat 4. Particular attention should also be given to ensuring night staff attend meetings as records indicate meetings have not been taking place due to poor attendance. We looked at the recruitment records for 3 members of staff and all contained references, job descriptions, forms of identification and a completed application form. One did not contain evidence of an enhanced criminal records check. We brought this to the registered managers attention, as a recent audit undertaken by the local authority had not identified this omission. We were pleased to see that progress is now being made towards providing staff with specialist induction and foundation training, by an accredited learning disability awards framework (LDAF/LDQ) provider. Sixteen staff have now completed this and 4 in the process. Over 50 of staff have now received an appraisal and dates have been arranged for the remainder. Monitoring sheets also demonstrate staff receive regular supervision. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 27 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. The management and administration of the home is based on openness and respect. Quality assurance systems ensure the home can measure if it is achieving its aims and objectives. EVIDENCE: As at the previous inspection the registered manager Mrs. Morgan demonstrated that she is keeping herself up to date with changes in legislation and understands her responsiblities as registered manager. Since the last inspection she has completed the Registered Manager’s award. All staff we spoke to were positive about the management of the home, praising the registered managers style of management. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 28 The quality assurance system that the manager has devised continues to be implemented. This includes a number of quality audit checks including medication, health and safety, resident consultation, environment, staffing and recruitment and infection control. Questionnaires have been sent to residents, stakeholders and families. The analysis of these now need to be incorporated into a development plan for the home. Prior to this inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. The contents of this were brief in parts and give minimal information about the service provided to residents. We discussed this with the registered manager, acknowledging this was the first time this document has been completed but advising greater detail is included when next requested by the CSCI. Senior management visits the home regularly. As at the previous inspection we noted that reports from these visits are not always completed by the Dudley Metropolitan Borough Council service manager responsible for undertaking these. The AQAA states that there are no written policies for food hygiene, sexuality and relationships or for the values of privacy, dignity and choice. It is recommended these be devised and implemented to ensure a consistent approach by staff when undertaking roles and supporting residents. We looked at a number of health and safety related records and found in the main these are up to date, ensuring the health and wellbeing of residents is maintained. For example temperatures for fridges and freezers are monitored, fire alarms are regularly tested, a qualified person has tested small electrical items and moving and lifting equipment is regularly serviced. The training matrix identifies a high proportion of staff have received training in manual handling, use of hoists, food hygiene and first aid. Greater numbers of staff should undertake refresher training for fire as the matrix indicates this has expired for eighteen staff. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 2 X 2 X Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 30 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 YA23 Regulation 13(4)(6) Requirement Local authority safeguarding guidelines must be followed at all times and for all incidents of alleged or potential abuse to reduce the risk of harm to residents. The CSCI must be notified via Regulation 37 of any incidents of aggression between residents in order that practices in the home can be monitored. The practice of residents paying for meals from their personal allowance cease and that an audit take place with monies reimbursed. Records must demonstrate staffing levels allow residents to participate in activities as per their needs and wishes. Timescale for action 02/06/08 2 YA23 13(4)(6) 28/05/08 3 YA33 18(1)(a) 28/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 31 No. 1 Refer to Standard YA1 Good Practice Recommendations The Service User Guide should be available in alternative formats such as easy read or pictorial so that people who may have difficulty reading may understand what services the home offers. Care plans should be signed where possible by the resident as evidence they agree with the contents. Records relating to the reviewing of care plans should be expanded to demonstrate where residents have developed. The home must ensure everyone is given equal opportunity to participate in regular meetings so that no one is excluded from decision-making processes. Further work should be undertaken to evidence requests made by residents in residents meetings are acted upon. Risk assessments should be reviewed every 6 months or as required to ensure changes are managed safely. Further work should be undertaken in order that the home can evidence activities requested in residents meetings are undertaken. To re-introduce a recognised nutritional screening tool for assessment and reviewing of nutritional needs. To continue to pursue the completion of the ‘priority screening for health care’ booklets. To identify ‘as and when’ (PRN) medication on medication administration records. To clarify with the general practitioner ‘use as directed’ instructions for prescribed creams. To ensure a stock of PRN medication is in the home for a named resident or request that this is taken off the medication administration record if no longer required. Until residents understand the difference between a concern and complaint, and staff receive guidance on where issues should be recorded, all concerns and complaints should be investigated with records maintained in one place. This will help residents gain confidence and understanding in complaint processes. To consider purchasing shower attachments that could be fitted to the bath taps to ensure clean running water for residents. To seek product and cleaning advice from the Health Protection Agency regarding mould in bathrooms in order that it is eliminated. DS0000024984.V364831.R01.S.doc Version 5.2 Page 32 2 YA6 3 YA7 4 5 6 7 8 YA9 YA14 YA17 YA19 YA20 9 YA22 10 11 YA24 YA30 Glebelands 12 YA32 The named resident should be reimbursed for the damaged clothing due to the error by staff when washing. To provide awareness training for staff in cerebral palsy and diabetes, tissue viability, Makaton and the values and principles of person centred approaches. To make arrangements for all staff to enrol on a NVQ qualification. The home should work with residents to let them know which staff are on duty and times they are working that day. If staff leave or if in the best interests of residents there is to be a change in key workers, individuals should be supported to understand the reasons for the changes. The frequency of staff meetings should improve to ensure staff are fully informed and supported in a consistent manor. Attention should be given to ensuring night staff attend meetings. The analysis of residents, stakeholders and families surveys should be incorporated into a development plan for the home. To ensure that there is a written report on the conduct of the home completed by the Dudley Metropolitan Borough Council service manager responsible for undertaking these. That written policies for food hygiene, sexuality and relationships and for the values of privacy, dignity and choice are devised and implemented to ensure a consistent approach by staff when undertaking roles and supporting residents. Greater numbers of staff should undertake refresher training for fire to reduce the risk of injury in the event of a fire. 13 YA33 14 YA39 15 YA40 16 YA42 Glebelands DS0000024984.V364831.R01.S.doc Version 5.2 Page 33 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. 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