Inspection on 05/06/07 for Glebelands

This inspection was carried out on 5th June 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glebelands 28/05/08

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 08/07/2008.

CARE HOME ADULTS 18-65 Glebelands Kempton Way Off Heath Farm Road Norton, Stourbridge West Midlands DY8 3AZ Lead Inspector Jayne Fisher Key Unannounced Inspection 5th June 2007 09:30 Glebelands DS0000024984.V336051.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.V336051.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.V336051.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.V336051.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). 26 July 2006 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. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels were provided on 22 May 2007 which are between £566.46 and £1132.75 per week. There are additional charges for toiletries and hairdressing. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 09.30 a.m. and 6.30 p.m. and was undertaken by one inspector with the home being given no prior notice. We spoke with eight residents, the registered manager and six staff members. Questionnaires were received from the majority of residents all of whom, completed these with assistance of staff. We talked to residents to confirm their responses. We also received comments from five relatives. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: Staff actively encourage and support residents to not only maintain their own independence, but also learn new skills. The building supports this aim with separate self contained flats each with a front door to which residents have access. Residents are enabled to lead fulfilling and meaningful lifestyles. Some have their own jobs, go to college or attend day centres. They participate household chores, do food shopping, plan their own menus and cook their own meals. There is a garden area where some residents are growing their own vegetables and plants. Residents have access to advocates and have the choice about whether they wish to vote in political elections. They can go out into the community on their own and are able to follow their preferred hobbies and leisure pursuits. There are no restrictions upon residents’ movement around the building. They clearly regard this as their own home and offered to make visitors drinks and lunch without prompting from staff. Residents have keys to their bedrooms and appropriate locks have been fitted to toilets and bathrooms to afford privacy to people. There are male and female staff so that residents can choose who they wish to support them. Bedrooms are decorated to suit people’s individual tastes. One of the flats has a range of equipment to meet some people needs who may have a physical disability. Residents are encouraged to maintain personal friendships and to keep in touch with their relatives. The atmosphere through out the visit was warm and welcoming. Staff and residents were happy to assist in the inspection process. There was lots of positive interaction seen between staff and residents. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Steady progress is being made towards raising standards and the service has many strengths. However, there are some particular weaknesses which still need to be addressed. The manager is aware of these, and is working actively to address them. Care planning and risk assessments remain poor and whilst staff are generally aware of peoples’ needs and preferences, there are new staff and agency staff who will not have this knowledge. Management are devising new systems to be introduced. Some improvements are needed in record keeping in order to demonstrate that residents’ needs are being met and actively monitored. For example with regard to food, activities and health care. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 7 Residents are able to voice their concerns although the complaints procedure could be made more accessible. Better record keeping of any issues identified would allow management to be assured people views are listened to, and there should be more opportunities for residents to participate in meetings. Although there are very good attempts to provide a person centred service, residents do not participate in interviewing new staff and on the whole do not take responsibility for their own medication. This should be reviewed. We raised serious concerns with regard to some furniture and furnishings which were heavily stained and required cleaning. There were two settees in one of the flats which needed to be replaced as they were damaged. The communal bathrooms and laundry in one of the flats were either dusty and dirty, requiring a good clean, or were untidy. These were also used as inappropriate storage space for some items. There are insufficient numbers of staff who hold a vocational qualification and the home is still experiencing staff shortages. Shortfalls are normally covered by using agency staff on a regular basis. This has the potential to impact upon the consistency of support to residents, some of whom can become distressed by different people providing their support. On occasions it has not been possible to engage agency staff which ultimately can lead to the home being shortstaffed. 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.V336051.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.V336051.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. There is an holistic assessment process so that new residents can be assured their individual needs will be measured and met. There is also a range of information available to inform new and existing residents of the services which are available at the home. EVIDENCE: We looked at the statement of purpose and found that this contained a range of information including details of admission procedures. There have been no new admissions to the home since 2004. The last person to be admitted is still happily living at the home which demonstrates the effectiveness of the admission procedure. She told us “I like living here – nice people”. There are currently two vacancies as two people have moved into supported living projects during the last twelve months. The manager told us that there are no intentions to admit any new residents for the time being because the future development of the home is still being discussed. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 10 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 poor. This judgement has been made using available evidence including a visit to this service. At present residents’ needs, goals and aspirations are not reflected in their care plans or risk assessments. This has the potential to place residents at risk particularly as they are not always supported by a consistent and stable staff group. EVIDENCE: The care planning system has required improving for a number of years. The manager is aware of this and told us that a senior member of staff is currently working on a new format for care plans. She was able to show us a blank template as an example. We looked at existing care plans which were available on each of the flats. As we have pointed out previously, and which is acknowledged by the manager, these do not contain sufficient guidelines for staff in supporting and meeting residents’ needs. For example, one person had a care plan in place which only covered one aspect of care (entitled ‘anxiety and aggressions’). This is despite Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 11 the fact that the resident requires support with most aspects of her daily living. The care plan was neither dated or signed, and there was no evidence that it had been reviewed. One resident has been seen by the dietician because of diabetes and health related complications. The dietician has made a number of recommendations but there was no care plan in place and poor recording regarding the resident’s food intake. This made it difficult to confirm that all of the recommendations were being followed and would not allow for effective monitoring by staff. We were reassured that the staff we spoke to knew residents’ needs, likes and dislikes and therefore did not have to rely on care plans. However, all of the staff were met had worked at the home for longer than twelve months. Staff are moved around each of the flats (four of the five staff we spoke to were not based on the flat they were working, being key workers for residents in other flats). New staff are being recruited and agency staff are regularly used so it vital that the care planning system is improved. In the past there have been poor attempts at introducing person centred planning systems. The manager told us that she has recently enlisted the support of external consultants for up to six residents in order to assist with this process. She said that there are plans for all residents to have this opportunity. There were no details in the care plans we saw regarding how staff communicate with residents and support them in decision making. The manager told us that staff have received training in communication passports and will be developing these with residents. We looked at risk assessments which have not changed since our last visit. Risk assessments as with care plans have not been reviewed or up dated since they were established in 2004. Not all risks have been identified or assessed. Risk assessments which are in place are basic in content and are generic in style and not person centred. One person’s risk assessment referred to him going to a day centre which staff told us ceased over twelve months ago. The risk assessment for one resident’s challenging behaviour included a control measure that staff are to lock bedroom doors during the day time ‘to stop other residents’ entering and causing damage’. We saw that this does not take place and staff confirmed that this was unnecessary. The risk assessment also referred staff to look at the behavioural management support plan in ‘appendix one’. However, there was no support plan in place. Staff admitted “we haven’t really looked at them” and agreed that they would benefit from risk assessment training. We spoke with residents about how they are offered opportunities to take part in the running of the home. One resident told us that she did not take part in Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 12 recruitment interviews of new staff and said “no we don’t have a chance to ask; I would like to though”. We asked about residents’ meetings and were told “sometimes we have them but our last one was cancelled”. We looked at minutes taken at meetings and found that two of the flats had had a couple of meetings since 1 January 2007. There were no meetings for the other two flats. The manager said that these should take place very month. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents now enjoy a stimulating and varied lifestyle within the home and community. Staff support residents to maintain important relationships with friends and families. Residents are provided with a varied and well balanced diet. EVIDENCE: We previously had concerns that residents who were more dependent, did not have the amount of opportunities as those who were independent. The manager told us that she felt this has been resolved because due to vacancies, one of the persons has moved out of the flat where the more dependent people lived. We chatted to residents and staff and examined records which demonstrated that there are more opportunities for residents to lead stimulating and interesting lifestyles. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 14 We looked at activity record sheets and these demonstrated that residents went out regularly into the community, undertook independent living skills and therapeutic activities. There are only a couple of areas for improvement. The activity sheets were not always consistently completed and in some cases needed more detail. For example, during one day the only activity according to records, undertaken by one resident was ‘socialising with peers in meeting room’. It is suggested that the activity records could be separated into morning, afternoon and evening which would help give a clearer picture of residents’ activities. Staff told us that they do not follow an activity programme. They said “we ask them what they want to do, and if they don’t want to do it they don’t have to”. Whilst this is a positive approach the manager agreed with us that an activity programme is beneficial and stated that there used to be one available in the flat. Although there is space on the activity record for staff to enter comments, which would help in evaluation and monitoring, this is normally left blank. During the day we saw residents engaged in a variety of activities including housework chores, going out to their day centres and colleges and going out in the evening to the pub. Residents chatted to us about their favourite outings and activities and some were looking forward to going on their holiday. Some residents go out independently and some have jobs. One person said “I work in a café on Mondays and go to college to do literacy”. Residents also confirmed that they had recently voted in the local elections. When we went into the flats residents asked us if we would like a drink or something to eat (when it was lunch time). There are no restrictions upon residents’ freedom around the house which they clearly regard as their home. It was pleasing to see that the telephone at the request of residents has now been moved to a more private area in the home. 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. All relatives who completed comment cards said that they were kept up to date with important issues and staff helped their relative to keep in touch. Residents confirmed to us that they held their own bedroom door keys. Although when in one of the flats (flat 2), staff told us that none of the residents have their own keys. They said that they were not sure why but thought that at least one resident would like to have her own key. We told the manager and she said she thought that this had been offered to all residents and agreed to review it. Some residents complained that staff failed to knock Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 15 on their flat doors when entering (despite signs being displayed). One resident said “they come into our flat and don’t knock on the door, it’s not very nice”. We did see that one agency member of staff failed to knock when entering a flat and this was raised with the manager. We saw residents eating lunch in one of the flats. They had made their own sandwiches and had chosen different options. In some of the flats residents take turns to cook the evening meal. A member of staff told us that she had just undertaken a healthy eating course and was now training residents. Residents told us that they were going to participate in healthy eating and chatted about how they were making their favourite meals with different ingredients which were more healthy. Residents confirmed that they went to the supermarket to do their own food shopping and we saw that residents were assisting staff to cook the evening meal in one of the flats. We saw that residents were involved in planning their own menus. We looked at the menu plan in one flat which was balanced and varied. As already stated however, residents’ food intake records need to be more consistently completed by staff and should be more descriptive. This is particularly beneficial for monitoring purposes for residents’ on special diets. For example rather than just entering ‘Sunday lunch’ or ‘sandwiches and crisps’. As we stated at previous inspections, nutritional screening needs to be reviewed rather than undertake just as a single exercise. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally residents receive personal support in a way that they prefer, although this needs to be kept under review in order to ensure it is person centred. Overall the health care needs of residents are met, although access to some routine appointments and screening needs to be improved. There are safe systems in place for residents to receive their medication with only a few areas for improvements. EVIDENCE: All the residents we spoke with said that they liked the staff who helped support them; there were however a couple of exceptions where residents felt their privacy and dignity was being compromised. One person said “we can’t have five minutes in the bedroom without X coming to ask if I’m alright”. Another person stated that they were constantly checked upon when in their own bedroom, but added that they had raised this with senior staff and it had now ceased. Another resident said “X keeps pestering us when we are in our bedrooms, when we want time out”. The manager told us that she had recently been made aware of some of the issues raised by residents and explained how she was going to resolve them. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 17 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 hand grips in bathrooms. Five relatives who completed comment cards said that the staff either ‘always’, or ‘usually’, were able to meet the different needs of residents. One relative stated “X’s care has always been of a high standard”. At previous inspections we have asked that residents’ personal preferences with regard to how they receive support are included in their care plans. We did not see this information on the flats but hopefully it will be incorporated into the new care planning system. For example, whether they prefer male or female staff. 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. However, when we looked at two residents’ health records for 2006 we found some anomalies. Whilst both residents had seen a variety of health care specialists there were no dental appointments or eye tests. There were only two chiropody appointments recorded in the twelve month period. There was no attendance at well person clinics for health screening. The manager told us that access to well person clinics and routine screening had been problematic in the past but some residents were now starting to access these health checks. We saw that the ‘Priority for Healthcare Screening’ booklets remain not fully completed. The manager explained that she is still waiting for assistance from the community learning disability nurse in helping to complete these action plans. These should either be fully completed or abandoned and a new system implemented with regard to health action plans. Residents are now receiving regular recorded weight checks. There is still an outstanding issue with regard to establishing detailed care plans with regard to how people’s health care needs are met, and in particular how one person is supported to manage their diabetes. There are good practice guidelines in place regarding some elements of diabetic care which have been obtained from a local hospital. However a detailed care plan specific to the resident is still needed. A senior support worker showed us the medication systems in place. We were told the that local pharmacist had visited on the same day and on carrying out an audit had raised no concerns (although she had not left a copy of her report). We looked at medication charts and saw that there had been an Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 18 improvement in record keeping, only a couple of gaps were seen (during the previous month cycle). The manager has introduced a competency monitoring system as we requested, and staff are now following the advice given by the G.P. with regard to urine testing. The medication cupboard was clean and tidy with no overstocking. There are guidelines in place for ‘as and when required’ (PRN) medication, only slight expansion is needed to include how many days the medication is given, before advice is sought. The manager told us that night staff are starting to receive training in the safe handling of medication. The senior support worker told us that he had nearly completed his training. The manager stated that she had completed a competency monitoring assessment to ensure that he was able to give medication safely. He demonstrated a good knowledge of the arrangements for the safe storage of medication. He has asked for advice from the local pharmacist after identifying that the drugs cupboard is exceeding the safe temperature. There are some issues which still require action. No procedures could be located for the secondary dispensing of medication. This is carried out by staff when some residents visit their families. The member of staff explained how this is undertaken, but there is no second person to witness the dispensing, and no records are maintained with regard to how many drugs are sent home with the resident and how many are returned. As previously stated this needs to be discussed further with the pharmacist to ascertain if safer systems can be suggested. We did not see the medication policy at this visit and there is an outstanding requirement to expand this document. It is recommended that this is sent to us. Staff still need to ensure that there are two people signing to witness any handwritten changes to computerized instructions on MAR sheets. As we previously recommended, checks should be undertaken for any medicines which are not dispensed as part of the monitoring dosage systems, and balances carried forward to enable regular auditing. Staff told us that there are currently no residents who self administer their own medication. It is suggested that consideration needs to be given as to whether residents would like to be able to take responsibility for their own medication, and if so, how staff can support them in this aspiration. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 19 Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 20 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. There is a complaints procedure in place, but it could be made more accessible to residents so that they all know how to use it. There are systems in place to ensure that residents are protected from harm although these could be enhanced further and thereby offering greater protection to residents. EVIDENCE: We spoke with a number of residents who knew how to make their concerns known. One person stated “I’ll tell Lynda” (the manager). Some residents talked about concerns and said that they had mentioned these to senior staff who had taken action to resolve the issues raised, (although we could find no related records). One person asked how she could make a complaint to the Commission and was not aware of the leaflet displayed in the foyer. Although this now contains the name and address of the Commission, it is rather small. It is suggested that copies could be more prominently displayed. It is also recommended that alternative formats are produced for residents for example, audio and pictorial. The manager said that she had brought a pictorial complaints leaflet from another care service, although we could not see this displayed. All relatives who completed comment cards said that they received appropriate responses to any concerns they raised. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 21 We talked to the manager about improving recording systems and using different strategies for explaining complaints systems to residents (such as residents’ meetings). She said that she thought this was a good idea. One resident had raised an issue during one meeting but there was no record to demonstrate what action had been taken. It is suggested that staff record what action is taken to address any items raised during these meetings in order to provide clear audit trails. There have been no complaints received about the Glebelands during the last twelve months. According to the training matrix and interviews with carers, most staff have received training in vulnerable adult abuse and positive approaches and low arousal techniques. As we requested, one resident now has a behavioural management support plan which has been ratified by a psychologist. Some of the other residents can display challenging behaviour from time to time. Although we when spoke with staff they were clear about how to manage this, the lack of detailed behavioural management support plans has the potential to place people at risk. A recent allegation of staff misconduct had been made, and upheld. This was not reported to the Commission as required under the Care Homes Regulations 2001. We spoke to the manager about the potential to interpret this as an adult protection issue and as such, should have been referred to the Local Authority safeguarding manager for further discussion. The manager agreed to do so in the future. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Generally residents live in an attractive and comfortable home although the standard of some furnishings and furniture have deteriorated. Procedures which are in place to reduce the risk of cross contamination to residents, need improvement. EVIDENCE: We looked around the building with one resident who was happy to accompany us and show us parts of his home. 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. We looked at a resident’s bedroom and this was decorated and furnished to a good standard with lots of personal possessions and equipment. Since we last visited the settee in Flat 3 has been replaced and residents confirmed that they had chosen the new leather settee. We saw that the Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 23 external premises had been made safer and repairs had taken place to the loose tiling. The garden was pleasant with an allocated area for residents growing their own vegetables and plants. We were told by the manager that security problems we identified with regard to the adjacent bungalows was no longer an issue. We were also told that residents had been consulted about privacy and were happy with the arrangements (although there were no minutes from meetings to confirm this). Residents also told us that the floor boards on the first floor had repaired so they are less noisy. We were disappointed to see that the carpets in communal areas were still heavily stained as was the dining room chairs, settees and armchairs. There was a broken settee in Flat 4, one of the cushions had been removed and a resident was sitting on the other side of the settee. Staff on duty told us that this because it was soiled, although a senior worker who later appeared said that this had been removed in order to deter residents from sitting on the suite. The second settee had a torn cover with foam exposed. The manager told us that since our last visit carpets and furniture had been professionally cleaned, but had become stained once more. We looked at cleaning schedules and apart from vacuuming, there was no regular washing or deep cleaning. Staff told us that they did not have suitable equipment to undertake this task and had borrowed some from another care service on one occasion. We felt that this needed urgent action and have written separately to the provider asking for this to be undertaken. The first floor of the building was very warm and two large humidifiers had been purchased and were located in the lounges. These were effective but do not promote a homely atmosphere. Residents in Flat 3 said that they could not always open the windows as the keys were held by staff because they also unlocked kitchen cupboards (where confidential information was held). Apparently this is a problem at night times when there are less staff on duty. Residents also complained that they had frequently requested that an extra shower room be provided by converting an existing toilet, but that they had not received a response to their request. We looked at the communal bathrooms and laundry area in Flat 2. The laundry door was unlocked and there were substances hazardous to health (COSHH) which had not been secured; there are hot temperatures in this area to which residents could have access. This door must be kept locked when not in use. The laundry was dirty, dusty and untidy. A small filing cabinet was being used to store COSHH and other items. More suitable storage space would be beneficial as this is a very small area. We had previously asked for mop heads Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 24 to be laundered on a daily basis. The manager told us that these are being soaked daily in disinfectant. It is recommended that this is discussed with the infection control nurse. The communal bathrooms were also untidy. There was a range of bedding, incontinence products and a foot spa located on top of the storage cupboard. There was also a wheelchair stored in this area and a coat rail. Staff had tied plastic aprons around the handgrips and there were numerous packets of toilet rolls left lying around. There were two clinical waste bins in this bathroom. We also saw a communal plastic jug which staff said was used for rinsing residents’ hair. The communal shower room was similarly untidy. The waste bin had no lid. We discussed our findings with the manager who agreed with us about the issues of infection control and impact upon residents’ dignity. She told us that there had been domestic worker vacancy but she had recently recruited a new person who was due to start work. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 25 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. There have been improvements towards providing staff with suitable training in order to meet the specialist needs of residents. Unfortunately, there are still some staffing shortages and this has the potential to impact upon the consistency of care provided to residents. Recruitment and selection procedures now offer greater protection to residents although slight improvements are still necessary. EVIDENCE: We looked at the training matrix and spoke with staff. They told us that the training had improved, one person said “we’ve having lots of training now, never had so much”. Some specialist training is now taking place and staff told us they have completed courses in healthy eating, epilepsy and the Mental Capacity Act 2005. There is still a range of specialist training which needs to be undertaken but we could see that there are plans for this in the near future, for example with regard to autism. Only eight of the twenty seven support staff hold have NVQ qualification but the manager told us that she is confident that this will be improved as senior staff are now being trained as assessors. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 26 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 5 support staff per day time shift). However the manager feels that the situation has now eased as two residents have left. Staff told us “things are getting better now we have more staff”. Although the manager told us that the sickness levels are improving, there are still some shortfalls due to vacancies and maternity leave. These are covered by agency staff. Agency staff had covered forty-nine shifts during the last two months. On some occasions staffing levels have been depleted as cover could not be organised. When this occurs it usually means there is one less worker on duty and the manager is keeping us updated. One relative who completed a comment card stated “A few years ago I knew all the staff and they knew me, but now the staff seem to come and go”. We looked at a new member of staff who had been recruited. Appropriate preemployment checks had been undertaken with one exception. The manager allowed the person to commence duties without awaiting the receipt of two written references. She told us that she had taken two verbal references (although there was no written record of these available for inspection), and due to a misunderstanding with the Human Resources department, had thought the references had been received. We spoke with an agency member of staff who was on duty. He confirmed that he had been shown emergency fire exits and had received suitable training. There were records to confirm that he had the required clearance checks and had suitable experience for supporting people with a learning disability. 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) provider. The manager told us that new staff are completing this within the required timescales and that existing staff are also undertaking this training. The training matrix did demonstrate that some staff were undertaking LDAF. We did not see any LDAF certificates for new staff and therefore this will remain a recommendation. Staff still require training in equality and diversity. We looked at records and found that improvements are being made towards increasing the frequency of staff supervision. Although as yet, not all staff are receiving bi-monthly supervision sessions or an annual appraisal. Glebelands DS0000024984.V336051.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. Residents are benefiting from a stronger management team who are keen to improve the quality of the service provided. Slight improvements are needed in order that residents’ health, safety and welfare is fully promoted. EVIDENCE: Since the last inspection visit the manager: Mrs. Morgan has been registered by the Commission. During our visit Mrs. Morgan demonstrated that she is keeping herself up to date with changes in legislation and had recently undertaken training in the Mental Capacity Act 2005 as well as other specialist training. She is now enrolled on a Registered Manager’s award. All staff we spoke to were positive about the support they received from their Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 28 supervisors and manager. There are regular staff meetings and increased supervision sessions for staff. Staff are not appointed unless they have the skills and qualities required. A number of improvements have already been highlighted in this report; there are still some weaknesses however the manager is aware of these, and they are receiving action. The manager has devised a quality assurance system which is starting to be implementing. There are a number of quality audit checks. Questionnaires have been sent to residents, stakeholders and families. The manager is aware that she needs to analyze all of the responses once received, and establish an annual development plan for the home. The home is visited regularly by senior management. Although reports from visits these are not always completed by one of the senior management team. The manager had reported on the pre-inspection questionnaire that all maintenance checks are up to date. We looked at a sample of service checks and found that they were largely up to date. We identified some that some improvements were needed: the fire alarm system is not tested on a weekly basis individual risk assessments for all COSHH products need completing items of COSHH were found unsecured in Flat 2 fridge and freezer temperatures are not always consistently checked and no records are maintained of what action is taken by staff when these are found to be too high or low. Improvements are being made towards mandatory training for staff. There were details of forthcoming training displayed in the office. According to the training matrix (and interviews with held staff), the majority of staff have received training in moving and handling, fire safety training and first aid awareness. Some staff still require training in food hygiene, infection control and health and safety, but we were told that this is in hand. Glebelands DS0000024984.V336051.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 3 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 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 1 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 X 2 X X 2 x Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 30 YES 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 YA24 Regulation 13(3) Requirement To clean or replace stained carpets and furniture in communal areas in all flats. To include the regular cleaning of carpets and furniture on the cleaning schedule. Urgent Action – by 5 July 2007. To replace worn and stained settees in Flat 4. Urgent Action – by 5 July 2007 Timescale for action 05/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations To develop a rigorous and robust care planning system and ensure that it incorporates all aspects of personal and social support and healthcare needs. Reviews of care plans should be undertaken at least every six months (or as and when their needs change). Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 31 Care plans should be produced in a format suitable for service users. To continue to implement a person centred planning system for all residents. 2. YA8 To offer more opportunities for service users to participate in the day to day running of the Home through joining staff meetings, representation in management structures, recruitment and selection of staff. To improve the frequency of residents’ meetings. To review and expand risk assessments to ensure that there are written risk assessments established for all aspects of service users lives which pose a risk. To ensure that there is a system for regular reviewing of risk assessments. To improve record keeping with regard to activities undertaken, monitoring and evaluation. To ensure that there are individualised activity programmes/planners in place for all residents, in order to help and guide staff. 5. YA16 To ensure that any restrictions on choices are negotiated with all individual service users and advocates. Outcomes to be recorded in service user plans and reviewed regularly: for example the decision to not to provide bedroom door keys and to keep this under regular review. To ensure more consistent and detailed recording of residents’ chosen options for breakfast, lunch and dinner. To re-introduce a recognised nutritional screening tool for assessment and reviewing of nutritional needs. To ensure that preferences or restrictions on residents’ choices be negotiated, included in service user plans and reviewed regularly with regard to preferred bed times, bath times and opposite or same gender care. To continue to pursue the completion of the ‘priority screening for health care’ booklets. To ensure that care plans are expanded for diabetic service users. These must include guidelines for management of diabetes, screening, monitoring and potential complications. 3. YA9 4. YA12 6. YA17 7. YA18 8. YA19 Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 32 To introduce a procedure for the monitoring of service users health to supplement annual attendance at well person clinics with regard to potential complications such as breast cancer and testicular cancer etc. Specific care plans must be developed for these areas of health care screening with guidance to service users (if appropriate) with regard to self-examination. To ensure that residents have access to routine dental and ophthalmic checks with records maintained. To review and expand the medication policy to include all subjects: staff training, drug hazard alert notices, key holding and to forward a copy to the Commission for Social Care Inspection. To ensure that when any changes of medication are made on the MAR sheets by staff, such as the addition of new medication, two staff initials are obtained to confirm accurate instructions have been recorded. To ensure that night staff who administer medication complete accredited training in the safe handling of medication (or any other staff who are responsible for administration of medication). To establish written procedures for the secondary dispensing of medication on behalf of service users when going on social leave. These must include systems for monitoring and checking medicines. Advice must also be sought from the local pharmacist with documented records maintained. To expand PRN guidelines to include maximum days medication should be administered before medical advice is sought. To consider introducing a procedure for auditing and balancing medications which are not received on a monthly cycle in the monitored dosage system such as PRN pain relief medicines. To carry out reassessments as to whether any of the residents can be supported to take responsibility for their own medication. To ensure that the complaints procedure is produced in varying formats such as audio and pictorial (and made easily accessible to residents). 9. YA20 10. YA22 Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 33 11. 12. YA24 YA30 To ensure that any issues or concerns raised by residents are fully recorded, as well as the action taken by staff to address these issues, (such as those raised during residents’ meetings, one to one sessions etc.). To review the current system for ventilation on the first floor in consultation with residents. To keep the laundry clean, tidy and dust free. To source more suitable storage for the laundry. To seek advice from the infection control nurse regarding the practice of washing of mop heads in disinfectant solution rather than hot thermal temperatures. To ensure that communal bathrooms are kept tidy and free from extraneous items. To cease using communal plastic jugs for rinsing of residents’ hair. To provide awareness training for staff in cerebral palsy and diabetes, tissue viability, Makaton, autism, risk assessment and management plus person centred planning styles. To ensure that all staff are working to obtain an NVQ II or III by an agreed date; or the Manager must provide evidence to demonstrate that through past work experience staff meet this standard. 13. YA32 14. YA34 15. YA35 To ensure that new staff do not commence any duties without obtaining all of the pre-employment checks required by the Care Homes Regulations 2001, Regulation 19 (including two written references). To continue to introduce induction and foundation training for new and existing staff by a Learning Disability Awards Framework accredited provider. To ensure that induction is completed within the first six weeks of employment and foundation, within the first six months. To provide all staff with training in equal opportunities and disability equality. To continue to ensure that structured supervision of all staff is carried out bi-monthly. To provide all staff with an annual appraisal. To ensure that the manager is supported to complete a Registered Manager’s award. To continue to develop an effective quality assurance DS0000024984.V336051.R01.S.doc Version 5.2 Page 34 16. YA36 17. 18. YA37 YA39 Glebelands system to include feedback from service users, stakeholders in the community. To establish an annual development plan for the home based upon a systematic cycle of planning and review. 19. YA42 To provide mandatory training for staff in health and safety, infection control and food hygiene. To ensure that there is more consistent recording of daily fridge and freezer temperatures. Staff should also take appropriate action which is fully recorded, when fridge or freezer temperatures are found to be either too high or low upon daily testing. To ensure that the fire alarm system is tested on a weekly basis (or at the frequency specified by the manufacturer). To ensure compliance with Control of Substances Hazardous to Health Regulations 1988 - to carry out and update individual risk assessment on products used. To ensure that substances hazardous to health (COSHH) are held secure at all times (for example, the laundry area of flat two), or to demonstrate through a risk assessment why this is not necessary. 20. YA43 To ensure that there is a written report on the conduct of the home completed by the providers representative who is carrying out monthly visits. A copy must be provided to the Registered Manager and a copy should be forwarded to the Commission for Social Care Inspection. Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Glebelands DS0000024984.V336051.R01.S.doc Version 5.2 Page 36 - 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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