Inspection on 13/03/08 for 56-58 Gravelly Hill

This inspection was carried out on 13th March 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

56-58 Gravelly Hill 18/11/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Gravelly Hill, 56-58 Erdington Birmingham B23 7PF Lead Inspector Monica Heaselgrave Key Announced Inspection 13th March 2008 11:00 Gravelly Hill, 56-58 DS0000065009.V358184.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 Gravelly Hill, 56-58 DS0000065009.V358184.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. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gravelly Hill, 56-58 Address Erdington Birmingham B23 7PF 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) 0121 328 0612 01952 610996 Caretech Community Services Limited Dione Harding (acting) Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate 3 services under 65 for reasons of learning disability. 18th November 2006 Date of last inspection Brief Description of the Service: 56 Gravelly Hill is a traditional terraced house. It is registered to accommodate two people who have a learning disability; one person currently lives at number 56. 58 Gravelly Hill is a traditional terraced house registered to accommodate one younger adult who has a learning disability and complex needs, this house has been occupied for approximately ten years. Both houses have an internal door that joins the two together. Each house can function independently from the other. Both houses have a traditional lounge, dining room and kitchen. Bedrooms are located on the first floor reached via the stairs. Some internal changes to the layout and use of rooms in house 58 has taken place over a number of years in an attempt to make it more conducive to the person living there. 56-58 Gravelly Hill is located alongside a busy main road in Erdington, a residential area of Birmingham. It is in walking distance of shops, pubs, parks, places of worship and public transport. The information supplied to the Commission prior to the inspection, did not state the fees charged to live at the home. A copy of the last inspection report is available in the home for visitors to read on request. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Information was gathered from a range of places to inform the judgements made in this report. These included reports received from the home, a completed Annual Quality Assurance Assessment (AQAA) and previous inspection reports. A visit was made to the home, (the home being two houses numbers 56 and 58 Gravelly Hill), and direct observations made of the support given to people using the service. The Inspector was able to meet the two people who live in the separate houses, but it was not possible to seek both people’s views directly, due to their communication support needs and learning disabilities. The Manager, Area Manager and members of the staff team were spoken with and written records (including personal files, care plans, staff files, safety records and other documents) as well as direct observations were used to inform the judgements made in this report. A partial tour of both houses was made. Surveys were received from external professionals, staff and people who live in the home; comments from these are included in this report. Thanks are due to the people who live at both houses and staff team for their help and support throughout the inspection process. What the service does well: People’s strengths and needs are properly assessed, to make sure they get the care they need. Care plans are detailed, so that staff are clear about how people like to be supported. Plans are reviewed regularly, to make sure that they are kept up to date. Staff help people to do the things that they value and enjoy. They have worked with other people from outside the home to ensure they are doing the right things to support the people living in the home. The person who lives at number 56 is supported to keep in touch with people that are important to them, and develop a social life outside of the home. They are able to be a part of their local community and to do things around the house, according to their individual wishes and abilities. People from both houses get good personal care and support to keep medical appointments and specialist healthcare, according to what they need. People are encouraged to eat healthily and to enjoy their food. All of these things are done to help them stay healthy and well. Many of the staff have worked there a long time, so people know each other well and staff have a good understanding of how people like to be cared for. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 6 The home is well run and the Manager has a positive attitude to developing the service for the benefit of the people who use it. People feel that they can speak up if they are concerned about anything, and are confident that what they say is listened to and taken seriously. The staff team has enjoyed regular training opportunities to help them do their jobs even better. People from outside of the home regard the staff as competent and professional, with particular skills in supporting people who have a range of complex needs. What has improved since the last inspection? What they could do better: 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. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 7 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 Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The comprehensive statement of purpose and service user’s guide provides information in a format suitable for the needs of people in the home. This ensures the information is meaningful so that they can make an informed choice about living in the home. The service has been very efficient in undertaking assessment of needs, working hard to establish what individuals want and need and how they can best provide it. EVIDENCE: CareTech (the registered provider) have developed the statement of purpose and service user guide. These have been reproduced in pictorial format and will include photographic input to inform people of the staff that work in the home. The format is well suited to the needs of the people who use the service. A new ‘welcome pack,’ which will also contain photographs, was seen, this had lots of information to enable people to know what to expect from the home and help people to make decisions about moving into the home. This information was also supported with pictures, about what to expect from the home, the people you would meet, the type of training and qualifications staff have in order to do their job, and lots of information about the routines of the day and how staff can support people with these. For instance giving some cards with the address and phone number to the service user to distribute to their friends. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 9 The information supplied to people who live in the home includes a contract, also in pictorial form, this details services, fees and accommodation, so that people using the service are informed as to what to expect. There has been some innovative ways of helping prospective individuals to choose a home that will meet their needs and preferences. Clear information is available to help people understand what services the home can provide. This now needs to be developed further so that the information is specific to Gravelly Hill. A minor amendment to change the address of the Commission on this information is needed. There is a robust system in place to ensure the support needs of people are in sufficient detail to inform care planning, this means that the assessment of need says exactly what support is needed and how it will be provided. A comprehensive assessment was seen, which demonstrates that the manager and staff team have clearly worked hard in developing this system for the benefit of the people who use the service. Information has been gathered from a range of sources including other relevant professionals including advocates and with the individuals’ interests taken into account. This ensures the home will meet their needs, aspirations and expectations. Comments from the most recent person to move into the home, confirmed that they had favourably introductions. They had opportunities to visit, meet the people who live and work at Gravelly Hill, and had opportunities to stay overnight, to support them in their decision to use the service. Five completed surveys were received, three of these from professionals involved with supporting the people who live in the home, and two surveys from the two people who live in the home, one completed with staff support. All stated that people had sufficient information to help them make a decision about using the service at Gravelly Hill. Comments included, “My manager and advocate helped me to choose where I wanted to live, I made visits and it’s near to work and bus stops”. “The home is very supportive in this regard”. Gravelly Hill, 56-58 DS0000065009.V358184.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): 6,7,9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are detailed, up to date, and person centred ensuring the person living in the home gets the support they want in ways that suit them. Staff had supported and encouraged people to be involved in the ongoing development of their plan. Risks are properly assessed, so that people are not denied opportunities to experience different things. EVIDENCE: Two people currently live at Gravelly Hill. One person lives at number 56, which is registered to accommodate two people. This person moved into the home in 2007. House 58 is registered to accommodate one person with complex needs who has lived there for approximately ten years. Care plans for the two people were up to date and set out in comprehensive detail the needs of the person, and how the care staff should carry this out. Care plans included information on the persons likes and dislikes, health Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 11 needs, personal care, culture and preferences. Staff had consulted with a range of professionals to promote best practice for the individual. A high level of consultation with the individual has ensured that their wishes and choices are known and carried through into their care plan. This is particularly admirable given the complex needs of the people in the home, staff has worked hard in seeking their views and exploring options with and for them. The risk assessment and daily report notes showed that these are linked to the care plan and the Health Action Plan. Both of these are in pictorial form to ease understanding. The Health Action plan shows the specific support the individual requires and is clearly detailed and allows staff to provide a consistent approach to meeting people’s health care needs. Peoples plans showed how decisions about accessing employment and education options are made, what weekly activities people wish to engage in, the support they wish to make friends and how they are to stay healthy. It was evident that staff have explored with individuals, specific routines that are important to them. This means that the person has positive and planned interventions designed to meet with the individuals’ choice and capabilities. Behaviour management strategies had been kept under review and gave information on how best to support people these included clinical advice from a range of external professionals. People are supported to make choices about what and when they eat, when to go out, how to spend their time when to see family and friends. Daily records seen indicate the choices that people make. The risk assessments covered general health, personal hygiene, independent travel, finances, behaviour and vulnerability. Discussions with the manager indicated that risk-taking is seen as an essential feature of supporting people to be safe and to promote their independence. A number of risk assessments were sampled and indicated that they are kept under review and updated due to changes in needs or circumstances. Due to some complex needs there are specific risk assessments in place covering visitors, such as when the dentist or optician calls. Staff spoken with was very well versed in what to do to support the individual and to advise the visitor. There is good consultation with the people who use the service. Regular keyworker meetings, and ‘Talk Time’ takes place, this ensures that people have a better-improved degree of choices and means of consultation. It was positive to see that goals are more specific and measurable, for example the planning and cooking of a meal, this means staff are able to support people in meeting goals and assessing if they had been met. There are several platforms designed to seek the views of people as to what they wish to do, for instance there is a monthly life and leisure plan discussion, monthly activity plan and a summary sheet. These provide a systematic way of seeking views, people are asked ‘How are you, how have you been involved in running the home, are Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 12 there any activities you would like to be doing, any improvements you would like to see. The inspector met the two people living at Gravelly Hill; one expressed their views as to how far they are consulted with regards to events within the home. They reported being involved in the redecoration of their bedroom, menu planning, activities, college and employment options, and developing a social life away from the home. Surveys received from people who use the service made positive comments relating to being able to do the things they enjoy, and having enough activities to engage in. People who live at Gravelly Hill are actively supported with cultural and dietary needs. People have identified needs in their care plan relating to their food requirements, and any risks associated with this. One person has specific preferences and another has some cultural preferences, both are provided positively. Observations took place at different times throughout the fieldwork visit people received good support from staff that spoke calmly and respectfully. Gravelly Hill, 56-58 DS0000065009.V358184.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): 12,13,14,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to take part in valued activities, so that they get to do the things that they like that are important to them. They are able to make use of local facilities, ensuring that they have a broad social life. They get the support they need to make sure that they can stay in touch with people who mean a lot to them. They are able to make positive choices about the food they eat, so that they enjoy their meals and have a balanced diet. EVIDENCE: The staff team help both people who live at the home with their choices. It is important that staff have the appropriate communication skills to enable residents to fully participate in daily living activities. It was particularly impressive to see that the care plan advises staff how to best communicate with individuals so that communication is a two-way venture and the resident has a means of expressing their choices. For instance one care plan advises staff of the pace and language to be used, how to position themselves so that Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 14 the individual can hear and see, and use of body language so as not to confuse the message you are communicating. The two people who live at both number 56 and number 58 are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. One person is fully involved in developing domestic skills in the house such as laundry, cooking, shopping and cleaning. The other person engages to a lesser degree. Both people have been supported to continue with and develop personal interests. From the two care plans looked at and a discussion with one person, it was evident that interests such as photography, arts and crafts, music, social clubs, college and employment options have been undertaken with appropriate risk assessments in place to ensure activities are undertaken safely. The home have assessed the lifestyle needs of the individuals and considered through the risk assessment process health and safety issues. This ensures people can engage in activities with the right support to keep them safe, for instance travelling independently. Records show that daily choices are made about the routine of the day, activity, meals, clothes and personal care. The individual has a choice over social contact with people who work in or visit the home, and this is respected. A book of pictures is used to help with communicating choices and preferences such as with meal planning. A record of choices made by the individual is recorded on a format known as “talk time”, this records requests made by the resident, such as wanting to join a martial arts club. It was also noted direct discussion takes place with the individual to review their choices and set new goals. This ensures that the care plan is meeting the needs and desires of the individual concerned. The involvement of the occupational therapist has been sought to support staff in developing the skills to engage in activities with one person, with a view to widening the choice of daily living skills. One person is fully involved in the domestic routines of the home. They take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. The menu is planned by them, with staff support and shopping days identified. The menu includes cultural choices and preferences. Healthy eating options appropriate to the individuals’ dietary needs are included. Links with the dietician and weight clinic are established. It is recognised that some choices are not always healthy and a care plan has been developed to promote a healthier diet. Health issues are being closely monitored. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs are clearly recorded in the health action plan. They give a comprehensive overview of the individuals health needs and act as an indicator of change in health requirements. This is well planned and promotes the health and well being of the individual. EVIDENCE: The personal appearance of the people living at numbers 56 and 58 Gravelly Hill, was good and indicated that they receive good support to attend to their personal care needs. They wore clothing appropriate to their age, culture, time of year and activity. Care plans had details of people’s personal care routines and preferences. There was enough staff on duty to support people in the way they prefer and require. Both people currently living in the two houses are mobile and do not require the use of lifting aids or adaptations. Bathing and shower facilities are suited to their needs. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 16 The home has a stable staff team which gives continuity of care to people living in the Home, this is particularly important so that staff have a good understanding of the complex needs of people and how best to respond to these. The manager has developed health action plans; a health action plan is a plan of what a person needs to do to stay healthy. There is now a lovely system which is in written and pictorial format and enables the individuals at Gravelly Hill with support, to say what their health care needs are, and what support they need in order to maintain good health. This gives clear details on any concerns to look for and how staff should respond to these. There was also a section on appointments attended, treatment received and next appointment date this will make it easy to track health care appointments. Specific health needs had been identified and where required people had input from a range of health professionals including dentist, optician, G.P. psychiatrist, dietician, and occupational therapist. The health action plan is linked to risk assessments for health concerns such as diabetic care, foot care, and weight concerns. A shorter version of this plan called a ‘Hospital Assessment Plan’ was also seen. This identifies essential information about the individual that should go with them to hospital. It includes ‘things you must know about me’, ‘things that are really important to me’ and ‘things I would like to happen’, these are colour coded red, amber and green and ensure hospital staff know the key areas that are important to the individual. The health action plan is a comprehensive well-written document. Staff has worked hard to complete these alongside the individual resident. It is recommended that the home has access to IT systems to help individuals to build their own health action plan as this will further enhance effective consultation and involvement of individuals who due to communication needs would otherwise find this a difficult task. Sampling of the accident records and regulation 37 reports showed that accidents are followed up and recorded to show what steps were taken to ensure the wellbeing of the person. There have been no accidents in the last twelve months. Incident reports were detailed and included body charts to identify where any injuries were evident. There is a robust system in place for reviewing any accidents or incidents and counter signing these documents by the Area Manager; this ensures that the safety and well being of people is kept under review. The home has medication policies, procedures and practice guidance. Staff spoken with had a good understanding of these. Medication records were seen and showed they are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. It was recommended that a temperature record be implemented Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 17 to ensure medication is not exposed to temperatures above the recommended levels. Staff are currently supporting one person to self-administer medication, this is within the risk assessment framework and identifies what support is needed to do this safely. Sample signatures were available for all staff that administer medication and protocols were in place for medication taken on an, ‘as required’ basis which ensure that the homes medication procedures promotes safe practice for people living in the home. Gravelly Hill, 56-58 DS0000065009.V358184.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 good. This judgement has been made using available evidence including a visit to this service. There are good arrangements in place to ensure that the views of the people living in the home are listened to and acted on. Robust procedures ensure people who live at Gravelly Hill are protected from abuse. EVIDENCE: The service has a complaints procedure that is clearly written and produced in pictorial format to ease understanding. There is a pre-printed complaint letter of response to inform the complainant of the outcome of their concerns, and this ensures people know they are being taken seriously. CSCI have been appropriately notified of incidents that have occurred in the Home. Regulation 37 reports have been completed logged and forwarded for information, ensuring there is a thorough paper trail in place to demonstrate that issues have been dealt with appropriately. The two people living at Gravelly Hill have communication support needs. One person is reliant on the vigilance of staff members who know them well to interpret changes in demeanour, behaviour or body language, to alert them to the fact that something is amiss. One person did comment that he knew he had the right to complain and clearly understood how to do so. The style of management is open and inclusive opinions are heard and acted upon, with good examples of people being at the forefront of consultation. There are platforms to seek resident concerns; through ‘Talk Time’, resident Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 19 surveys and advocates. Concerns voiced through an advocate led to a positive outcome for the resident. A record of any complaints made is maintained. Staff had completed training in the protection of vulnerable adults, and policies and procedures to include whistle blowing are readily available to them. Staff gave satisfactory answers to what they would do if they suspected abuse. The Manager was aware of the new Mental Capacity Act and staff had completed training on this subject. This Act provides a statutory framework to empower and protect vulnerable people who may not be able to make their own decisions. One of the people spoken to during the visit said they can talk to staff or the manager if they are not happy about something, “I like the staff if anything goes wrong they are always there to help, and listen to me”. One completed survey from a person living at Gravelly Hill showed they knew who to talk to, to make a complaint or raise a concern. The home had not received any complaints since the previous inspection and CSCI had not received any concerns, complaints or allegations about the Home. Multi agency procedures advising staff what to do and who to contact were available in the office. The responsibility of reporting protection issues is known, discussions with staff confirmed that they had training in this area and understand the steps that need to be taken to protect people in their care. The AQAA provided information that indicated a whistle blowing policy was available ensuring staff know the expectations of reporting matters of protection. Discussions and observations at the time of the fieldwork indicated a commitment by the manager to the safeguarding of the people who live at Gravelly Hill. People live independent lives and are supported to take acceptable risks within a risk assessment framework. The ‘missing persons procedure’ has been amended to include a visual check of the person on their return and any concerns reported to the G.P. It was positive to see that protocols for one individual regarding personal safety had been discussed, agreed, and signed by him. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 20 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): 24,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The design and lay out of house 58 provides a physically safe environment, but not one that can be fully utilised or accessed by the person living there. Both house 56 and 58 are comfortable and a programme to improve the decoration, fixtures and fittings is evident, although several areas now need improving. EVIDENCE: House 56 was refurbished in 2007 one person currently lives there. The communal areas of this house presented as homely, and clean with furniture and fittings appropriate to the needs of the person who lives there. The kitchen was spacious and clean with domestic appliances the person could manage with support. The person who lives in the home uses the kitchen, he said he enjoys cooking and spends time in the kitchen with staff planning his menu, shopping and cooking. The bedroom had been redecorated, was individual in style and clearly reflected personal tastes and preferences. Personal items had been encouraged Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 21 to make the environment more homely and personal. The bathroom facilities meet the needs of the person who lives there. There is a nice garden to the rear, which is utilised in the summer months. To the front of the property the brick wall has many bricks missing, this has been a concern at previous inspections and has not been repaired. House 58 was clean and comfortable. Not all areas of the house were viewed due to the potential distress this would cause to the person, who has complex needs. Changes to the immediate environment have been made over a number of years in an attempt to safeguard the safety of the person living in the house, and provide an environment that was suited to the persons’ complex needs. The areas of the house have therefore been arranged to suite these needs. This has included doors being fitted to the top and bottom of the stairs to prevent injury to the person on the stairwell. The lounge area has been converted to a snoozelem room, which has sensory, and soft furnishings for the person to utilise safely. The AQAA informs that the bathroom facility, kitchen and snoozelen need to be further developed. The carpet has a ‘busy’ pattern, which may not be the best design for the person who lives in the house who has autistic tendencies. The carpet colour and pattern on the stairs is the same design and does not help recognition of the other steps. This could be a safety hazard for the person and staff who use the stairs daily, as it is difficult to recognise the definition of the steps, for instance where one step ends and another begins. The stairs are narrow and steep and do not provide adequate space should a situation develop that needs staff intervention. The house is located on a very busy main road, the volume of fast moving traffic and generating noise is evident, and parking is limited. Currently the person living in the house chooses not to go out. The porch to the front of the property is in a poor state of repair, drain pipes at the front of the property need attention, and the fence panels to the rear of both gardens have fallen and need replacing in order to secure the grounds. New kitchen doors have been fitted to the kitchen units, new flooring and a repair to the ceiling has been done. The bedroom has been redecorated (although this was not viewed on the day). The AQAA informs that the maintenance team will be devising a plan of action to address environmental issues, these will need to be undertaken in a timely manner, as with the front brick wall this has been a concern for some time. A programme of repairs for both interior and exterior should be completed to inform the Commission of proposals to address these issues. Whilst it is evident that efforts have been made over a number of years to improve the property at number 58, in terms of maintaining a ‘safe’ environment, the suitability of the house to meet the need of the resident in Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 22 terms of its lay out and design, is not ideal. It does not provide a physical environment that can be fully utilised or accessed by the person living there. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People, who live at and have contact with Gravelly Hill, have confidence in the staff team. Staff are competent and have access to a good range of training opportunities to help them meet the needs of people at the home. The organisations recruitment processes protect people. EVIDENCE: The staff team is well established, and consists of people who have got to know the people who live at Gravelly Hill, well. There has been no staff turnover in the last twelve months, except for the manager, who is known to the people who live at the home, through another service. Staff rotas show that staffing levels have been maintained. People who live at Gravelly Hill have complex needs and appropriate staffing levels are essential. One person described staff in very positive terms, they said they like them, enjoy good relations, and can talk to them. Interactions between staff and people in the home were entirely positive, and the way people were supported was respectful. Staff responded well to prompts by people who live in the home. For example, a person who clearly indicated that they wished to spend time alone was supported to do so. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 24 Routines such as getting up and meal times are flexible to ensure they suit the individuals’ needs. Another person was assisted with preparing the evening meal. Staff members showed skills in using preferred communication techniques to support people with difficulty in communicating their needs. Two staff files were looked at both showed key pieces of documentation including ID, photo, health declaration and completed application form and two references, is maintained. One file showed confirmation of CRB clearance. The other related to a pre CareTech employee and did not have the CRB and POVA check. The Area Manager identified on site with the personnel department how the oversight had occurred and confirmed that a new CRB and POVA check would be carried out. The system in place for recruiting staff ensures that people are protected by the home’s practice. It was positive to see that service specific training has been completed to meet with the specific needs of the people who live at Gravelly Hill. This included Autistic spectrum, Epilepsy, sex and sexuality, diabetes, and challenging behaviour. All staff had completed the mandatory training including Fire Safety, First Aid, Manual Handling, Adult Protection and Food Hygiene. The homes self assessment information (AQAA) advised that 50 of staff had achieved NVQ level 2 or above in care. The Area manager advised that further service specific training is being booked in Schizophrenia, dementia and bereavement. The consistently good approach to staff training and development ensures a competent and skilled workforce meets peoples’ needs. Staff spoken to felt that they are supported to translate their training into good care with positive outcomes for people using the service. Discussions with staff identified that they had a good understanding of the specific needs of people to include their methods of communication, and understanding and anticipating behaviours; this ensured they had the skills necessary to support the individual in a positive manner. Positive comments were received in surveys returned by external professionals who know the service well, these included; ‘The staff are very good at understanding the needs of the client and use their strong personal relationship with the client to meet needs.’ ‘Staff is constantly refining their skills to understand the needs of the client’. ‘The staff have a very individualised and person centred approach’. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and management team ensure the smooth running of the home in a competent manner. Systems are in place for monitoring the quality of the service offered with a view to continuous improvement. The health and safety of the people living in the home and staff was being well managed. EVIDENCE: The current Manager has worked in the home for several months. She is known to the people who live there and has a good working knowledge of their needs. She has enrolled for NVQ level 4 and is undertaking CareTechs’ standardised manager-training scheme, which sets out the expectations of care managers and equips them with the necessary skills to manage the home. She has previous experience in a senior role in other services run by the organisation. She presents positively and is working hard to improve the Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 26 service for the benefit of the people who use it. There are positive signs that steady improvements are being made particularly in the area of engaging the people who live in the home, to have a more active say in planning their care. An application to register the Manager with the Commission for Social Care Inspection should now be made. A system for monitoring and assuring the quality of the service provided has commenced. Surveys for people who live in the home have been produced in pictorial form to ease understanding. Visits on behalf of the Registered Provider take place each month as required. Other related activity has been referred to earlier in this report, including key worker meetings, care plan reviews, analysis of activity opportunities, Talk time, and so on. The organisation has a generally good record in taking positive action to find out what people think about the services provided. Work already done in this regard needs to be collated, information analysed, and findings made available, so that these show how the views of people using the service have been used to guide its future development. The work done already in person-centred planning and setting goals with measurable outcomes will support this process further. Safety records were sample checked. The manager carries out regular health and safety audits and maintenance checks for both house, and a maintenance person is available to oversee any work/repairs required. This ensures that the immediate environment is maintained safely for the people who live in both houses. Records of checks on the fridge and freezer and water temperatures have been completed appropriately. Food stored in the fridge was labelled appropriately and dated, however rotting carrots were removed from one fridge and celery dated 5th February and cucumber, removed from the other. There needs to be better monitoring of the food safety in both houses, to ensure people living there are not using foods where the date has expired. The bank staff member preparing the evening meal did not have up to date food safety training, there needs to be a system to ensure that where bank staff are working in the home, their training and qualifications are in line with the tasks they will be expected to undertake. The fire alarm and emergency lighting systems, and the fire-fighting equipment had been serviced. Fire training and evacuation drills were up to date ensuring staff know how to support people in the home, in the event of a fire. At the previous inspection it was reported that the fire officer had asked for an emergency light to be considered on the staircase of the two houses. This area was viewed, it is difficult to see other steps, there are no ‘mind the step’ signs and the carpet colours do not help recognition of other steps. It is a dark narrow stairwell there are therefore concerns that this may impede safe Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 27 evacuation in a smoke filled environment. This was discussed with the Area manager who was advised to carry out a risk assessment and look at how this area can be made safer for the people who live in the two houses by providing adequate lighting in emergencies and that the steps at the top of the stairs can be clearly seen. The Landlord’s gas safety certificate and certificate for the electricity circuit are both in date. Portable appliance testing has been carried out on electrical equipment kept in the home. Regular testing and recording of water temperatures have been completed, and the home’s COSHH store was secure. The management of records relating to accidents and incidents is good; risk assessments are in place to identify strategies for self-injurious behaviours. These are further supported by behavioural management plans in consultation with the psychologist. Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 YA24 Regulation 13(4a-c) 23(2 b) Requirement To ensure the premises are safe and comfortable for the people who live in the home, the following repairs are needed: *Repair brick wall to front of property. *Repair/replace fence panels to rear of both properties. *Repairs to porches of both properties. *Repairs to drainpipes both properties. A programme of repairs for both interior and exterior should be completed to inform the Commission of proposals to address these issues. Adequate lighting and a means of ensuring the steps at the top of the stairs can be clearly seen, in both houses, must be reviewed to ensure safety in emergencies. Timescale for action 30/07/08 2. YA42 YA42 13(4)(a) 23(4)(b) 30/07/08 Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The format for the service user guide should be developed so that it contains information that is relevant to 56-58 Gravelly Hill. This will assist people to have accurate information about their home and the terms and conditions of their stay. It is recommended that the home has access to IT systems to help individuals to build their own are plan and health action plan. This will further enhance effective consultation and involvement of individuals who due to communication needs would otherwise find this a difficult task. A temperature record should be implemented to ensure medication is not exposed to temperatures above the recommended levels. To improve the environment review the suitability of the carpet design in house 58. Develop the bathroom facilities in house (58) and the kitchen in house (58). So that people have an environment that is safe and comfortable. It’s recommended that an audit be undertaken to ensure all pre-CareTech employees have appropriate CRB and POVA checks in place, to protect vulnerable people in their care. An application to register the Manager with the Commission for Social Care Inspection should now be made, to ensure a person who is competent to do so manages the home. It is recommended that the findings of the quality assurance monitoring is collated, analysed, and made available, so that these show how the views of people using the service have been used to guide its future development. This report should be in a format suited to the needs of the people who use the service. 2 YA6 3. 4. YA18 YA24 5. YA34 6. YA37 7. YA39 Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands Office 77 Paradise Circus Queensway Birmingham West Midlands B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gravelly Hill, 56-58 DS0000065009.V358184.R01.S.doc Version 5.2 Page 32 - 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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