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Inspection on 06/12/06 for 29 Greenhill Road (westholme)

Also see our care home review for 29 Greenhill Road (westholme) for more information

This inspection was carried out on 6th December 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff present at this inspection demonstrated good knowledge of service users individual needs and had clearly made strong relationships with them. Considerable effort has been made to personalise service users bedrooms to reflect their personal tastes and interests. The staff are very good at helping people stay in touch with their family. This includes making phone-calls, writing letters and in person. Service users spoken with said they were generally happy with the home, comments included `the food is nice` and `I can speak to my keyworker about any problems I have`. Staff have training in how to meet the needs of the service users so they can support them well. Where staff have been unable to meet the needs of one service user they sought the advice of other health and social care professionals on how this individuals needs can be best met.

What has improved since the last inspection?

This home has improved in many areas.The Manager has met with other staff and identified how assessments for prospective new service users can be more comprehensive to ensure the home does not admit anyone whose needs it cannot meet. Staff have been working with a health professional to complete an assessment for each individual to establish if there has been any improvement or deterioration in individuals needs. Each service user now has a care plan that is generally up to date and provides staff with most of the information they need so that they know how to support individuals. Information about the goals agreed for individuals was seen to be improved from previous visits, anticipated dates for completion and who was responsible were clearly recorded. The Manager has developed a tracking system that highlights when assessments are due for review as previously not all assessments were regularly reviewed to ensure individual needs are still met. The Manager has undertaken several audits of the activities undertaken by service users, comparing what activities were scheduled and what actually took place. The Manager said the results of the audits had been extremely useful in planning future activities and identifying areas for improvement. A menu book has been developed and placed in the dining room so that service users can read what the meal of the day is. Medication practice is much improved so that service users now receive the medication they need safely. The premises were generally in good order and improved since the last inspection, making the home a nicer place to live. Work is also underway to install a passenger lift, this will assist service users who have mobility difficulties to access the first and second floors more easily. Recruitment practice has improved to ensure that service users are protected from having unsuitable people working with them.

What the care home could do better:

Action is needed to ensure care provided is consistent with the care plan so that all service users get the support they need. The Manager must ensure that food is properly stored and is in good condition, and discarded when past its best or use by date so that service users do not eat food that is in poor condition.A satisfactory complaints procedure is available but this must be consistently applied when responding to complaints to ensure service user views are listened to and acted on. Improvement is needed to financial recording to ensure individuals monies are safeguarded from risk of financial abuse. Staffing levels are not always satisfactory at weekends, this needs review so that staff have the time they need to meet service users needs. The staff training records need review so that they are up to date and the reader can easily ascertain the training undertaken by staff. For some newer staff supervision needs to be more regular to ensure staff are well supported in their job role. The Manager needs to ensure all areas of risk to service users are assessed to protect their health and safety.

CARE HOME ADULTS 18-65 Greenhill Road, 29, (westholme) Moseley Birmingham West Midlands B14 9SS Lead Inspector Kerry Coulter Unannounced Inspection 6th December 2006 09:45 Greenhill Road, 29, (westholme) DS0000016713.V323674.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 Greenhill Road, 29, (westholme) DS0000016713.V323674.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. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill Road, 29, (westholme) Address Moseley Birmingham West Midlands B14 9SS 0121 449 6383 0121 449 6573 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) suehullin@tracscare.co.uk TRACS Vacant Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be aged under 65 years 14 people requiring care for reasons of learning disability or acquired brain injury (14 LD,PD) Date of last inspection 13th June 2006 Brief Description of the Service: 29 Greenhill Road comprises of two units, TRACS Westholme, and TRACS Hilltop. TRACS Westholme is registered to accommodate ten people under the age of 65, who have a Learning Disability or Acquired Brain injury. Three of the rooms within the accommodation on the ground floor have been adapted to support people with impaired mobility. The remaining bedrooms are on the first floor, and full mobility is required to access these rooms, however installation of a passenger lift to improve access is underway. This part of the home has a communal lounge, dining room, smoke room, kitchen, and bathrooms and toilets on both floors. TRACS Hilltop occupies the second floor of the home. Hilltop provides care and support for up to four service users working towards more independent living, offering people the opportunity to develop skills such as budgeting, cooking, home making, and taking greater responsibility for planning their lifestyle. This area of the home has a separate staff team, and its own facilities such as a lounge, kitchen, laundry and bathroom. The home has a large, mature garden at the rear. The home has its own transport, and is located close to local bus routes. The current scale of charges for living at the home ranges from £947.87 to £1494.85. Copies of CSCI reports are available in the home, on request. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and reports from the provider. The unannounced fieldwork visit was carried out over nine and a half hours. This was the homes second key inspection for the inspection year 2006 to 2007. The inspector spoke with three staff and the Manager, six service users and time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. Service user, relative and professional survey forms were left with staff at the home. At the time of writing this report one survey had been returned from a relative and ten from service users. What the service does well: What has improved since the last inspection? This home has improved in many areas. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 6 The Manager has met with other staff and identified how assessments for prospective new service users can be more comprehensive to ensure the home does not admit anyone whose needs it cannot meet. Staff have been working with a health professional to complete an assessment for each individual to establish if there has been any improvement or deterioration in individuals needs. Each service user now has a care plan that is generally up to date and provides staff with most of the information they need so that they know how to support individuals. Information about the goals agreed for individuals was seen to be improved from previous visits, anticipated dates for completion and who was responsible were clearly recorded. The Manager has developed a tracking system that highlights when assessments are due for review as previously not all assessments were regularly reviewed to ensure individual needs are still met. The Manager has undertaken several audits of the activities undertaken by service users, comparing what activities were scheduled and what actually took place. The Manager said the results of the audits had been extremely useful in planning future activities and identifying areas for improvement. A menu book has been developed and placed in the dining room so that service users can read what the meal of the day is. Medication practice is much improved so that service users now receive the medication they need safely. The premises were generally in good order and improved since the last inspection, making the home a nicer place to live. Work is also underway to install a passenger lift, this will assist service users who have mobility difficulties to access the first and second floors more easily. Recruitment practice has improved to ensure that service users are protected from having unsuitable people working with them. What they could do better: Action is needed to ensure care provided is consistent with the care plan so that all service users get the support they need. The Manager must ensure that food is properly stored and is in good condition, and discarded when past its best or use by date so that service users do not eat food that is in poor condition. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 7 A satisfactory complaints procedure is available but this must be consistently applied when responding to complaints to ensure service user views are listened to and acted on. Improvement is needed to financial recording to ensure individuals monies are safeguarded from risk of financial abuse. Staffing levels are not always satisfactory at weekends, this needs review so that staff have the time they need to meet service users needs. The staff training records need review so that they are up to date and the reader can easily ascertain the training undertaken by staff. For some newer staff supervision needs to be more regular to ensure staff are well supported in their job role. The Manager needs to ensure all areas of risk to service users are assessed to protect their health and safety. 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. Greenhill Road, 29, (westholme) DS0000016713.V323674.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 Greenhill Road, 29, (westholme) DS0000016713.V323674.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): 2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure prospective service users individual aspirations and needs are assessed before they move into the home to ensure the home is a suitable place for them to live. EVIDENCE: Requirements were made at the last key inspection to ensure a full preadmission assessment of prospective service users is undertaken and better use is made of trial visits. The Manager has discussed with senior staff how these improvements can be made. Minutes of meetings show it has been agreed that pre-admission visits will be more thorough. Whist no new service users have moved to the home, an assessment was available for a potential new service user. A full assessment had been completed by a senior Tracs staff. The Manager had also contributed to the assessment with the view that this individuals needs were not compatible with other service users already accommodated. Sampled terms and conditions had been signed by the service user or their representative. These included the level of fee and room allocated. Greenhill Road, 29, (westholme) DS0000016713.V323674.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, 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff generally have the information they need to support service users to meet their needs and achieve their goals. Service users are supported to make decisions about their day-to-day lives. Service users are usually supported to take risks within a risk assessment framework but one area of risk had not been assessed. EVIDENCE: Since the last inspection the staff have been working with a health professional to complete an assessment for each individual that covers life skills, communication, cognition and emotion. The Manager said that the assessments will be used in future years to establish if there has been any improvement or deterioration in individuals needs. The care provided to three service users was case tracked. Each individual had a care plan. This was an improvement from the last visit when one of these individuals did not have a plan available. The plans sampled covered all areas Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 11 of need to include family, activities, community, communication, health needs, routines and religious /cultural needs. Behaviour guidelines were observed to be available where needed and included triggers to behaviours and guidance for staff on how to respond. Information about the goals agreed for individuals was seen to be improved from previous visits, anticipated dates for completion and who was responsible were clearly recorded. In one care plan records indicated the individual should be monitored hourly, some records showed this was being done. However on some days the record had gaps and on one day only two observations were recorded. Discussion with a staff member and the Manager gave conflicting information as the staff said this individual was monitored hourly but the Manager said it was no longer needed. Action is needed to ensure care provided is consistent with the care plan. Service users have an annual review. It is good that staff work with service users before the review to seek their views. Service users are then encouraged to attend their review meeting, which includes staff, relatives and other care professionals as appropriate. Staff are struggling to meet the needs of one individual due to them refusing most input from staff. Staff are working closely with other care professionals to try and meet the individuals needs whilst professionals identify another service that can meet them more effectively. Several meetings have taken place with professionals, another is planned for January. Records showed that service users are consulted on what goes on in the home and are supported to make choices as much as they are able to. Regular meetings are held with service users. Topics discussed include meals and activities. The minutes of the most recent meeting were on display in the hallway. Some of the content was a little difficult to read due to the handwriting, consideration should be given to typing the minutes, making them easier for service users to read. Surveys received from service users recorded the views that they always, usually or sometimes make decisions about what they do each day. There were no service users who said they never made decisions. Risk assessments for service users were wide ranging and including smoking, manual handling, fire evacuation, falls from bed, refusal of medication, accessing the community. Risk assessments sampled had been evaluated regularly. Since the last inspection the Manager has developed a tracking system that highlights when assessments are due for review as previously not all assessments were regularly reviewed. However not all areas of risk to service users had been assessed. During the visit work was underway to install a new passenger lift in the home. The contractors had been working in the home for several days. Some service users had to pass by the lift shaft to get to their bedrooms. A risk assessment was not available for risks to service Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 12 users but had been completed for the contractors. Following the visit a risk assessment was completed and forwarded to the CSCI. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that people who live in the home experience a meaningful lifestyle. Contact with family and friends are facilitated. Service users are offered a healthy diet and staff support them appropriately at mealtimes. EVIDENCE: Activity records for three service users were sampled. Two participated in a wide range of activities to include- lunch out, visit to the pantomime, walks out to buy newspapers, hand massages, pub visits, shopping and gardening. One service user who has been choosing not to engage in activities away from his room has been offered 1:1 time with staff. Sampling of daily records showed that generally planned activities take place. One service user spoke about how they were enjoying a flower arranging course at a local college. It was nice to see that the flower arrangements were on display around the home. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 14 Newspapers and magazines were observed to be available in the lounge for service users to look at. During the visit staff were observed engaging with service users, for example playing dominoes. One staff spoken with said that one service user was doing three different college courses including British Sign Language, another has started doing some voluntary work at a library. Since the last inspection the Manager has undertaken several audits of the activities undertaken by service users, comparing what activities were scheduled and what actually took place. The Manager said the results of the audits had been extremely useful in planning future activities and identifying areas for improvement. To improve the variety of activities on offer the Manager recently ran a competition for staff, a small prize was awarded to the staff who came up with the best ideas for activities. Records and discussion with the Manager and staff show that service users are supported to maintain contact with friends and family. For example one service user has had recent contact with a relative they previously did not know existed. Contact with relatives form part of the goals set with individuals. For example for one service user staff are to support them to write to their sister on a weekly basis. During the visit one staff was observed supporting a service user to telephone a relative another service user went out with staff to purchase Christmas cards for their relatives. The rights of service users were respected by staff. For example service users were given choices throughout the day, this included what time to get up, what they wanted to eat and if they wanted to go out. Staff were observed to knock on bedroom and bathroom doors before entering. One service user refuses to take their prescribed medication. Whilst staff respect their right to do so, they have also been concerned about the effects this may have. Agreement has been reached following discussion with other health and care professionals that the service user is aware of the consequences of not taking the medication and so their right to refuse it must be respected. Part of the lunch time meal was observed. The tables were set nicely with tablecloths, flowers and condiments making the dining room a pleasant place to eat a meal. Choice of meal was available. Choices of drinks were on the table so that service users could help themselves to what they wanted. Support was given by staff to individuals who needed it. Since the last inspection a menu book has been developed and placed in the dining room so that service users can read what the meal of the day is. Menus showed that a variety of food is offered that includes fresh fruit and vegetables. The Manager said that culturally appropriate food was available, an example was given of soda bread for individuals of Irish descent. Service user views about the meals provided were mixed, but the majority spoken with said they were happy with the meals on offer. Fruit was observed to be available in a clear container in Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 15 the kitchen. One piece of fruit was clearly visible that had green mould growing on it. Whilst all the fruit was checked and some thrown away when this was brought to the attention of the Manager there should already have been systems in place to ensure food is eaten or thrown away when it is past its best or use by date. Following the visit the Manager wrote and said that fruit will be stored in a ventilated container with the remainder kept in the fridge to avoid spoilage due to the heat in the kitchen. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal and healthcare support in the way they prefer and require and their health needs are generally well met. Medication management was generally good, ensuring service users get the right medication at the right time. EVIDENCE: Service users met with had been supported with their personal care and were smartly dressed, appropriate to their age, gender and the weather. One service user spoken with confirmed that staff supported her in regularly attending the hairdressers where she has her hair set. The survey form received from one relative recorded that they were satisfied with the overall care provided. One service user is refusing most personal care from staff. It is an improvement that staff now have detailed guidance on how to try and support this individual whilst recognizing their right to refuse care. Sampled care plans included detailed guidance on individuals personal care preferences. For Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 17 example for one individual it was recorded that they will not tolerate male staff for personal care and only some female staff. Sampled health records showed that service users are supported to maintain health and access health appointments as needed to include chiropodist, dentist, opticians and annual health checks. The home are struggling to meet the needs of one service user due to the individual refusing care offered. Health input has been offered by health professionals but the individual concerned has not consented to meet with most of the professionals. It was recognised by staff that this individual may consent to meeting with a psychologist if they were of a female gender. This proved successful in meetings taking place but the outcome of the meetings was not in the psychologist view, successful. The home is continuing to discuss with relevant professionals how this individuals needs can be best met. Weight records are now completed monthly and show that staff are monitoring individuals weight, where service users have declined to be weighed this is recorded. One service user has been refusing to take their prescribed medication for some time. It was agreed at a multi disciplinary meeting that this individual was capable of making their own decisions and administering medication covertly was not an option. Staff continue to offer medication daily and record on the chart when it is refused. A risk assessment had been completed for risks resulting from not receiving prescribed medication. Medication is stored in a locked cabinet. At the front of each service users Medication Administration Record (MAR) there was a photograph of the individual so it is clear whom the medication is to be given to. MAR’s were signed appropriately and these cross-referenced with the blister pack indicating that medication had been given as prescribed. Where individuals are prescribed as required (PRN) medication a protocol is in place stating when, and why this should be given to the individual. Copies of prescriptions are retained so that staff can check the correct medication has been received from the chemist. Audits of ‘as required’ medication are completed to ensure stocks tally with medication records. The medicine fridge temperature had been taken regularly to make sure medication is stored at a safe temperature. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is available but this must be consistently applied when responding to complaints to ensure service user views are listened to and acted on. Systems to protect service users are generally satisfactory but improvement is needed to financial recording to ensure individuals monies are safeguarded from risk of financial abuse. EVIDENCE: The complaints procedure was clearly displayed in the hallway along with complaint forms and CSCI comment cards. The procedure is available in an audio format for service users who are unable to read. All surveys received from service users recorded that they knew who to speak to if they had a complaint. The CSCI has not received any complaints about the home since March 2006, details of this are included in the previous inspection report. The homes complaint log was observed. This detailed complaints received by the home and generally recorded action taken to investigate and resolve them. Unfortunately for the most recent complaint, made by a service user about another service user in September there was little information about what had been done as a result of the complaint. The record needs to be completed to show that all complaints are properly investigated and action is taken to resolve them to ensure service users feel their views are listened to and acted upon. Since the last inspection there has been one allegation of staff acting inappropriately towards a service user. This was reported by the Manager to Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 19 the CSCI an Social Services in line with adult protection procedures and was investigated by Tracs. In the service user files sampled, each individual had their own inventory of personal possessions. These were up to date. This shows that staff at the home assist individuals in looking after their possessions and have a system to monitor if anything goes missing. The financial records of one service user were tracked. Monies balanced with the record and receipts were available for expenditures. It is good that staff check the monies twice daily to ensure they are correct. At the last inspection it was identified that for one service user their cheque book had three stubs that were not dated and did not detail the expenditure. Bank statements were also not available to track these cheques. At this visit there was some improvement, statements were available and the majority of cheque stubs had been fully completed but not all. The Manager must ensure that all cheque stubs are appropriately completed so that service users monies can be properly audited and safeguarded. Since the last inspection the majority of staff have had additional training in studio III techniques tailored to one of the service users as due to their physical disabilities some of the previously taught techniques were not suitable. At the last inspection in June it was identified that adult protection training was of a short duration and requirements were made for Tracs to review this training to ensure it is adequate for staff and enables them to recognise potential abuse and respond appropriately to protect service users. The Manager said that the review had been completed and additional training was scheduled for staff to take place in January. Greenhill Road, 29, (westholme) DS0000016713.V323674.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, 26, 27 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. TRACS is working hard to improve the accommodation to ensure that service users are provided with a comfortable and homely environment. EVIDENCE: The Provider continues to take positive action to improve the premises. Since the last inspection the dining room has been redecorated and looks homely with touches such as tablecloths and fresh flowers. New curtains have been fitted in the lounge. A new extractor fan has been fitted in the smoking room making it a more pleasant place to use as the smell and effects of cigarette smoke are reduced. Work has been done to reseal the worktop by the sink to ensure effective infection control, as required at the last inspection. Work is also underway to install a passenger lift, this will assist service users who have mobility difficulties to access the first and second floors more easily. Carpets in hallways still need replacement, as previously required. The Manager said that new carpets would be fitted once the lift installation had Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 21 been completed. A few weeks after the inspection visit notification was received that the carpets had been fitted. Bedrooms sampled were personalised according to individual choice and gender. Décor was generally in good order. Bedrooms contained many personal items, some had their own fridge so making the rooms relaxing and comfortable for the person to spend time in. Service users spoken with were happy with their rooms. The ground floor bathroom has been refurbished since the last inspection. The layout of the bathroom is now better suited to the needs of the service user who uses it. On Hilltop the bathroom has been refurbished to include new tiles making it a more pleasant place to undertake personal care. The garden was observed to be well maintained. One service user has taken an interest in the garden and has been involved in planting bulbs and choosing some small trees. Appropriate hand wash facilities were observed. Hand towels and hand wash were provided in all toilets, the laundry and the kitchen. The majority of service user surveys received recorded that the home was always fresh and clean, a couple said it was usually fresh and clean. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing and their support and development are variable and improvements are needed to ensure that an effective staff team supports service users and meets their individual needs. Service users are protected by the home’s recruitment policy and practices. EVIDENCE: Staff spoken with demonstrated good knowledge of the individuals in their care. Support to service users is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Seven service user surveys recorded that staff treat them well, the remaining three service users said staff usually treated them well. The cultural and gender composition of the staff team reflects the service users. Six staff at the home have completed an NVQ in care. This does not meet the standard of 50 having achieved the award, but other staff are currently working towards achieving an NVQ. One relative commented that there were not always enough staff on duty, however it must be noted that this was from the only relative survey received and may not be reflective of other relatives opinions. Some staff spoken with Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 23 felt that whilst staffing levels generally met the needs of service users this was not always the case at weekends when the cook and laundry assistant were not on duty. Staff then undertake a full range of multi-role tasks including laundry and cooking and most staff work 12 hour days, which results in them each taking a one-hour break during the day. One staff felt that although there were not many incidents where service users hit each other these could be further reduced if there were more staff available to supervise service users. Further review is needed of the numbers of staff on duty when the cook is off duty to ensure there are still adequate numbers of staff to undertake both care and cooking duties. The hours worked by the Manager were not recorded on the staff rota. This made it difficult to fully assess the numbers of staff on duty. The Manager said she worked Monday to Friday however this needs to be recorded to include annual leave and training days. Following the visit the Manager forwarded a copy of the rota for December, showing that the hours worked by the Manager had now been recorded. Three staff records were sampled, there was evidence that satisfactory references and CRB checks had been received and that a robust recruitment procedure has been followed to ensure service users are protected. Staff spoken with said they received all the training they needed. Since the last inspection the majority of staff have had additional training in studio III techniques tailored for one of the service user as due to his physical disabilities some of the previously taught techniques were not suitable. Training undertaken by staff includes cultural diversity, infection control, autism, epilepsy, care planning, food hygiene, health and safety, manual handling and first aid. Forthcoming training booked for staff includes ‘understanding clients perspective’, studio III refresher and adult protection. Discussion with the cook indicates that training in basic food hygiene and nutrition has been undertaken. Staff spoken with said that supervision is fairly regular. Records for staff were sampled, most staff had received supervision fairly regularly. For some newer staff supervision needs to be more regular to ensure staff are well supported in their job role. For example for one staff who had started work at the home in August there was a record of only one supervision. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 24 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, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements of the home have improved and changes made are improving the quality of the service and outcomes for service users. EVIDENCE: The manager is very service user focussed, and endeavours to provide a well run home. Since the last inspection the Manager has made an application to the CSCI for registration. The Manager is currently undertaking the Registered Manager Award to ensure she gains the right qualifications for the role of the Registered Manager. Systems are in place to assure quality. This includes monthly visits to the home by a service manager who completes a report. Audits are carried out periodically to include health and safety, financial and an audit called ‘first impressions’. An annual quality questionnaire is also completed where service Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 25 users, relatives, staff and health and social care professionals have the opportunity to say what they think about the home. Record keeping has improved. Service user daily records were sampled and were generally satisfactory completed. Staff were not judgemental in their entries and records were dated and signed. Daily records are recorded on loose leaf numbered pages, some of these had become mixed up in their order. It is recommended that to ensure records are not lost or mixed up a system of attaching the completed records is used. Some improvement is still needed to record keeping, for example some staff training records were not up to date. It was difficult to track all the training undertaken by staff due to each staff having one record per year, this means that to fully track training undertaken several records have to be examined. A training matrix was in place but this did not cover all areas of training. For example, for one staff who said they had completed medication training this was not recorded on the training records. Records showed that staff had fire training via an external organisation in November 2006. It is good that the staff have also attempted to do some fire training with service users. Care plans showed that for some individuals this had been less successful than others due to their level of understanding or willingness to participate. A new fire risk assessment has been completed since the last inspection to ensure that action is taken to minimise the risk of a fire starting. Work has also been undertaken to ensure requirements made by the West Midlands Fire Service have been met. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer services the equipment regularly to ensure it is maintained in good working order. A fire drill is held every six months so that staff and service users know what to do if there is a fire. A Corgi registered engineer completed the annual test of the gas equipment in September and stated that it was in a satisfactory condition. An electrician completed the five-yearly test of the hard wiring in September and stated that it was in an unsatisfactory condition. The Area Director for Tracs said that electrical work to ensure the system was safe was booked to be done on 11th December. Systems are in place to monitor the temperature of the fridge and freezer to ensure food is stored at safe temperatures. At the last inspection some records showed that the fridge temperatures were too high but did not record any action taken to reduce the temperature. Since then a new fridge has been purchased and alterations made to the temperature recording system. Recent temperature recordings showed that the temperature was too high but records showed that appropriate action had been taken. As previously required, new risk assessments have been completed that take into account changes to the environment that have been made in recent years. During the visit work was underway to install a new passenger lift in the home. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 26 The contractors had been working in the home for several days. Some service users had to pass by the lift shaft to get to their bedrooms. A risk assessment was not available for risks to service users but had been completed for the contractors. Following the visit a risk assessment was completed and forwarded to the CSCI. Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 27 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 X 2 3 3 X 4 X 5 3 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 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 2 X Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 28 YES, THREE Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12(1) 15 13(4) Requirement The Manager must ensure that supervision of service users is in line with their care plan. The Manager must ensure that all areas of risk to service users are satisfactory assessed. The Manager must ensure that food is properly stored and is in good condition, and discarded when past its best or use by date. The Manager must ensure the record of complaints show that all complaints are properly investigated and action is taken to resolve them to ensure service users feel their views are listened to and acted upon. Financial procedures require review to include the completion of cheque stubs to ensure service users personal monies are properly safeguarded. Outstanding requirement from 30/07/06. Timescale for action 06/01/07 2. YA9 YA42 06/01/07 3. YA17 16(2)(i) 06/01/07 4. YA22 22 30/01/07 5. YA23 12(1) 13(6) 30/01/07 Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 29 6. YA32 18(c) 7. YA33 18(1,a) 8. YA36 18(2) 9. YA41 12(1) 17(2) 10. YA42 13(4) At least 50 of care staff must have NVQ level 2 or above in Health and Social Care. Adequate numbers of staff must be provided to safely meet service users needs, and to cover staff breaks. Outstanding requirement from 01/12/05 and 30/07/06. All staff must receive supervisions at least bimonthly, and a record of these maintained. Outstanding requirement from 30/07/06. The staff training records need review so that they are up to date and the reader can easily ascertain the training undertaken by staff. A copy of the electrical installation certificate to show the system is safe must be forwarded to the CSCI. This has now been received by the CSCI. 30/06/07 30/01/07 30/01/07 28/02/07 30/01/07 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. 2. Refer to Standard YA8 YA41 Good Practice Recommendations Consideration should be given to typing of service user meeting minutes, making them easier for service users to read. It is recommended that to ensure daily records are not lost or mixed up a system of attaching the completed records is used. DS0000016713.V323674.R01.S.doc Version 5.2 Page 30 Greenhill Road, 29, (westholme) Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenhill Road, 29, (westholme) DS0000016713.V323674.R01.S.doc Version 5.2 Page 31 - 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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