Inspection on 21/05/08 for 2 & 10 Grove Road

This inspection was carried out on 21st May 2008.

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

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

Other inspections for this house

2 & 10 Grove Road 04/05/07

2 & 10 Grove Road 26/04/06

2 & 10 Grove Road 02/11/05

2 & 10 Grove Road 16/06/05

2 & 10 Grove Road 26/07/04

2 & 10 Grove Road 12/03/04

2 & 10 Grove Road 05/09/03

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

CARE HOME ADULTS 18-65 Grove Road, 2 & 10 Kings Heath Birmingham West Midlands B14 6ST Lead Inspector Sarah Bennett Key Unannounced Inspection 21st May 2008 10:00 Grove Road, 2 & 10 DS0000016795.V364890.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 Grove Road, 2 & 10 DS0000016795.V364890.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. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grove Road, 2 & 10 Address Kings Heath Birmingham West Midlands B14 6ST 0121 441 3221 0121 441 3541 Paul.McDonald@sense.org.uk www.sense.org.uk Sense, The National Deafblind and Rubella Association Paul McDonald (not yet registered) Care Home 8 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) Category(ies) of Learning disability (8), Sensory impairment (8) registration, with number of places Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care home only to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 8 Sensory Impairment (SI) 8 of the following age range: from 18 years of age and above The maximum number of service users to be accommodated is 8 2. Date of last inspection 4th May 2007 Brief Description of the Service: Grove Road is located in a small cul-de-sac in a residential area of Kings Heath. The Home comprises of two purpose built properties each accommodating up to four people who have a learning disability and sensory impairment. Grove Road is within reasonable walking distance of the main shopping area of Kings Heath, where there are numerous shops, public houses, restaurants, churches and recreational amenities. There is a large park close by and public transport is easily accessible. 2 & 10 Grove Road are on opposite sides of the cul-de-sac. Each house has a lounge and a separate dining room, a modern fitted kitchen and a small laundry room. The administrative office is located at number 2 and the staff sleeping in room at number 10. Number 2 also benefits from a conservatory, which gives additional space. All bedrooms are of single occupancy and are decorated and furnished to reflect individual interests and personalities. There are bath and shower facilities in the upstairs bathroom plus separate toilets on the landing and on the ground floor. Both homes are comfortable and well furnished and there are many aids and adaptations related to sensory and other disabilities. There are four men living at number 2 whilst at number 10 there is a mixed gender group. The people living there have diverse cultural backgrounds, which are reflected in the choice of decoration and furnishings. Both properties have rear gardens. Information is shared with the people living there by use of objects of reference to enable individuals to make choices and map out their location within the Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 5 home. The service users guide stated that the fees charged to live there are specific to the needs of the individual and the requirements of their funding authority. It stated, “The approximate cost for someone to live there is £90,000 a year. These payments are dealt with by Sense’s finance team on behalf of the person.” This information was correct at the time of inspection so the reader may wish to contact the care home for up-to-date information. The last inspection report was available in the home for visitors to read if they wish to. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors carried out the visit over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the Annual Quality Assurance Assessment (AQAA) completed by the manager. Relatives and friends of the people living there and staff had completed surveys about the home. Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The home has a Registered Care Manager (RCM) and an Unregistered Care Manager (UCM). The RCM was not on duty but the UCM and the General Manager for Sense were spoken to, as were the staff on duty. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: Relatives said, “We consider ourselves fortunate to have our relative placed at Sense and cannot commend the staff highly enough.” “Staff are wonderfully caring and meet our relative’s different needs.” “The home does everything well, especially broadening our relative’s horizons and independence.” Staff know the people living there well and understand how to listen to them. Plans that explain how to care for the people living there are well written so that staff know how to support them. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 7 Staff help the people living there to do as much for themselves as they can be as independent as possible. There is a choice of healthy food so that people are supported in their diet to keep well. The people living there go out and do things they enjoy with staff that know them well. Staff said that they enjoyed working at the home and with the people living there. “ It’s an excellent unit to work in and I think the sensory impaired people we work with have made some big strides in their personal development.” Staff have training to help them understand how to protect the people living there from harm and understand how to help them keep well. Staff said, “ We have a great staff team at present that work well together and strive for the future of the deaf blind people. We have lot’s of ideas to improve the home and the lives of deaf blind people.” What has improved since the last inspection? Relatives said: “Generally I am happy with the service. The past year there has been problems but now more staff are in place, I’m hopeful things will improve.” There is some new furniture and some rooms have been redecorated, which makes the home more comfortable. Staff said: “ As a team we are always trying to improve the service that we provide, it’s an ongoing process.” There is a new manager, who is working with the staff to make things better and safer in the home. Records about people’s health needs are filled in properly so that they get good health care. People that live in house 2 now have a garden that they can get around and enjoy. Water is not as hot as it was in sinks in house 10, so people are not at risk of being scalded. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 8 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. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 9 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 Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have most of the information they need so they can make an informed choice as to whether or not they want to live there. EVIDENCE: Staff said that the statement of purpose had been updated but the manager is reviewing it before making it a final document. The statement of purpose available in the home was dated 2006 and needed updating with the management arrangements. Staff said the updated document would include this information. The service users guide included the relevant and required information so that people have the information they need to make a choice as to whether or not they want to live there. It was produced using photographs and pictures making it easier to understand. All the people living there were admitted prior to the last inspection. There were no vacancies therefore the standard relating to assessment was not looked at. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff do not have all the information so they are able to support individuals to meet their needs and ensure their safety and well being. The people living there are supported to make choices and decisions about their day – to - day lives. EVIDENCE: Three records of the people living there were looked at. These included an individual care plan, which detailed how staff are to support the individual to meet their needs and achieve their goals. Care plans stated the likes and dislikes of the person so that staff know what the person wants. The communication book stated that one person had a sore bottom. Staff stated that this was due to horse riding and was improving. However, there Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 12 was not a short term care plan in place so that staff know how to support the person with this to ensure they are not in pain or discomfort and can heal well. Care plans stated how the person communicates. This may not be through speech because of their needs but may be through body movements, sign language, objects of reference (objects that are specific to the person for example if someone is thirsty they may communicate this by showing staff a cup) and facial expression. It is important that staff know how each person communicates so that they can support them appropriately and in the way they choose. Some people use a ‘communication choice box’, which contains some objects relevant to the person that will help them to choose what they want so they can have a say in their day-to-day life. Records showed and it was observed during the day that staff used these with individuals to enable them to make choices. One person’s records stated that they have a portable communication bag – a bum bag to help them to make important choices when out in the community. This shows that staff regard the choice of individuals as important at all times and have thought carefully about how they can support people to communicate what they want. One person’s records stated, “ Has responded well to new communication systems and being given more choice.” One person’s records included behaviour guidelines that were completed by the behaviour support team. These gave good detail about possible triggers for the behaviour so if possible staff could support the person to avoid the triggers and not behave in a way that could affect their well being. They also stated the early warning signs for the behaviour and how staff should respond to try and stop the behaviour. One person’s records stated their religion but it did not state whether they practiced this and if so how this affects their life. The General Manager said that this was the religion of the person’s family and the person did not follow this. This should be stated so that it is clear and if people do have religious needs that they are considered. There is a Practice Development Worker (PDW) based in the home. They said that their role is to work with other professionals in introducing communication systems for individuals, develop care plans, review guidelines, do individual assessments and chair Person Centred Planning (PCP) meetings. They also do observations on the care practice of staff. They deliver communication and deaf blind training. As a dysphagia (swallowing difficulties) practitioner they do annual screenings to assess how people are managing with their eating and drinking. The PDW said that they sometimes work shifts so they can look at morning and evening routines and how these suit the people living there. Each person has an annual review and records showed that they had attended this with their relatives where appropriate. Each person has a ‘core team’ who support them although all staff at the home would work with individuals. The ‘core team’ ensure that the individual has Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 13 what they need and their plans and guidelines reflect these. Each month the ‘core team’ meet together. Records of these meetings showed that they discussed how the person was being supported to make choices and do the things they wanted to do. Risk assessments lacked detail as to how staff are to support the individual to minimise the risks to their safety and well being. For example records sampled included a risk assessment on the person being at risk of sunburn. These included the same risk for each people. They did not take into account that the risks will differ depending on individual’s skin type, the medication they may be taking or how their behaviour may be affected by spending time in the sun. They did not detail which sunscreen would be suitable for the individual to use, this could greatly reduce the person’s risk of being sunburnt. Some risk assessments had not been reviewed regularly to make sure they were still relevant. The UCM stated that he and the RCM had planned a meeting to review risk assessments and these would be done in the next month. This remains outstanding from the last inspection and must be done to ensure the safety of the people living there. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 14 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. Arrangements are in place so that the people living there experience a meaningful lifestyle. People are offered a healthy diet that ensures their health and well being. EVIDENCE: Records sampled showed and it was observed that people lead busy lives doing the things that they enjoy. These include a range of activities including swimming, rambling, going to the pub, rock climbing, listening to music, massage, having a foot spa, art sessions, cooking, going to a sensory room, horse riding, going to parks, shopping, gardening and going to restaurants. Activity records included what activity was offered to the person and their response to the activity to assess whether or not this was something that they Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 15 enjoyed. Where a person had refused an activity this was recorded to show that this is their choice and not that staff had not offered activities. Records showed that people do not do activities outside of the home in the evenings. The UCM said this was because 1:1 staffing was not provided for individuals all day and evening so if people went out it left the homes below the minimum staffing so they focus on day activities. However, they are looking to introduce evening activities and change the times of the middle shift so this is more flexible. This will ensure that if people do want to go out in the evenings they have an opportunity to do this. Given the age of several of the people living there this will ensure that they have the same opportunities as people of the same age who do not live in care homes. The day before one person went to Wales with staff and walked up the Brecon Beacons. This was in preparation for a holiday with staff to Snowdonia later in the year where they plan to walk up Snowdon. Given the needs of the people living there it is to be commended that staff ensure they have the opportunity to take part in adventurous activities that would enable them to develop as a person. Each home has a vehicle that staff drive to enable the people living there to access the community. Staff said that they had tried to support people to use public transport. For some people this was difficult and resulted in them behaving in a negative way which had a negative affect on the public’s perception of the people. Staff felt that therefore it was not fair on some people living there to have to face the discrimination when they could still benefit from accessing the community in their own transport. Records sampled included details of their relative’s birthdays so that people could be supported to send cards and presents to them so helping to maintain contact with the people important to them. One person’s records stated that their relative had attended their review and said that communication from the home could be better. They requested monthly contact about the person and how they were. Staff said that this is happening. Records show that people are supported to keep in touch with their relatives by telephone calls from staff on their behalf, visits to the home and staff supporting individuals to visit their relatives. Care plans stated how individuals are to be supported with daily living skills enabling them to develop their independence. Records sampled showed and it was observed that people are supported to do as much as they can around the home and where possible to go shopping with staff for their toiletries and personal items. Records sampled included disclaimers about having door keys, using lockable facilities in their bedrooms and opening their own mail. Because of the needs of the people living there they would not be able to do these things however Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 16 the organisation recognises that not having these can seem as though people are being restricted. Food records sampled showed that the people living there are offered a variety of nutritious food that they enjoy. Some people have active lifestyles and records showed that they are given adequate amounts of food so they have the energy to pursue the activities they enjoy. The menu did not reflect the cultural background of all the people living there. The General Manager said that people have been offered food that reflects their cultural background but they prefer to eat traditional English food. Records showed and staff said that each Saturday there is a cultural night where people have an opportunity to taste different foods and these are included in menus if people want this. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that individual’s health and personal care needs are met. Arrangements for the management of the medication are not sufficient to ensure that medication is given to individuals as prescribed, which could impact on their health and well being. EVIDENCE: Records stated whether or not the person preferred to have male or female staff support them with their personal care so they do not become embarrassed or anxious. Care plans included very good detail about what support the person needed with their personal care. This included encouraging the person to do things for themselves so increasing their independence. Records showed that people are supported to go out and buy their own toiletries so they can use the products that are suitable for them. These included products that were suitable to their cultural background to ensure their skin and hair care was good. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 18 Records showed how each person is to be supported with their mobility not just in the home but also in familiar and unfamiliar surroundings, outdoors and when using transport. Relatives said, “We are always kept up to date with important issues. Staff always give the support to my relative that I expect or agreed.” “ Staff usually give the support to my relative that I expect or agreed.” “Staff sometimes give the care to my relative I expect or agreed.” “Staff usually meets the needs of my relative.” As several of the people living there are unable to communicate verbally whether or not they are in pain each person has a care plan that states what they do and how they behave when they are in pain. This enables staff to recognise this and take action to reduce it so ensuring they are comfortable and well. Records sampled included individual health action plans. This is a personal plan about what a person needs to be healthy and what healthcare services they need to access. The UCM said that a new format is being used for health action plans. These would all be completed in the next few months and will include more information about how to support people to meet their health needs. Records sampled showed that where appropriate people are referred to other health professionals for advice. This advice is recorded in their care plan and followed so that individual’s health needs are met. People have regular dental check ups and when they need to have regular chiropody. A relative said, “They were prompt in letting me know what was happening about the hospital and also the dentist when my relative need these attention, I was truly informed.” Some people have massages using massage oils. Agreement had not been sought from the person’s GP to ensure that the oils used for the person did not interact with any medication they were taking or have an adverse reaction to their health. One person’s records indicated that they had a disturbed sleep pattern, as they were not aware of when it was night or day due to their sensory impairments. Their care plan clearly stated how staff are to support the person so that they do not sleep for long periods during the day. Their daily records indicated that sometimes they slept from one to three hours at a time during the day so disturbing their sleep pattern at night. Staff need to follow the person’s care plan and try to discourage them from sleeping during the day so their sleep pattern is established and their health is not affected. Medication is kept in a locked cabinet in each home. The pharmacist supplies some medication in blister packs so that staff know what medication is to be Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 19 given to each person and when. Some medication cannot be stored appropriately in blister packs so this was supplied in boxes. Staff had recorded on the persons Medication Administration Record (MAR) when and how much of each medication had been received. This should ensure that it is easy to check that medication has been given as prescribed, as the amount left should cross-reference with the amount on the MAR. One person’s records stated that 78 paracetamol tablets had been received in 2/07, there were 100 tablets in their box so it did not seem that staff had recorded when further stock had been received for the person. 43 sachets of a medication had been recorded as received for one person on 27/3/08, 12 had been recorded as given but there were 52 sachets left. The amounts of some other tablets had not been recorded when received so it was not possible to audit if the medication had been given as needed. Other medication audited did not cross-reference with the person’s MAR. Staff check one person’s medication at the change of each shift as it is regarded as a medication that can be misused. The amount of tablets left is recorded. From checking the records it appeared that 10 tablets were missing. Later in the day a record was found that these had been returned to the pharmacy. Staff had not noticed when checking each shift that the records did not cross-reference with the amount of tablets. Staff need to ensure that they check this accurately and report any missing tablets as per the medication procedure so that they are not misused, which could impact on a person’s health and well being. One person’s medication states that each month they should not take the medication for a week. It was noted that in one month they had not had this break but had continued taking this medication. This could impact on the person’s health and well being. The UCM stated they had planned to meet with the practice manager from the health centre to discuss the prescription arrangements as they are currently done for three months and they would like to change this to monthly. They said they hoped this would help to improve the management of the medication. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that the people living there and their relatives know their views are listened to and acted on and that they are safeguarded from abuse. EVIDENCE: The statement of purpose stated that the complaints procedure is given to all the people living there and their families, friends and advocates so they know how to make a complaint. We have not received any complaints about this service in the last 12 months and the home had not received any. Relatives said, “ I know how to make a complaint, they have always responded appropriately if I have raised concerns.” “ I know how to make a complaint, it does take time to sort out problems.” Staff said that they knew the procedure to follow if a person living there or their relative raised concerns about the service and would ensure these are dealt with. Since the last inspection a member of staff had been dismissed following an allegation of abuse made by another member of staff. The General Manager said that a referral had been made to the Protection of Vulnerable Adults (POVA) list for the staff who was dismissed. If their name is on the POVA list it will be difficult for them to work with vulnerable adults in the future. The General Manager said that support is given to ‘whistleblowers’ so that staff feel more able to raise concerns about the practice of their colleagues ensuring that Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 21 the people living there are protected from abuse. The AQAA stated and the General Manager said that they have introduced ‘Protection’ questionnaires for staff to check their knowledge on this and it also includes looking at how staff manage individual’s behaviour. If they are not completed well enough staff are required to attend further Protection training. Staff also recently undertook Person Centred Planning (PCP) training recently. The General Manager said that this training reinforced that this is the home of the people living there and it is their choice of activities not the choice of staff. This helps to focus staff on who they are providing a service for and minimises the risk of the people living there being subject to institutional abuse. The UCM said that they had received training with other managers last year in the Mental Capacity Act 2005. The Code of Practice for this Act was available in home 10 for staff to refer to and this training is to be given to staff. This Act came into force in April 2007 and states that each person’s capacity will be assessed as to whether or not they can make a decision about their life. If they are assessed as not having the capacity other people including an Independent Mental Capacity Advocate (IMCA) can make that decision for them in their ‘best interests.’ All staff should be aware of the implications of this Act for the people living there. Each person had a list of their belongings that had been regularly updated so it was easier to track what belonged to whom and when they had bought it. If something should go missing this will make it easier to track when they last had it. These had not been signed. The UCM said that they are changing these forms so that they can include the relevant information and there is space for signatures. The organisation reported to us in January 2008 that some people’s money had gone missing from the safe. The General Manager said the money had been reimbursed to individuals. It was not possible to find out when the money went missing or who had taken it, as it had not been reported promptly so several members of staff had access to it. Three members of staff had been taken through the ‘Capability’ process to ensure they are competent in handling people’s money and were making good progress. The policies and procedures for handling money and the handover of shifts had changed and been tightened up. The Sense West Adult Protection procedure included contacting us, the General Manager, the duty social worker and the police if an there was an allegation of abuse so it could be investigated appropriately by a multi – agency team. The numbers to contact the police and social worker were not available. Several people are placed by different authorities so it would easier for staff to report these if the local numbers of social work teams were available for the areas covered. Individual’s benefits are paid to Sense who deducts the costs for accommodation and up to 60 of the person’s mobility allowance for transport Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 22 costs. A cheque for the remaining amount is sent to the home to be put into individual’s bank accounts. The UCM said that two members of staff withdraw money from the bank for people when they need it and this is held for each person securely in the home. Record of transactions held included two signatures of staff so that people’s money is not just spent by one member of staff giving an extra safeguard. Receipts were kept for all transactions and checked by the managers regularly. There are also regular audits by a central team within Sense. Records showed that three people had recently been out for a meal that was paid for from their own money but this should be included as part of the fees they pay. The UCM stated this is not usual practice as meals would come out of homes funds and it would be repaid. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 23 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, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made and further are planned to ensure that the environment is homely, comfortable and safe and meets the needs of the people living there. EVIDENCE: Sanctuary Housing Association own the property that people live in. In house 2 staff said that the blinds had recently been replaced, the hall had been redecorated and the flooring in the hall replaced making it more homely and comfortable. The lounge was decorated in a homely way and people looked very comfortable in their surroundings. Staff said that the conservatory is going to Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 24 be made into a ‘soft area’ using beanbags, mats and cushions to make it more useful for the people living there. There was a portable heater in the lounge, which had a wire trailing from it that people could have tripped over. People could also be at risk of scalding themselves if they touched it when it was on. There was not a risk assessment in place that stated how these risks are to be minimised. The surface of the dining room tables was worn. These should be repaired or replaced to make sure that they do not harbour dirt, which could put people at risk of infection. There is a gate at the kitchen door as it is too dangerous for some people to be in the kitchen when staff are cooking. Staff said that people can go in the kitchen at other times as long as staff are in there to ensure their safety. One of the rails of the gate was broken and this should be repaired to make sure it is safe. Since the last inspection a lot of work had been done in making the garden accessible to the people living there. New turf had been laid and a path had been laid to the summerhouse. Staff said that they are going to get some garden furniture and create a sensory garden so that the people living there can spend time in the garden, which they will benefit from. Bedrooms seen in both homes were personalised although staff said that one person would be provided with new furniture in their bedroom. This will be more suitable for the individual and less bulky, which will give them more room, as the bedroom is quite small. On each bedroom door there was a tactile, textured sign that reflected the interests of the individual helping them to recognise their bedroom. There were finger guards on the doors so that when people are feeling their way from one room to another they are not at risk of getting their fingers trapped. In the bathroom there is a bath with a shower facility in it. Staff said that people are all able to get in and out of the bath and handrails are provided to help people. Colour contrast was provided between the walls and skirting boards and doorframes. This helps people with a vision impairment to be able to recognise where doors are and find their way around easier. At the last inspection the door to the laundry was locked. This is a fire exit and after consultation with the fire authority the door is no longer locked so that people can get out of the home quickly if there is a fire. Staff said that hazardous substances are now kept in a locked cupboard outside so that people are not at risk of misusing them. The staff sleep-in room is situated in house 10. Staff said that the shower in the sleep-in room had been broken for about two weeks and had been Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 25 reported to the maintenance team. They are using the shower upstairs; although they said this is not impacting on the people living there it would be beneficial to have the shower in the sleep-in room repaired so that people do not have to share this facility with staff as well as the other people living there. A relative said, “I do think the care home could improve a little more on updating the living space and condition according to modern times like bathroom space.” In house 10 the lounge had been redecorated and new furniture had been provided making it homely and comfortable. Space in the lounge was limited. Staff said and the AQAA stated that there are plans to build a conservatory to increase the space but it had not yet been decided who will pay for this. In the dining room the table and chairs had been replaced and new flooring was laid. The kitchen had been refurbished and staff said that it was now much more suitable to the needs of the people living there. The garden was accessible to the people living there. There are raised beds so that people can help with the gardening if they want to. There is a large patio area with garden furniture, hanging mobiles and a large barbecue so that people who live there can enjoy spending time out there in the warmer months. The AQAA stated and staff said that the external paintwork is to be repainted this year. The AQAA stated that digital aerials are to be fitted to both homes this year so that people can watch digital TV. Both of the homes were clean and free from offensive odours making them pleasant to live in. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 26 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, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development generally ensure that the people living there are well supported so ensuring their well being. The recruitment practices ensure that the people living there are protected from abuse. EVIDENCE: The AQAA stated that nine of thirteen staff have achieved NVQ level 2 or above in Care and that one member of staff is working towards achieving it. This exceeds the standard that at least 50 of staff have achieved this qualification to ensure that they have the skills and knowledge to work with the people living there. Staff rotas showed that there are three staff on duty during the day in each house. At night there is a waking night staff in each house and one staff sleeping –in at house 10. The AQAA stated, “Staffing levels have increased in both houses to meet the needs of individuals who require additional support.” Rotas indicated that some staff were working excessive hours without a break. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 27 According to the rotas on 1/5/08 one member of staff had worked a late shift followed by sleep in, they had then worked all day and evening on 2/5 plus a sleep in followed by an early shift on 3/5. They also indicated that later in the month this person would be working excessive hours without a break. The General Manager said that she would ensure this did not happen. This has implications not only for the health and welfare of the member of staff but also for the people living there. Following the inspection the General Manager confirmed that the member of staff did not work excessive hours later in the month. They also stated that the manager would monitor the hours that staff work so this did not happen again. The General Manager said that two staff had been recruited in house 2 and would start once the necessary checks had been completed. The AQAA stated, “In the last twelve months four full time and one part time staff have left.” Agency and bank staff cover vacancies. The General Manager said that a bank co-ordinator is to be employed so that they can have a larger team of bank staff, which will reduce agency bills and more staff that know the people living will work with them. The AQAA stated, “Agency staff are predominantly very familiar to the people, through induction, shadow shifts and retaining the same workers. New staff (including Agency) are required to complete shadow shifts prior to working in a hands on capacity, wherever possible.” Relatives said, “Quite a few staff have left in recent months, need more regular staff for continuity of care.” “Need more stable staffing to take people out daily.” The AQAA stated there have been staffing issues, which has at times had an impact on the services. We have not had the service of a fulltime Practice Development Worker, which has also had an impact on some of the development work we would have sought to achieve. Recent successful recruitment drives have ensured that we can reduce our staffing vacancies. Staff said there is usually enough staff to meet individual’s needs. Regular staff meetings take place so that staff are updated with people’s changing needs and are aware of policies and procedures in the organisation. The week before the staff from house 2 had a team-building day, which they said was very useful and they had developed a plan for the home so as to improve the lives of the people living there. Three records of the staff working there were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken ensuring that ‘suitable’ staff are employed to work with the people living there. Staff said that their employer had carried out the required checks before they started work. The AQAA stated and the General Manager said that the recruitment process now includes assurance that new staff are aware of certain aspects of the role they will be expected to undertake including a visit to the home. This helps to ensure that people do not start working with the people living there and find that they are not suited to the job. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 28 Staff records sampled showed that staff have regular training that is appropriate so they have the skills to meet the needs of the people living there. Staff said that they have relevant training. Staff said that the training that Sense provide is of an excellent standard. Records sampled showed that when staff first started working at the home they had an induction so they knew how to meet the needs of the people living there. Staff said, “ My induction covered very well everything I needed to do the job when I started.” Staff said and staff records sampled showed that staff meet regularly with their manager to discuss their job role and for support. Records showed that each member of staff has an annual development review. The AQAA stated, “The appraisal (Performance Review) process has been reviewed and is now a lot more in depth.” Records sampled showed and staff said that the PDW undertakes observations on the practice of staff. As part of this they indicate areas to improve so to improve the care and support given to the people living there. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 29 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 adequate. This judgement has been made using available evidence including a visit to this service. Generally the management arrangements ensure that the people living there benefit from a well run service and people can be confident that their views underpin the development of the home. Arrangements do not always ensure that the health, safety and welfare of the people living there is promoted and protected, which could affect their well being. EVIDENCE: The General Manager said the last registered manager had left since the last inspection. A new RCM had been in post since February this year. There is also a UCM to ensure that the home has the necessary management support. The RCM has previously been a RCM in another home managed by Sense and has worked for the organisation for nine years. They have the application to be Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 30 registered with us for this home and in the AQAA stated that they are currently applying for their CRB. They have achieved NVQ level 4 in Care and the Registered Managers Award. A quality audit was completed in October 2007. As part of this questionnaires were sent to relatives, the people living there, staff and professionals who had placed the people living there. Staff said that there is good teamwork, they get good guidance from their managers and are a contented workforce. They said refurbishment is needed of the garden and house. 60 of relatives said the service was good or excellent and that a good level of support was provided by staff. They said that the environment was poor, since then a number of improvements had been made to this. Findings showed that it took a long time to resolve disciplinary issues. The General Manager said that in response to this an investigation officer had been appointed by the organisation to speed up this process whilst ensuring issues are thoroughly investigated. A health and safety audit in May 2008 found that staff fire training was not up to date and there was not a system for regular vehicle checks. Records showed that fire training was booked for staff who need it in June. Since the last inspection the laundry door (house 2) is not locked following advice from the fire authority to ensure that people would be able to evacuate quickly if there was a fire. The lock was still on the door and should be removed to minimise the risks of staff using it. There was a sign on the door informing staff that the door is not to be locked. Fire records showed that staff regularly test the fire equipment to make sure it is working. Records showed that since January this year house 2 have had to borrow the key from house 10 to test the emergency lighting, as their one did not fit it. Another key should be available to make it easier for staff to do this and ensure they do it regularly. A fire plan was in place for each person that stated what support each person needed if there was a fire so that staff were aware of this. The last fire drill in house 2 was in November 2007. There should be one every six months to ensure that staff and the people living there know what to do if there was a fire so this is now due. An engineer had serviced the fire alarm (house 2) in March 2008 and stated that the panel needed replacing but there was no record of this being done. An electrician completed the five yearly test of the electrical wiring in 2006 and stated that it was in a satisfactory condition. The AQAA stated that a Corgi registered engineer had completed the annual test of the gas equipment in September 2007 and stated that it was safe to use. A requirement was made at the last inspection that people are not at risk of scalding from hot water temperatures. Records showed that staff test the Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 31 water temperatures regularly and these are at the recommended safe temperatures so that people are not at risk. Staff regularly test the temperatures of the fridge and freezer to make sure that food is stored at the correct temperature so that people are not at risk of food poisoning. Records showed that the temperatures were within the recommended ranges. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 32 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 3 X X 2 X Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 33 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4) Requirement Risks to individuals must be identified and a risk assessment completed, which is subject to regular review so that individuals are supported to take responsible risks and maintain their personal safety. Not met from previous inspections. 2. YA20 13 (2) All medication must be given as prescribed so that people’s health needs are met. Medication records must clearly state the amount and when medication has been received or returned to the pharmacy. This will ensure that medication is being given as prescribed so ensuring people’s health needs are met. Staff must not work excessive hours without a break. This could impact on the health and welfare of DS0000016795.V364890.R01.S.doc Timescale for action 30/06/08 31/05/08 3. YA20 13 (2) 31/05/08 4. YA33 13 (4) 22/05/08 Grove Road, 2 & 10 Version 5.2 Page 34 5. YA42 13(4) (a-c) the member of staff and the people living there. Action must be taken to 30/06/08 ensure that any risks from the portable heater in the lounge (house 2) to the safety of the people living there are minimised so ensuring their safety and well being. 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 updated statement of purpose should be available so that prospective service users have the information they need so they can make a choice as to whether or not they want to live there. Short – term care plans should be in place to ensure that when people have an injury or infection staff know how to support them to meet their needs. The people living there should be offered the opportunity to go out in the evenings if they want to so that their lifestyle is reflective of other people their age. Agreement should be sought from individual’s GP to ensure that if they use massage oils these do not interact with any medication they were taking or have an adverse reaction to their health. Staff need to follow individual’s care plans to ensure their health needs are met. The adult protection procedures should include the details to contact the police and social work teams so it would easier for staff to report these ensuring that allegations are investigated appropriately. The people living there should not pay for meals from their own money but this should be included as part of the fees they pay. The shower in the sleep-in room should be repaired so that people do not have to share this facility with staff as well as the other people living there. The dining room tables (house 2) should be repaired or DS0000016795.V364890.R01.S.doc Version 5.2 Page 35 2. 3. 4. YA6 YA13 YA19 5. 6. YA19 YA23 7. 8. 9. YA23 YA27 YA30 Grove Road, 2 & 10 10. 11. 12. 13. YA42 YA42 YA42 YA42 replaced to make sure that they do not harbour dirt, which could put people at risk of infection. The gate at the kitchen door (house 2) should be repaired to make sure it is safe and people are not at risk of going in the kitchen when it is not safe for them to do so. There should be regular fire drills so that staff and the people living there would know what to do if there was a fire. Action should be taken to ensure that staff are not at risk of locking the laundry door (house 2) so that the people living there and staff can evacuate quickly if there is a fire. The fire alarm panel (house 2) should be repaired as recommended by the engineer to ensure it would always warn people if there was a fire. Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grove Road, 2 & 10 DS0000016795.V364890.R01.S.doc Version 5.2 Page 37 - 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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