Inspection on 23/09/08 for Hagley Road

This inspection was carried out on 23rd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hagley Road 16/09/09

Hagley Road 30/04/08

Hagley Road 16/05/07

Hagley Road 17/10/06

Hagley Road 26/01/06

Hagley Road 16/09/05

Hagley Road 07/01/05

Hagley Road 20/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOME ADULTS 18-65 Hagley Road 429 Hagley Road Edgbaston Birmingham West Midlands B17 8BL Lead Inspector Sarah Bennett Key Unannounced Inspection 23rd September 2008 09:30 Hagley Road DS0000016865.V372307.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 Hagley Road DS0000016865.V372307.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. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hagley Road Address 429 Hagley Road Edgbaston Birmingham West Midlands B17 8BL 0121 420 2970 0121 420 2970 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) Mind in Birmingham Manager post vacant Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia (MD) 10 The maximum number of service users who can be accommodated is: 10 30th April 2008 Date of last inspection Brief Description of the Service: 429 Hagley Road is situated on a busy main road close to Bearwood. The building is of a traditional appearance and is in keeping with other properties in the area. There are no external indicators to emphasise the function and purpose of the home, it blends in well with the other residential houses. Close to the home is a shopping centre, pubs, restaurants and leisure facilities. The area is also well served by a range of transport systems. The homes brochure states that: ‘The home provides long term care for people suffering with mental health problems’. The homes philosophy gears towards a slow track rehabilitation with people who live there being allowed time to develop and enhance the skills they have. The home allows the people living there to fulfil their potential and future goals in terms of their accommodation. The service users guide did not state the fees charged to live at the home. The information included in this report applied at the time of inspection and the reader may want to obtain more up to date information from the care service. A copy of the last inspection report is available in the home for visitors to read if they wish to. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 5 Hagley Road DS0000016865.V372307.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 one star. This means the people who use this service experience adequate quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. This was the homes second 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. 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, their relatives, the Operations Manager and the staff on duty were spoken to. 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. At the last key inspection there were concerns about the management of the home. Since then the Registered Manager has been demoted and no longer works there. An acting manager is in post and recruitment is taking place to replace the manager. An ‘expert by experience’ took part in part of the visit. An ‘expert by experience’ is a person who, because of their shared experience of using services, visits a service with us to help get a picture of what is like to live there. Where they are quoted directly in this report they are referred to as the ‘ex by ex’. Following the last key inspection we had concerns about this home and the safety of the people living there. However, this key inspection has found that improvements are being made to improve the lives of the people who live there. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Money held in the home for the people who live there must be recorded accurately to ensure it is spent in the way the person wants it to be. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 8 The kitchen cupboards and worktops must be replaced so that the kitchen is clean and hygienic for people to store and prepare their food in. Staff must regularly test the fire equipment to ensure that it is working and would protect the people living there if there was a fire. The service users guide should include the fees charged to live there so that prospective service users can make an informed choice about whether or not to live there. More support should be given to individuals so that all their identified needs are met so ensuring their well- being. The people living there should be given more opportunities to meet together to make choices and decisions about their lives in the home. This will ensure their well being and improve their self esteem. The people living there should have planned activities including doing household tasks so improving their well being and self esteem. Records should be kept of the food that individual’s eat to ensure that people have a healthy and nutritious diet so they can be well. All the people living there should be encouraged and motivated to do their personal care and their health needs should be monitored. This will promote their dignity and self esteem and ensure their health needs are met. All the people living there should be aware of how to make a complaint so they would know what to do if they were unhappy with the service provided. This will help to ensure that people feel their views are listened to and acted on. All staff should receive updated training in safeguarding vulnerable adults so they know how to protect the people living there. All staff should be aware of the Mental Capacity Act 2005 and how this legislation may affect the people who live there. The home should be well maintained, decorated and clean so it is homely and comfortable for the people living there. Staff should ensure that the locks and lights in toilets and bathrooms are working to ensure the privacy of the people living there. Action should be taken to make sure that the home is safe and people’s health and safety is promoted so that they can be safe and well. 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. Hagley Road DS0000016865.V372307.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 Hagley Road DS0000016865.V372307.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: The service users guide and statement of purpose had been updated with the current management arrangements so that people were aware of this information. Generally the service users guide stated the required and relevant information so that prospective service users would have the information they need. It did not state the fees charged for living there. This information should be available so to help people to make a choice as to whether or not they want to live there. The people living there have lived there for several years. No new people admitted since the last inspection so Standard 2 relating to assessment of people before they move into the home was not assessed. There were nine people living there so there was one vacancy. Hagley Road DS0000016865.V372307.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, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have the information they need in care plans and risk assessments to support the people living there to meet their needs and do the things they want to do. These are not always followed, which could impact on people’s well being. EVIDENCE: The records of three of the people living there were looked at. These included an ‘Essential Lifestyle Plan,’ which stated what is essential for the person, what is important to them and what they prefer and enjoy. The plan stated what support the person would need from staff. Since the last inspection improvements had been made in how staff supported individuals to achieve the things that are essential, important and which they prefer/enjoy. For example it was stated that it is essential for one person to have their medication on Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 12 time and their records showed and it was observed that this was done. One person’s records stated it was important to them that they travelled independently. Their records showed and it was observed that they were able to do this. One person’s records stated that they preferred to have a sandwich when other people living there had a takeaway meal. Their records showed and the person said that they had this. Further improvements are needed to ensure all individuals’ needs are met. For example one person’s plan stated that it was important that they showered daily. Their records and observations showed that this did not always happen. One person’s plan stated that it was important that the person weight was monitored. Their records showed and staff said that this did not happen. One person’s plan stated they enjoy going to the pub for meals but their records showed that they did not do this. Records sampled included a monthly evaluation of their care plan and a summary of what they had done during the month and if any changes were needed to their plan. Each person had an annual review. Where the person wanted to they had been involved in this and had invited their relatives or friends if appropriate. A meeting had recently been held with the people living there. Minutes of this showed that they had been informed of the management arrangements, they talked about going on a day trip to Blackpool, talked about the food and where they wanted to go for their Christmas meal. People were asked if they wanted to go to an Indian restaurant for their Christmas meal with people from another home. They said they did not want to but wanted to go somewhere local. One person said they have meetings every month. Minutes were only available for one meeting. One person told the ex by ex that meetings are not held very often because most of the people living there are not interested. People were observed doing what they wanted to do during the day and helping themselves to drinks and snacks. Records sampled included individual, detailed risk assessments so staff knew what support people needed so they can take risks in their day-to-day lives whilst ensuring they are as safe as possible. Since the last inspection risk assessments had been reviewed regularly and updated as necessary to ensure the risks are current and relevant to the person. One person’s risk assessment stated that a risk to their health and well being might be severe self neglect. This included not eating, which could result in them losing weight and being malnourished. Their risk assessment stated that staff needed to check the person’s weight regularly. Their records showed and staff said that this had not been done. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living there do not all experience a meaningful lifestyle, which could impact on their well being. Some people do not have a nutritious diet, which could affect their health. EVIDENCE: One person told the ex by ex that they had been doing a college course for a few years and were soon starting a placement at a sheltered workshop as part of an Employment Preparation scheme. They said they will get the bus to the placement on their own, but staff have offered to help them find their way for the first few times. Daily records sampled showed that people went to local shops and sometimes went to the Post Office to get their money. Two people’s records sampled stated as part of their daily routine on Tuesday (the day of the visit) they went Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 14 to a local pub for lunch with staff and the other people living there. Records did not show this had happened on previous Tuesdays and no mention of this was made on the day. The Operations Manager said that daily routines are being updated for individuals to make them more meaningful with the things that people say they want to do. One person’s records stated that they enjoy going to the library but they often do not take the books back on time so incur fines. Their daily records did not mention that they had been to the library or had planned to. If this is something they enjoy staff should offer them the support they need so they take their books back on time. It was good to see one person who in the past has not wanted to go out in the local community being supported to go to the local shops when they asked to go. One person spent time in the afternoon in the dining room talking to staff and listening to their favourite music. One person told the ex by ex that they used to go to football matches with the old staff but this had not happened yet with the new staff. One person said they go to the cinema when they want to see a particular film. They look up the cinema listings with staff on the computer in the office and decide what they want to see. The ex by ex said, “ During the visit I did not see the people living there interacting with each other or being engaged in any activities. Staff interactions with people seemed to be mainly brief and in passing.” One person told the ex by ex that they sometimes go to local shops on their own, but mostly they stay around the home. They said that most of the people living there spend most of the time in their own rooms. It was observed throughout the day that there were no organised activities and most people spent a lot of time in their own rooms. Some people went on a long day trip to Blackpool the week before. One person said, “I enjoyed myself, didn’t go on rides, liked the Tower, had pub lunch, went on the pier.” In the last few months a day trip to the coast and to a butterfly farm in Stratford had also been arranged. One person told the ex by ex that they didn’t enjoy the Blackpool trip but enjoyed the visit to the butterfly farm. Another person said they had enjoyed the Blackpool trip. Staff said that people had not been on holiday this year due to the staff changes. They said these would be organised with individuals next year when the staff know people better and if they want to go away they will be supported to go. Records sampled showed and people said that their friends and family can visit when they want to and they can visit them. Review meeting minutes showed that people’s friends or family attended if they wanted them to. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 15 One person told the ex by ex that they help out with chores around the home, do their own laundry and clean their room on their own. Records sampled showed that people help with cleaning and doing their own laundry so helping them to develop their skills and be more independent. Food records are not kept for individuals. Menus stated that people were to be offered an alternative if they do not like the meal that is offered. Records sampled did not show that people had an alternative. However, the evening meal was a meat casserole but one person who does not eat meat was offered a fish dish instead. One person said that often they do not like what is offered for the main meal. Staff said that they had recently started Internet shopping for most of the food needed but there are still opportunities to do smaller shops locally. Records sampled showed that people often went to local shops to buy fresh foods. The freezer was full with a variety of food. The fridge was clean and contained fresh food. Staff had dated food when it was opened so they knew when it had to be used by to minimise the risk of food poisoning. There did not seem to be any monitoring of what people ate during the day. One person said they had been to the chip shop for lunch so did not want any more lunch. They then ate several chocolate biscuits, bananas and had a sandwich that other people had for their lunch. One person told the ex by ex, “ I go to the chip shop every day.” Another person said, “ The food is getting better and the staff do most of the cooking.” One person’s records showed that staff had advised them to eat fruit instead of cakes and ice cream. Records should be kept of what individuals eat particularly where care plans have identified that people are at risk of not getting the nutrition they need and so may be under nourished. Some people’s health may also be affected by not eating a nutritious and healthy diet. One person said, “ Smashing food, I eat what I’m given.” There was a bowl of fresh fruit on the dining room table that people helped themselves to during the day. The ex by ex said, “As I arrived lunch was being prepared by the two staff on duty with assistance from one person who lives there. Lunch was egg and tomato sandwiches.” In the recent meeting the people living there had agreed that the food was good. Hagley Road DS0000016865.V372307.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, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are not always supported well with their personal care, which could affect their self –esteem and well being. Generally people are supported to meet their health needs and take their medication so to keep well. EVIDENCE: Care plans stated how people are to be supported to meet their personal care and health needs. The ex by ex said, “ The appearance of two of the people I spoke to was unkempt and their clothes looked dirty. The other person was clean and tidy.” It was observed that some of the people living there looked unkempt and had not been well supported with their personal care. Two people told the ex by ex that they get less support from the new staff although the other person said that they are more supported. A member of staff was observed supporting one person to sew buttons on their clothes so that they looked smart. The person was pleased with this and felt they had been supported well. Some good interaction was observed between staff and the people living there making the people feel valued. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 17 Records sampled showed that people are supported to attend health appointments when necessary and referrals are made to health professionals so that people get the treatment they need. One person had blood tests, which showed that they had raised cholesterol and would need a healthy diet and exercise to lower this. Their care plan did not state how staff are to support them with this. This is important to ensure that people are getting the support they need to be healthy. Records sampled showed that people’s mental health was stable. Observations throughout the day showed that although some people lacked motivation none of the people living there were in distress or suffering from acute mental ill health. One person’s records sampled showed that when they were distressed and seemed to be responding to ‘voices’ staff spent time talking to them helping them to calm down. Since the last inspection all medication has been locked in a cupboard so that it is safe and people are not at risk of taking medication that is not prescribed for them. Lloyds supply the medication in weekly blister packs that are pre packed by the pharmacist. This makes it easier for staff to know what to give to each person and when. Adequate medication was available for people so that they could have the medication they are prescribed. Medication sampled showed that it had been given as prescribed. Records sampled showed that people had regular medication reviews to ensure that the medication they are prescribed is effective in helping them to be well. At the front of each person’s Medication Administration Record (MAR) there was a photograph of the person so that unfamiliar staff would know who to give the medication to. Staff had signed each person’s MAR to show that they had given them their medication. Some people at times refuse to take their medication or do not want to take it at the time staff offer it to them. Individuals had been involved in discussing the risk of not taking their prescription medication and had suggested ways in which they are more likely to comply with taking it. For example one person had said that they do not want to be asked repeatedly to take them so asked for staff to ask them hourly and encourage them to take it to prevent them being unwell. The person had signed to say they agreed with this. Some people are prescribed as required (PRN) medication. Guidelines were in place stating when, why and how much of the medication should be given to ensure that this was not misused. Staff had signed the MAR when PRN medication was given and stated why and when the next dose was due if appropriate. Staff had recorded when people had been given painkillers and whether they had one or two tablets to ensure they did not receive more than they should which could be detrimental to their health. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 18 Some medication was kept in the fridge, as it needs to be stored at a certain temperature. Staff had tested the temperature of the fridge and ensured it was stored at an appropriate temperature. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for making a complaint do not always ensure that the views of the people living there are listened to and acted on. The people living there are not always protected from abuse, neglect and self – harm. EVIDENCE: The service users guide included details of how to make a complaint if people were unhappy with the service. This was produced in an easy to read format so it was easier to understand. It was also displayed on the notice board in the dining room. At the recent meeting the people living there had discussed the complaints procedure. The minutes stated that people were confident that they know how and who to complain to. One person told the ex by ex, “ The new staff will listen to what I want, but that they don’t talk to me that much.” One person told the ex by ex that they did not know if there was a service user guide or about advocacy. Another person said they would not make a complaint, as they are a bit shy to speak up. Another person said they know how to make a complaint but doesn’t think that they would be listened to. The Operations Manager said that they had not received any complaints since the last inspection. They said they had received positive feedback from Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 20 professionals and relatives since the acting manager had been in post. We have not received any complaints about this service since the last inspection. At the last inspection one person made an allegation about the manager resulting in the manager being suspended later that day. A meeting followed this with the professionals involved with the person and the Provider conducted an investigation into the allegations made. The Operations Manager said that following this investigation a referral to the Protection of Vulnerable Adults (POVA) list was not required for the previous manager, as the allegations were not founded. All but two of the people living there are responsible for managing their own money. Two people’s money is kept in the safe and staff give it to them daily or as required. A record book of the money they keep in the safe and how much they are given is kept. One person’s book stated that they had £10 more than was actually kept in their cash tin. It also seemed that the week before they had some money deposited in the safe as their balance had risen without any explanation. The Operations Manager said they would check with the staff why there were these discrepancies in the recording and ensure that the person’s money was appropriately accounted for. The other person’s record book cross-referenced with the money in their tin and receipts were kept of the purchases they had made to show that their money was spent appropriately. The minutes of a recent staff meeting showed that staff had talked about the Mental Capacity Act 2005 and a copy of the Act was in the office for staff to look at. The Operations Manager said that training for all staff in this was to be arranged. The Mental Capacity Act came into force in April 2007. This legislation requires an assessment of people’s capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. All staff should know about this legislation so they are aware of the implications of this for the people living there. Staff training records showed that some staff had received training in safeguarding vulnerable adults. The Operations Manager said that all staff are to receive updated training in this. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People do not live in a homely, comfortable and safe environment that meets their individual needs. EVIDENCE: Since the last inspection the dining room had been redecorated and looked a lot brighter and more pleasant for people to eat their meals in. Cloths had been bought for each of the three small tables. One person was laying the tables and said that it was their ‘job’ to do this each day making them feel valued. Staff said that new chairs are going to be bought for this room to make it more comfortable. On one wall of the room there are two large notice boards. Staff said that one of these is to be removed and replaced with pictures so it looks more homely. The ex by ex said, “The notice board was quite crowded and some of the information was out of date – this tends to Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 22 happen with notice boards, but maybe a tidy-up could be scheduled for once a week, involving the people living there?” The ex by ex said, “ The two lounges are furnished in a modern style. The smoking lounge is much bigger than the non-smoking lounge, and also gets more natural light. The non-smoking lounge is cosy, but quite small and lacking in natural light. There is a computer in there but it is apparently not used by the people living there.” Since the last inspection work had been done to make both lounges more homely and comfortable. The Operations Manager said that the smoking lounge is to be redecorated and new furniture is to be bought. Since the last inspection the downstairs hall had been repainted making it look brighter. The area of wall that appeared damp had been treated and a vent hole had been installed to minimise the damp and the wall re -plastered. Since the last inspection the door of the smoking lounge had been repaired so that it shuts firmly to prevent smoke from escaping if there was a fire. There was a sign on the door that said that only the people living there can smoke in there so that people know what parts of the home are smoke free. The kitchen was clean and new net curtains had been fitted to the window to make it more private as the window looks out over the main road. The cupboards were worn and some could not be opened because they were broken. The worktops were scratched and marked and in need of replacing to ensure that they are clean and minimise the risk of food poisoning. Three people gave permission for us to look at their bedroom. Two bedrooms seen were in need of redecorating. The ex by ex said, “One bedroom had been recently redecorated and had a new carpet, and did look fresh and bright.” The Operations Manager said it was planned to redecorate all bedrooms and staff would be going out with individuals to choose the colour schemes for these. Bedrooms were personalised. One person said that their bed is comfortable and they are supported to change their bedding once a week. The people living there said they had been able to personalise their bedroom. The ex by ex said, “ When I went to use the toilet the first bathroom I went into had a broken lock and so I had to find another.” The lock on this bathroom door was broken and was also broken at the last inspection. It was not clear whether this had been repaired since or had broken again. Staff on duty reported it to maintenance that afternoon to be repaired. A new extractor fan had been fitted to the ground floor bathroom to reduce the condensation. The light was not working, which could make it dangerous for people to use this room particularly at night. Staff reported this to maintenance as an urgent repair that afternoon. Since the last inspection a new extractor fan had been fitted in the laundry room and it had been redecorated so reducing the condensation and making it a more pleasant place for people to do their washing. The cupboards on the Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 23 walls that contain hazardous cleaning materials have big padlocks on them detracting from a homely atmosphere. The Operations Manager said that they plan to get the cupboards changed so that they will look better but can still be locked to prevent people from being at risk of misusing the cleaning materials. The toilet and shower room on the first floor had been redecorated and new flooring had been laid making these more comfortable. A cleaner is employed part-time to clean the communal rooms of the home. These were clean and free from odours. Staff support people to clean their own bedrooms. The cleanliness of these had improved since the last inspection but some people still needed further support so that they were clean and comfortable for people to spend time in. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 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 are sufficient to ensure that the needs of the people living there are met. EVIDENCE: Since the last inspection the whole staff team has changed. This is part of the organisation’s plan to improve the home so it is better run for the people living there. The previous staff have been moved to other jobs within the organisation. Some of the new staff had worked for Mind in Birmingham before and others have been recruited. This has obviously been an unsettling time for the people living there. One person said that they preferred the old staff and miss their key worker. One person told the ex by ex, “The new staff are more friendly and treat us better.” Another person said that they get more encouragement from the new staff. Staff said that the staff changes had gone okay and that the people living there had not seemed too unsettled. The home’s statement of purpose stated that three of the staff including the manager had achieved National Vocational Qualification (NVQ) 2 or above in Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 25 Care. It stated that other staff would be doing NVQ once they had completed their induction and mandatory training. There are seven staff employed in the home. The standard states that over 50 of staff should have NVQ level 2 or above in Care so that staff have the skills and knowledge to meet the needs of the people living there. Therefore, they do not meet this standard. Rotas showed the staff that were on duty at the time showing that they reflect the staffing of the home. Rotas sampled showed that the staffing levels were adequate to meet the needs of the people living there. The Operations Manager said they had recently appointed a full-time care staff and are waiting for the necessary checks to be done before they can start. They said once the staff starts the home would be fully staffed. The frequency of staff meetings had improved since the last inspection so that staff were kept updated in how to support the people living there and any changes in practice or within the organisation. The Operations Manager did not have access to the recruitment records and the manager was not on duty but training staff at another venue in ‘Written Communication Skills’. Following the inspection the Operations Manager sent us confirmation that all staff have had a recent Criminal Records Bureau (CRB) check to ensure that ‘suitable’ people work with the people living there. Staff said they had an induction when they started at the home. They said new staff who had not been employed by MIND in Birmingham before have a detailed induction pack to work through. Staff said that bank staff also have an induction so they know how to support the people living there. Staff said they recently did training in Infection Control and do all the mandatory training. Staff training records sampled showed that staff had received training in food hygiene, self-harm, mental health awareness, fire safety, individuality of support, first aid, abuse, risk assessment, safe handling of medication and diversity. Staff said that they have monthly supervision with the manager so they aware of their job role and their training needs are identified. The Operations Manager said that they are starting to roll out appraisals across the organisation and currently managers are receiving training in this. They will then do staff appraisals. This will ensure that the performance of staff is monitored regularly and they are given opportunities for development. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 26 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. The current management arrangements ensure that people benefit from a well run home that considers their views on the home should be developed. The health, safety and welfare of the people living there is not always promoted and protected which could impact on their safety and well being. EVIDENCE: Since the last inspection the Registered Manager had been demoted and no longer works at the home. An acting manager is in post who is the manager at another home run by MIND in Birmingham. The Operations Manager said that the acting manager is at the home 3-4 days a week. Another member of staff is able to act up in the manager’s absence. The Operations Manager said that Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 27 she often visits the home to see how things are going. Staff said that the acting manager is good and knows what she is doing. They said that the home is run more efficiently for example there is plenty of food now and petty cash. The Operations Manager said that an advert for a manager was going in the press later that week. Prospective candidates for the manager’s post would be given a chance to meet the people living there and staff before the interview and the interviewing panel will take into account their feedback. There is planned to be a handover period with the acting manager. The Operations Manager said that feedback from relatives had been positive since the acting manager has been in post and all relatives were informed by letter of the change. As a local MIND group they have to meet the National MIND Quality Standards. A Quality Group has been set up which includes two of the people living there and two staff. The Operations Manager said they are also trying to involve relatives. A copy of the action plan following our last report was sent to relatives so they can see how MIND in Birmingham is responding to this. The findings of this inspection show that several improvements have been made since the last inspection and further improvements are planned. Members of the MIND in Birmingham Committee visit the home and a report of their visit is sent to us. The Operations Manager said that they meet bimonthly with the Committee visitors to discuss their findings and talk about what improvements are needed. The Operations Manager said that they visit the home unannounced weekly. Staff said that the Operations Manager visits regularly. Fire records showed that staff had tested the alarm weekly up until 2/9/08 and then it had not been tested since. Staff tested the alarm during the afternoon and found that there was a fault on the kitchen door and it did not shut automatically. Staff reported this to maintenance as urgent. This shows the need to test the fire equipment often so that these faults can be found and people are not at risk of fire equipment not working in the event of there being a fire. Regular fire drills had been held and records showed that people responded well to these. One person who lives there had been out when both of the fire drills held this year had taken place. It is recommended that a fire drill be held when this person is at home to ensure they know what to do if there is a fire. One person told the ex by ex that they know the fire procedure but fire drills are not held that often. Fire records showed that an engineer regularly services the fire equipment to ensure it is working and well maintained. At the last inspection a recommendation was made that the fire risk assessment is updated as it is not dated so it is not clear when it was last reviewed and if some things are still relevant. This remains outstanding and should be done to ensure that the risks of there being a fire are minimised as much as possible. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 28 Staff test the water temperatures as part of the weekly health and safety checks. This is to ensure that the temperatures are within the recommended levels so that people are not at risk of being scalded. Records showed that on the last test two of the baths were above the recommended safe level. The recording sheet stated all temperatures exceeding 43 degrees centigrade must be reported to maintenance. There was no evidence that this had been done. The Operations Manager said that they would check this. Staff had tested the fridge and freezer temperatures daily to ensure they were within the recommended limits for safe food storage. Records showed that they were within the recommended limits to minimise the risk of food poisoning. Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 3 X X 1 X Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 (6) Requirement Money held in the home for the people who live there must be recorded accurately to ensure it is spent in the way the person wants it to be. The kitchen cupboards and worktops must be replaced so that the kitchen is clean and hygienic for people to store and prepare their food in. Staff must regularly test the fire equipment to ensure that it is working and would protect the people living there if there was a fire. Timescale for action 31/10/08 2. YA30 16 (2) (j) 31/03/09 3. YA42 13 (4) 24/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The service users guide should state the fees charged so to help people to make a choice as to whether or not they want to live there. More support should be given to individuals so that all DS0000016865.V372307.R01.S.doc Version 5.2 Page 31 Hagley Road 3. YA7 4. 5. 6. 7. 8. 9. 10. YA9 YA12 YA13 YA17 YA18 YA19 YA22 11. 12. 13. 14. 15. YA23 YA23 YA26 YA27 YA42 16. YA42 their identified needs are met so ensuring their wellbeing. The people living there should be given more opportunities to meet together to make choices and decisions about their lives in the home. This will ensure their well being and improve their self esteem. Staff should support all the people living there as stated in their risk assessments to ensure their safety and wellbeing. The people living there should have planned activities that they enjoy doing so improving their well being and self esteem. Staff should support individuals to do the things they enjoy in the local community to improve their self esteem. Records should be kept of the food that individual’s eat to ensure that people have a healthy and nutritious diet so they can be well. Staff should encourage and motivate all the people living there to do their personal care. This will promote their dignity and self esteem. Care plans should state how people are to be supported to meet all their health needs to help them to be well. All the people living there should be supported to make a complaint if they are unhappy with the service provided. Friends and family of the people living there should be informed of the complaints procedure. This will ensure that people feel able to raise concerns and how to do this. All staff should be aware of the Mental Capacity Act 2005 and how this legislation may affect the people who live there. All staff should receive updated training in safeguarding vulnerable adults so they know how to protect the people living there. All the people living there should be supported to clean their bedrooms so that they are clean and comfortable for them to spend time in. Staff should regularly check the toilets and bathrooms to ensure that locks and lights are working to ensure the privacy of the people living there. The fire risk assessment should be regularly reviewed to ensure that appropriate action is being taken to minimise the risks of there being a fire. Outstanding from last inspection. Action should be taken to ensure that water temperatures are maintained at 43 degrees centigrade so that the people living there are not at risk of scalding. Outstanding from last inspection. DS0000016865.V372307.R01.S.doc Version 5.2 Page 32 Hagley Road 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 Hagley Road DS0000016865.V372307.R01.S.doc Version 5.2 Page 33 - 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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