Inspection on 30/04/08 for Hagley Road

This inspection was carried out on 30th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 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 23/09/08

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 27/09/2008.

CARE HOME ADULTS 18-65 Hagley Road 429 Hagley Road Edgbaston Birmingham West Midlands B17 8BL Lead Inspector Sarah Bennett Key Unannounced Inspection 30th April 2008 09:20 Hagley Road DS0000016865.V363856.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.V363856.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.V363856.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 Philip Anthony Glenholmes Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may provide care for ten Service Users with a mental disorder (MD excluding learning disabilities or dementia) under the age of 65. That a named service user who is over 65 years of age can be accommodated and cared for in this Home. 16th May 2007 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 stated that the fees charged to live at the home are £390.81 per week. 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.V363856.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is no stars. This means the people who use this service experience poor quality outcomes. The visit was carried out 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 manager completed a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). 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 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. Some relatives and people who live completed our ‘Have your say’ survey about the home. Their views are included in this report. What the service does well: People living in the home said, “The staff are good to me.” “ I go to the post office every week to get my money and pay my rent, I look after my own money”. Each person has a care plan. These are regularly reviewed and state how individuals are supported to achieve their goals. This means that staff know what support each person needs and staff are aware if people’s needs change. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 6 Staff have completed accredited training in the safe handling of medicines so they know what the medicines they give to people are for and how to give them in the right way. People are supported to keep in touch with their family and friends. This means that they can maintain relationships that are important to them. What has improved since the last inspection? What they could do better: Medication must be stored safely so that the people living there will not have access to medication they are not prescribed, which could impact on their health and well being. The arrangements for staffing must be reviewed to ensure that the health and welfare of the people living there is not put at risk. Routes to fire exits must be clear to ensure that the people living there and staff would be able to exit safely if there was a fire. Action must 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. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 7 The service users guide should included the information that is needed so that prospective service users know what is available to help them make an informed choice about whether or not to live there. Staff should support individuals as stated in their care plan to ensure that their needs are met. They 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. The people living there should be given an opportunity to make choices and decisions about their lives. 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. The people living there should be offered a healthy, varied and nutritious diet so ensuring their health and well being. All the people living there should be aware of how to make a complaint if they are unhappy with the service provided. All complaints should be recorded so it is clear what has been done to resolve them. This will help to ensure that people feel their views are listened to and acted on. 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 meetings should take place regularly so that staff have an opportunity to be kept informed of the needs of the people living in the home and how they can be met. A representative of the provider should visit the home monthly and write a report of this. This will show that the service provided to the people living there is being monitored and ensure that their views are being considered. 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.V363856.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users do not have all the information they need to make an informed choice as to whether or not they want to live at the home. EVIDENCE: The service users guide generally included the relevant and required information. It had not been updated with the details of the current manager so that the people living there are not informed of the management arrangements. This remains outstanding from the previous inspection. The manager said they had updated the statement of purpose. It included the required information so that prospective service users would have the information they need about the home. It was not dated so it was not clear when it had been updated or how current the information in it was. The people living at the home have lived there for several years and there have been no people admitted since the last inspection. Therefore, the standard relating to assessment was not looked at during this visit. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have information so they know how to support the people living there but these are not always followed, which could impact on individual’s health and well being. People who live there are not always given opportunities to make choices and decisions about their lives, which could affect their self esteem. EVIDENCE: The records of three of the people living there were looked at. These included an individual care plan that stated how staff are to support the individual to meet their needs and achieve the things they want to do. Care plans are known as ‘Essential Lifestyle Plans’ in this home. They state what is essential to the person, what is important, the things the person enjoys and prefers, what their routines are and what support they need from staff. They were detailed and focussed on the individual. It was clear that the person had been involved in their plan and they had agreed to it. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 11 During the visit it was observed that people were not receiving support to ensure their needs were met. One person’s plan stated that it was essential that staff supported them to keep their room clean and tidy and not clutter the floor. When the person showed us their bedroom the floor was cluttered with magazines and books and they had not been supported to keep it tidy. The plan also stated that it was important to the person that they had a shower daily. It was evident that the person had not been supported to do this. It was evident that the person had not been supported to do this. Staff were not observed offering this person support with their personal care. Until January this year a monthly summary had been completed with the person and their key worker. This stated how the person has been supported to meet their needs and achieve their goals. It was not clear why this process has stopped, as it was a good way to monitor how effective the person’s care plan is. It was also an opportunity for the person to meet with their key worker and decide what support they need from staff, what they would like to do and raise any concerns they have about the service provided. Records showed that people had an annual review. One person’s review was held in the afternoon and they had invited their relatives to attend. Some meetings with the people living there had taken place to enable them to have a say in how they want their home to run. Minutes of a meeting held in January this year showed that staff apologised to the people living there that the Christmas party did not take place. Given that the people living there are predominantly from a British Christian background it is disappointing that they had not been supported to celebrate. They said that because of this a monthly activity and day trips would be arranged. There was no evidence that this had been done. The minutes stated that the next meeting would be held in February but there were no minutes for this or since then. The AQAA stated that they could do better by encouraging the people living there to take a more active part in decision making. It said in the last 12 months there had been regular house meetings and in the next 12 months they plan to encourage all the people living there to have a real say in meetings rather than leave it for others to say it for them. It was not evident that regular meetings had taken place so that people can be more active in making decisions. In the meeting in October 2007 people talked about the non - smoking lounge. One person said they would like a new music centre for this lounge. It was good to see that this had been provided. Records included individual risk assessments. These stated how staff are to support the person to be as independent as possible whilst minimising the risks to their health and well being. Individual’s were involved in their risk assessments and had agreed to the actions needed to minimise the risks. For example one person had agreed that because of the risks to their health they would only buy one packet of cigarettes a day and would smoke one each Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 12 hour. Risk assessments had been reviewed and updated where needed to make sure that they were still effective. Hagley Road DS0000016865.V363856.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. Arrangements do not always ensure that the people living there experience a meaningful lifestyle, which could affect their mental health and well being. The people who live there are not always offered a healthy and nutritious diet, which could affect their health. EVIDENCE: Daily records sampled showed that people go to the pub, have takeaway meals, go shopping, go to the post office to pay their rent and go to restaurants occasionally. One person goes to college and said that they enjoy this. One person said they recently went to the cinema with staff. Staff said that one person who never used to go out now goes shopping once a week. The AQAA stated staff are supporting people to take part in a range of social and leisure activities and to access community facilities. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 14 During the day some people were observed to go out for a walk or to local shops. Apart from the person who went to college there were no planned activities either inside or outside of the home. Staff said there are few activities, some people go to the pub some evenings but most people stay in their rooms and do not want to do anything. During the day people were observed in their bedrooms or sitting in the lounge watching TV or talking to staff. The people living there said that there is not much to do at the home. Relatives said, “The home could improve by staff interacting with the people who live there more. Apart from when they call them for their medication or dinner I have not seen anyone talk to people living there or do anything with them. They could probably do some hobbies or some activities.” Some people said that they went on holiday to Blackpool with staff last year and had a good time. Staff said that one person went on holiday for a few days to Devon with their key worker. The AQAA stated in the next 12 months they plan to have more individual rather than group holidays and one person is planning to go abroad with his key worker. Records sampled showed and people said that they are supported to keep in contact with their family and friends. One person’s relatives visited during the afternoon for the person’s annual review. Records sampled showed that people are supported to be as independent as possible by helping with cleaning the home and their bedroom, doing their laundry and going to the post office to collect their money. Staff said that people do their own laundry with support as needed. When looking in the laundry it was clear that support was not always given as there had been washing powder spilt all over the floor but people had not been supported to clear it up. One person’s bedroom seen was dirty. They said that staff had asked them the previous day if they wanted help to clean it. They said they were tired so it had been left. The manager gave two people their mail as it arrived and staff supported them to read it, when they were asked to. Complaints have been received about the food and that at times there is not any food in the home. The manager said that he had tried to create a system where each person goes out with staff and buys their own food to help them with budgeting and increasing their independence skills. The manager said that the change was not received well by staff and the people living there and had led to concerns that the people living there are being starved. Due to the proposed staffing changes the manager said he had decided to now wait until new staff were in post before changing this. He said that in the past food was locked away so people did not have an opportunity to eat when they wanted to. If food runs out the manager said there is money available to go and get more. The manager said the people living there choose the menu. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 15 During the day one person went out to local shops to buy some food. After this there was only 49 pence left in the petty cash so if more food was needed that day it was not clear who would pay for this. Staff said petty cash is usually collected the following day. Staff said that they buy food for the home from their own money sometimes, as no money is available. The manager was on the phone during the morning ordering food from a supplier. They asked staff a few times what quantity of food was needed and what type of food they normally order indicating that this was not something they did often. Staff said that this is the first time in weeks that a food order had been done. One person living there said there was often no food and money was not available. Another person said, “ There is plenty of food, staff cook it for us and help me to make a sandwich.” During the morning staff were cooking the evening meal of Spaghetti Bolognese. They said they usually prepare it and leave it for the late staff to heat up. One person said we have one cooked meal in the evening but I would like a cooked meal twice a day. Another person said, “Staff put the food in front of you, there is only one meal a day. I have a bowl of cornflakes in the morning but it is not enough and a sandwich at lunchtime. We have not had three cooked meals a day for about four years here but would like to.” Staff said that they used to keep records of what people ate but do not do this now. This would help in assessing whether or not people are having a varied and nutritious diet. One person had bought a ready meal for their tea as they said they do not like mince. Staff supported them to heat this up when they wanted it. Another person said they did not really like Spaghetti Bolognese and when tea was served had half a plate of spaghetti. They said they had toast for lunch. Another person said, “We have what we are given, if we don’t like it, we go without.” The minutes of the staff meeting in October 2007 showed that staff had discussed shopping and food running out prior to shopping trips. They also talked about people having takeaways. The minutes stated: “Manager unhappy that no one is going out to fetch take away and thought it was a waste of resources. Residents are to collect their own if they want one or otherwise have food from the kitchen. Staff said that sometimes food had ran out so a takeaway was the only choice.” Adequate food stocks were available as were fresh fruit and vegetables. Staff said that it was stocked up the week before but was the first order in months. The menu for the week stated that for breakfast there is a choice of cereals, toast or eggs. A choice of cereals and bread was available. Lunch was sandwiches, jacket potato, soup, beans or spaghetti on toast. People said that lunch was usually sandwiches. Some people had pork pies at lunch - time. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 16 The menu for dinner was varied, nutritious and appropriate to the cultural background of the people living there. The menu said in the evenings people usually have a main meal followed by a dessert. Staff said that desserts are not normally offered. A dessert was not offered following the evening meal on the day of the visit. Hagley Road DS0000016865.V363856.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 poor. This judgement has been made using available evidence including a visit to this service. Arrangements do not always ensure that the personal care and health needs of the people living there are met, which could impact on their self esteem and well being. EVIDENCE: Care plans sampled detailed how individuals were to be supported to meet their personal care and health needs. Daily records sampled showed that staff were encouraging one person to have a shower as stated in their care plan. Some people had not been well supported with their personal care on the day of the visit. One person was observed throughout the day walking around with their clothes on inside out. Their records did not state that this was their preference but that they liked to look smart but needed support to do this. They had not been supported to have a shower, wash or brush their hair. During the morning they went to the local shop. This not only has a negative effect on the person’s self esteem but also on the views of the local community in how they perceive people who have a mental illness. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 18 One person’s weight chart stated they needed to be weighed monthly. They had only been weighed twice in two years. In two years they had lost 13lb in weight. The reasons for this were not clear or whether this was a positive or negative effect on the person’s health. A significant loss or gain of weight can be an indicator of an underlying health need. Therefore, if it says that a person should be weighed monthly this should be done to be able to monitor their health. Records sampled showed and people said that health professionals are involved in their care. Some records were not clear as to the outcome of health appointments so that staff could support the person in following any advice given. This could impact on the person’s health needs being met. Staff said and the AQAA stated that all staff had completed accredited training in the ‘ Safe Handling of Medicines’. This ensures they know how to give medication, what it is for and what side effects people may have from their prescribed medication. Medication is supplied by Lloyd’s pharmacy in weekly individual packs so it is easier for staff to know what medication in what dosage to give each person. The packs for each week are stored in a locked medication cabinet. Staff said that the weekly packs are delivered on a Friday to use from the next Monday. As there is not room to store this and the current packs in the medication cabinet they are stored in a wooden two-drawer cabinet in the office. There is a lock on this but staff said the key for this could not be found. The back of the cabinet is broken. Staff said they move the cabinet away from the wall, put the packs in the back that is broken and push it back against the wall. The office is locked overnight but not during the day so this cabinet could be accessed and the medication taken by people who it is not prescribed for. This was brought to the attention of the Operations Manager during the visit. There was a photo of the individual at the front of their Medication Administration Record (MAR) so that unfamiliar staff would know who to give the medication to. Packs and MAR sampled indicated that medication had been given to the person as prescribed. In the locked cabinet there was a bottle of tablets for one person to take when they required them. It was not clear how many tablets were given for the person to take or when as the label had faded. The medication was not stated on the person’s MAR. Staff said that the person is no longer prescribed this medication and it needs to be returned to pharmacy. One person’s medication needed to be stored in the fridge, as per the pharmacist’s instructions. There was a lock on the fridge but it was full of ice and staff said it had never been defrosted. This may affect the efficiency of the medication. Staff had checked the temperature of the fridge daily up to 20th April to make sure it was at the required temperature. Staff said they had not recorded it since as they had run out of record sheets. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 19 The local Mental Health Team supplies one person’s medication and not taking it could seriously affect their mental health. There was enough medication in their bottle for their evening dose only then it would run out. Staff said that the manager should have ordered more but had not done this. By the end of this visit another bottle had been ordered and delivered so the person could continue their medication as prescribed. Hagley Road DS0000016865.V363856.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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for making complaints 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, which could impact on their well being. EVIDENCE: The AQAA stated there have been two complaints received by the home, which were resolved within 28 days and one safeguarding investigation. The complaints file at the home did not record these so it was not possible to look at the concerns raised and whether or not they had been satisfactorily resolved. However, the Operations Manager did inform us of the safeguarding investigation which had found that no abuse had taken place. We received one complaint from a relative who was concerned about all the staff team being moved and that this could result in lack of consistency for the people living there. This relative remains concerned about this, as this issue had not yet been resolved. We have been made aware of another two complaints made in April this year by relatives of the people living there to the local Mental Health Team. These related to there not being any food in the home, the conduct of the manager and the home being dirty. Following these complaints and the outcome of this inspection the Team Manager was to set up a meeting with the care coHagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 21 ordinators for the people living there to discuss what they can do to safeguard the people living there. During this visit one person living there made an allegation to us about the manager. This was reported to the Operations Manager who contacted the local Mental Health Team and the police. The manager was suspended that afternoon pending investigation. A safeguarding meeting was held later that week and agreed that the organisation would investigate this. One of the people living there who completed the ‘Have your say’ survey said that they did not know who to speak to if they were unhappy or how to make a complaint. The complaints procedure was available in the service users guide that each person has a copy of. One person said that staff never listen and act on what I say. There had not been meetings with the people living there recently so people had not had an opportunity to ensure their views are listened to. Staff said that they had received training on safeguarding adults and how to prevent abuse a few years ago. One person living there said, “ It’s ok here, I feel safe and protected.” Staff said that they had not received training on the Mental Capacity Act and did not know anything about this legislation. 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. All the people living there except for one look after their own money. One person’s money is held securely in the home. Their finance records crossreferenced with the amount in their cash tin, indicating that their money was being used appropriately. Staff said and records showed that the person has their money when they ask for it and spends it on what they want to. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not sufficient to ensure that people live in a homely, comfortable, clean and safe environment, which could have an impact on their well being. EVIDENCE: Several of the people living there smoke and people smoke in the lounge. Since the last inspection the room that was the staff office had been converted into a non-smoking lounge so that the people who do not smoke have somewhere smoke free that is comfortable to sit in. The people living there and relatives said that this was good. There were some stains on the carpet of this room and these should be removed to make it more comfortable. The manager said they are going to get the strip light replaced to make it more homely. The smoke – free regulations that came into force in July 2007 state that rooms for smoking should not contain furniture or be comfortable so that Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 23 people do not spend much time in the room but use it only to smoke. Many of the people living there have smoked for several years and if they were forced to give up this may have a detrimental effect on their mental health. The room was comfortable but there was also an extractor fan on an outside wall so that the air could not go into other smoke free rooms. The sign on the door should comply with the smoke free regulations so it is clear that people smoke in this room. The hinge at the top of the lounge door was broken. Staff said it was broken recently and then repaired but had broken again. This was repaired during the afternoon after the Operations Manager had noticed that it was broken. It is essential that the door closes properly to minimise the risk of there being a fire. Two of the people living there agreed to show us their bedrooms. One person’s mattress was slipping off their bed and there was no sheet on their mattress. The mattress seemed to be the right size for the bed but because the bed was not against the wall was slipping off. Their pillow was very stained, although staff said it had recently been bought but there was no cover on it to protect it from becoming stained. The person had many personal things in their bedroom that reflected their interests. Their care plan stated that they needed support so their floor did not become cluttered with personal items, which could be a hazard. There were several books, magazines and clothes all over the floor, indicating that they had not received the support they needed. The other person’s bedroom was dirty. The person has a skin condition and their care plan stated that they needed support to clean their bedroom so that it is hygienic. It was clear that they had not been supported to do this, as there was a lot of dried, flaked skin on their bedroom carpet. They said that staff did ask them if they wanted help the day before but they were tired so it was not done. Their bed sheet was also covered in dried, flaked skin and their bedding was in a pile on their bed. Two people living there are in a long-term relationship and share a bedroom. This has been their choice for several years. They did not want us to see their bedroom but said they had what they needed. Since the last inspection shower rooms, toilets and bathrooms had been redecorated making these cleaner and more comfortable for people to use. In one toilet on the first floor there were cigarette burns on the flooring. This should be replaced so it is comfortable for people to use. New windows had been fitted in the sleep-in room. Staff said they clean this room. The room was very dusty, some of the furniture was broken and there were electrical cables from an extension lead running across the floor. In this room there was a fire exit to the house next door. A bedside cabinet obstructed part of this door. There is only one person’s bedroom on the second floor that is opposite the sleep-in room. The person would need to use the fire exit in the sleep-in room if there was a fire when they were in their bedroom. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 24 This room is small and cluttered with furniture, which could make it difficult to manoeuvre safely. This was raised with the Operations Manager during this visit. The hall on the ground floor is dark and in need of redecorating. The border in the middle of the wall was coming off the wall in several places and some plaster was coming off the wall. Staff said it had not been redecorated for several years. The AQAA stated in the next 12 months they plan to redecorate the dining room and hallway, and complete the herb garden and barbecue area. In the laundry there were damp patches on the ceiling. There was no extractor fan and only a small sky light window to prevent the build up of condensation. There is a tumble dryer and washing machine available and staff said that the people living there do their own washing with support if needed. As stated earlier in this report people had not received sufficient support as there was washing powder spilt all over the floor. At the rear of the home there is a long garden with grassed areas, trees and shrubs. The manager said they had started making a herb garden and patio area to be used so that people can spend more time out there. At the bottom of the garden there is a greenhouse. The manager said that last year some people grew tomatoes and they hoped to do this again. They had dug the ground over to plant potatoes and onions with people who want to do this. This will provide an interest and activity for the people living there. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing arrangements are not sufficient to ensure that an effective staff team supports the people living, which could impact on their health and welfare. EVIDENCE: The AQAA stated that all staff have NVQ level 2 in Care. This exceeds the standard that at least 50 of staff have achieved this qualification so they have the skills and knowledge to meet the needs of the people living there. Before this visit we were told that the whole staff team apart from the manager are being moved to other services within the organisation and a new team of staff (some of whom have worked at the home before) will come in. This is because the staff do not work together with the manager for the benefit of the people living there despite several team building initiatives. Relatives spoken with said, “It’s dreadful all the staff are going, we were shocked when we heard they were all going. The people living here will lose all familiar friends/carers- the expertise and security and people they could confide in.” Staff said they wanted to stay working at the home but had been told they had to move. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 26 The manager said that one new member of staff had started and three more were due to start. There is one agency staff working there on a block contract so that they get to know the people living there. People living there said, “We are short staffed, they are moving them around, two new staff came and they have just been moved. Agency staff work here, some are good but some are lazy.” Relatives and health professionals have commented that the people living there are unsettled because of the staff being moved and they are worried that this may have a negative impact on their mental health. There was an agency member of staff on the late shift. They said it was the third time they had worked there and they were doing the sleep-in. They said they had an induction when they started working at the home. Because the manager was suspended during this inspection this meant one of the staff on duty was not familiar with the people living there or their needs. Permanent staff said that agency staff had covered some shifts recently, there are some different ones but some work there regularly. This helps to ensure that they know the people living there. Rotas showed that there are two staff on duty during the waking day and one staff sleeping-in at night. A member of staff who started working there the week before had three days induction extra to the shift so they could get to know what support the people living there needed. Staff meeting minutes showed that these took place at least monthly until January 2008. Staff said there had not been a meeting since then. Staff said they had not had supervision for about three months. This may have contributed to the lack of organisation and the breakdown in communication between staff and the manager that was evident during this visit. Staff recruitment and training records were not looked at during this visit but will be at the next key inspection in this inspection year. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management arrangements do not ensure that the people living there benefit from a well run home. This means that their views on the running of the home are not considered and their safety and welfare is not promoted or protected, which could impact on their health and well being. EVIDENCE: Since the last inspection the manager has been registered with us. The manager has experience of working with people who have mental health problems and of managing a care service. The manager has achieved NVQ level 4 in Care and the Registered Managers Award indicating that they should have the skills and knowledge to manage a care service. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 28 During the visit staff alleged that the manager does not manage the home in a way that benefits the people living there. They said that earlier in the week he had booked an agency staff to do a sleep-in shift who had not worked there before. He had booked them to come in at 10pm as the other staff are going off duty. This resulted in the late staff having to stay over their time to introduce her to the people living there. It did not give the agency staff sufficient time to get to know the people living there. This could have put at risk the health, safety and welfare of the people who live there. The findings of this visit show that the people living there are not benefiting from a well run home. During the visit one person living there made an allegation about the manager resulting in him being suspended pending investigation. An acting manager was put in to manage the home the following week during his absence. Staff said that the Operations Manager visits the home regularly. There were not reports of the findings of their visit to ensure that the home is being well run for the benefit of the people living there. A visitor from the Mind in Birmingham committee visited in January 2008 and stated that the environment was good and the home was being well run. There was not a record of any visits since then. Water temperature records showed that staff had tested these to make sure they are not too hot or cold. The recommended safe temperature so that people are not at risk of scalding is 43 degrees centigrade. Records showed that on the last test some temperatures were 45 and 46 degrees centigrade. There was no record of any action taken to reduce these. The AQAA stated that 100 of staff had completed food hygiene training. It was therefore disappointing that the fridge was dirty and the temperatures of the fridge and freezer had not been tested regularly because staff had run out of forms on which to record these. Both of these could contribute to people being at risk of food poisoning. An electrician completed the annual test of the portable electric appliances in January 2008 to make sure they were safe to use. An electrician had completed the five yearly testing of the electrical wiring in 2007 and stated that it was in a satisfactory condition. A Corgi registered engineer had completed the annual test of the gas equipment the day before and stated that it was safe to use. Fire records showed that staff test the fire equipment regularly to make sure it is working. The last drill was held in January this year. Seven people who live there and four staff took part in this. It was recorded that it was difficult to know whether the people living there are in or out, which could result in a person being left in the home when there is a fire. There was not a record of what action taken to address this to ensure that people are safe. The fire risk assessment was very detailed but had not been updated since 2005. This Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 29 should be regularly reviewed to ensure that appropriate action is being taken to minimise the risks of there being a fire. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 30 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 2 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 1 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 1 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 X 1 X X 1 X Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA6 YA17 Regulation 12 (1) (a) 16 (2) (i) Requirement Staff must support individuals as stated in their care plan to ensure that their needs are met. The people living there must be offered a healthy, varied and nutritious diet in adequate quantities so ensuring their health and well being. The people living there must be encouraged and motivated to do their personal care. This will promote their dignity and self esteem. The health needs of the people living there must be monitored to ensure their health needs are met. Medication must be stored safely and as per the pharmacist’s instructions. This will ensure that people who live there will not have access to medication they are not prescribed, which could impact on their health and well being. Arrangements must be in place to ensure sufficient supplies of individual’s prescribed medication are available at all times to ensure their health and DS0000016865.V363856.R01.S.doc Timescale for action 31/05/08 01/05/08 3. YA18 12 (1) (a) 31/05/08 4. YA19 12 (1) (a) 31/05/08 5. YA20 13 (2) 01/05/08 6. YA20 13 (2) 01/05/08 Hagley Road Version 5.2 Page 32 well being. 7. YA22 22 (3) (4) All complaints must be recorded so their outcome is clear and where appropriate what action has been taken to resolve them. This will help to ensure that people feel their views are listened to and acted on. The arrangements for staffing must ensure that the health and welfare of the people living there is not put at risk. Routes to fire exits must be clear to ensure that the people living there and staff would be able to exit safely if there was a fire. Arrangements must be in place so that staff know which people living there are in the home so that if there was a fire appropriate action could be taken to ensure that they are safe. 30/06/08 8. YA33 12 (1) (a) 30/06/08 9. YA42 13 (4) (ac) 13 (4) (ac) 01/05/08 10. YA42 31/05/08 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. Refer to Standard YA1 Good Practice Recommendations The service users guide should be updated with the current management arrangements. This is so that prospective service users know what is available to help them make an informed choice about whether or not to live there. The people living there should be given an opportunity to make choices and decisions about their lives. This will ensure their well being and improve their self esteem. The people living there should have planned activities that they enjoy doing so improving their well being and self esteem. People who live there should be supported to do household tasks and in cleaning their bedrooms so improving their skills in independence and promoting their self esteem. DS0000016865.V363856.R01.S.doc Version 5.2 Page 33 2. 3. 4. YA7 YA12 YA16 Hagley Road 5. YA20 6. YA20 7. YA22 8. 9. 10. 11. 12. 13. 14. YA23 YA24 YA24 YA24 YA24 YA26 YA26 15. 16. 17. 18. YA30 YA30 YA33 YA39 19. YA42 Medication no longer prescribed for individuals should be returned to the pharmacy so that people are not at risk of being given medication that could affect their health and well being. Staff should ensure that the temperature of the medication fridge is within the recommended limits so that medication is stored appropriately and is effective in meeting individual’s health needs. All the people living there should be aware of how to make a complaint if they are unhappy with the service provided. 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. The flooring in the first floor bathroom should be replaced to make it comfortable for people to use. The hall should be decorated so it is light and comfortable for the people living there. Signage should be provided that complies with the ‘Smoke free Regulations 2007’ to ensure that the people living there know which rooms people smoke in. The flooring and lighting should be replaced in the nonsmoking lounge so it is homely, clean and comfortable for people to spend time in. The people living there should be supported to keep their bedrooms clean so they are comfortable for them to spend time in. Staff should ensure that the people living there have comfortable beds and bedding. This will help to ensure they get the sleep they need and this does not impact on their health and well being. The home should be kept clean so that it is clean and safe for the people living there. An extractor fan should be provided in the laundry so that condensation does not build up, which could impact on the health of the people living there. Staff meetings should take place regularly so that staff have an opportunity to be kept informed of the needs of the people living in the home and how they can be met. A representative of the provider should visit the home monthly and write a report of this. This will show that the service provided to the people living there is being monitored and ensure that their views are being considered. The fire risk assessment should be regularly reviewed to ensure that appropriate action is being taken to minimise DS0000016865.V363856.R01.S.doc Version 5.2 Page 34 Hagley Road 20. YA42 21. 22. YA42 YA42 the risks of there being a fire. The temperatures of the fridge and freezer should be checked regularly to ensure that food is stored appropriately so that people are not at risk of food poisoning. The fridge should be kept clean so that food is not contaminated and people are not at risk of food poisoning. 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. Hagley Road DS0000016865.V363856.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands Office 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.V363856.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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