Inspection on 19/05/05 for Hamilton Court

This inspection was carried out on 19th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hamilton Court 02/05/07

Hamilton Court 07/06/06

Hamilton Court 16/11/05

Hamilton Court 23/03/05

Hamilton Court 16/12/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Tudor Views 2 Hinstock Road Handsworth Birmingham B20 2EU Lead Inspector Julie Preston Unannounced 19 May 2005 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 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 Stationary 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. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tudor Views Address 2 Hinstock Road Handsworth Birmingham B20 2EU 0121 515 4955 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tudor Views Ltd Vacant Care Home 13 Category(ies) of Mental Disorder (13) registration, with number of places Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home provides personal care only for thirteen people for reasons of mental disorder, excluding learning disability or dementia. (13MD) 2. Service users must be aged under 65 years. 3. That a minimum of two staff are on duty at all times, one of whom should be designated senior. 4. That the manager completes the Registered Managers Award or equivalent by April 2005. 5. That additional garden space is created for the service users to the side of the home which affords a degree of privacy for service users, within 4 months of registration.. Date of last inspection 23 March 2005 Brief Description of the Service: Tudor Views is a large detached house situated opposite a park in the Handsworth Wood area of Birmingham. The home provides care to people with mental health problems and currently has an all male service user group. Shopping, leisure and public transport facilities are within walking distance of the home. Bedrooms are available on all floors and there are two lounges on the ground floor, one of which is a designated smoking area. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors over five hours and included discussion with service users and staff, a tour of the premises, examination of care plans and risk assessments that describe how service users are cared for, sampling of policies and procedures and staff recruitment records. A letter of serious concern was sent to the registered provider in March 2005, following concerns identified about the poor care planning and risk assessment procedures followed within the home and the manner in which the home was being run. This inspection has identified some minor improvement to care plans and risk assessments, however further work is required to ensure that service users needs are being met by an effective process of individual planning. A new manager has been appointed and is due to begin work in the home, however support and supervision of the person in charge at present continues to be poor. The home received a letter of serious concern from the CSCI’s pharmacist inspector in March 2005, identifying a number of serious shortfalls in the way medicines were managed within the home. At this inspection all requirements made in relation to medicines management had been met. There have been no complaints about the home since the last inspection. What the service does well: What has improved since the last inspection? The staff have worked hard to improve medicine management to a safe level and have implemented robust systems to achieve this. The fire evacuation procedure has been updated and more regular fire drills take place. Arrangements have been made for staff to take part in Basic Food Hygiene training and some staff have received fire safety training. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Service users needs are assessed prior to their admission to the home by a process of care management that details how their individual needs are to be met. The procedures for assessment of prospective service users is not made available to staff and was not available for inspection. EVIDENCE: Staff on duty were unable to provide information about the procedures used to assess the needs of prospective service users that may be admitted to the home. One staff member said that assessment would be completed by the Director of the organisation (Amkam) that works in partnership with the registered providers and that she would not be involved in the process. Those service users currently living in the home had all been referred via a process of care management (by a social worker) and records of the assessment of their needs was included in their personal files. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Care plans and risk assessments are not completed in sufficient detail to enable staff to meet the needs of service users. EVIDENCE: Two care plans sampled showed that some work has been done to identify the needs of service users and instruct staff how to meet those needs. One plan detailed a change in the needs of one person and there was a record that the plan had been reviewed. Staff spoke about their practice in relation to the changes in the person’s needs, which was consistent with the information in the written plan. There has been no recording of food consumed by a service user who’s individual plan states that food intake must be monitored. This does not enable effective monitoring to take place. A second care plan did not identify the service users current needs following the last review in August 2004 and an admission to hospital. Risk assessments sampled showed some improvement since the last inspection in that they had been reviewed, however one assessment stated that a risk management plan was needed, which had not been completed. A risk assessment that identified concerns about a service user’s mobility did not provide any instruction about how to meet the person’s needs in this area. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Staff at the home respect the rights of service users and are mindful of their privacy. The home’s routines are in the main flexible and promote service users independence. EVIDENCE: Service users reported that they have a key to their bedrooms but not to the front door of the home. There was no information available to support the practice of not offering front door keys to service users. A member of staff stated that service user’s mail is given directly to them and assistance given to deal with it as required. A service user confirmed this during the visit. Observation of the interaction between staff and service users showed that staff spend time talking to service users and have formed good relationships with them. One service user said that staff were “friendly and good for a laugh” while another said that staff respect his privacy and are respectful of him. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 11 Service users have some responsibility for cleaning their bedrooms and one person said he preferred to do this exclusively as he didn’t like staff being in his room when he wasn’t there. This person said that staff stay out of his bedroom and ask his permission to go in, which he was happy with. Service users were seen to take their meals in either the dining room or the lounge in front of the television. A service user said that the arrangements for having meals and drinks were flexible and that he could choose where and when he had his meals. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 The systems for medicine management have improved since the last inspection. Clear comprehensive arrangements had been installed to ensure service users medication needs are met. The manner in which service users’ health care appointments are recorded creates difficulties in monitoring the outcomes of the appointments. One service user is at risk of poor health as no arrangements are in place to monitor his diet. EVIDENCE: Health care records within the home were difficult to track, as appointments and their outcomes are recorded in the general daily records of each service user meaning the reader has to sift through a range of other information to find the entry required. An entry in a service user’s daily records stated that he had refused his medication. A member of staff said that this is a regular occurrence for this person and that staff would respond by contacting the RMO for advice. There was no evidence that this had taken place nor a written protocol that states this is the agreed course of action for this person. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 13 Staff at the home have supported a service user whose health care needs have changed by making referrals to healthcare professionals, which were recorded in the person’s file. A means of monitoring the service user’s diet had not been implemented. This had been identified as necessary within his care plan. The pharmacist inspector for the CSCI visited the home on 18/5/05 and made the following comments; “Following a letter of serious concern from the last pharmacist inspection the home has worked hard to install and adhere to strict policies for the safe handling of medicines. The majority of audits undertaken were correct and the Medicine Administration Records (MAR) charts were well written and accurately recorded all transactions. Protocols for occasional use medicines were written and adhered to.” Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 A complaints procedure that instructs service users to address their complaints to staff at the home is available, however this does not provide service users with an opportunity to complain directly to the CSCI. This limits service users choice of making representation outside the confines of the home. Adult protection procedures do not reflect the guidance of Birmingham Social Care and Health department and do not provide staff with information that will protect service users should an incident of abuse take place. EVIDENCE: There have been no complaints made to the home since the last inspection. There is a complaints procedure in place and service users confirmed that they knew how to make a complaint to staff in the home. The complaints procedure does not provide information about the rights of service users to make complaints directly to the CSCI. A service user said that he was not aware he could contact the CSCI in the event he wished to make a complaint. The home’s adult protection procedures do not reflect the guidance issued by the lead agency (Social Care and Health) in adult protection and remain the same as at the last inspection. Staff have not received adult protection training. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 The premises are generally comfortable and well maintained, however service users are placed at risk of injury as no controls have been identified to protect those that smoke in their bedrooms. EVIDENCE: The premises were clean and warm on the date of the visit. Furniture in communal areas is of good quality and sufficient seating is provided in the two lounges for the number of people living and working in the home. The dining room does not contain enough chairs should the maximum number of service users the home is registered for be accommodated. A broken freestanding heater in the smoking lounge needs to be repaired or replaced. A pile of broken tiles were seen in a ground floor bathroom, which had not been disposed of following the last inspection. There has been some progress to review fire safety procedures following a visit by West Midlands Fire Service in May 2005. Fire doors have been repaired and a storeroom cleared of flammable materials. The home has not reviewed the fire risk assessment to incorporate controls for service users that smoke in their bedrooms. Immediate requirements were made that this is completed within seven days. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 36 The home’s recruitment and selection procedures are poor and do not protect the service users living there. Service users do not benefit from a team of well supported and supervised staff. EVIDENCE: Three staff files were sampled during this visit. One file showed that no CRB (Criminal Records Bureau) check had been made and that only one reference had been taken up prior to employment. A second file contained references from a friend and one addressed “to whom it may concern”. The third file did not contain a photograph of the member of staff. There were no records of supervision available after August 2004 for two of the staff, with one record showing that no supervision had been recorded since the person’s employment began. The supervision records relating to a senior member of staff identified that he had not received more than one supervision session since March 2005 and the supervision that had taken place identified that the person needed to work Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 17 under guidance. There were no arrangements in place to provide this guidance other than a reference to the new manager performing a supervisory role when he took up his post. This was of concern as the person is currently managing the home and immediate requirements were made that the registered provider addresses the matter within seven days. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Progress has been made to maintain the health and safety of service users living in the home through the development of staff training and the regular testing of fire safety equipment. Risk assessments for controlling Legionella and storing food are not in place, which has an impact on the well being of service users. EVIDENCE: The person responsible for cooking has not received training in Basic Food Hygiene, which was a requirement of the last inspection in March 2005. It was however reported that this training is due to take place within the next few weeks. Seven members of staff have completed fire safety training in May 2005. The fire alarm system is tested on a regular basis and records showed that a service had taken place in September 2004. The most recent fire drill in May 2005 included the participation of service users. One service user said he had been told what to do in the event that the fire alarm went off. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 19 Risk assessments relating to the safe storage of knives and COSHH products have been reviewed and staff spoke about practice in these areas, which was consistent with the assessments in place. There are guidelines in place for the control of Legionella, however they do not include information about the testing of water and in particular the testing of water in the many rooms not currently in use in the home. No risk assessments were seen to have been completed for food storage, which was a requirement of the previous inspection. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x 2 x Standard No 31 32 33 34 35 36 Score x x x 1 x 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tudor Views Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score 1 x x x x 2 x E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 2 6 Regulation 14(1)(ad) Requirement Timescale for action Within 6 weeks Within 2 weeks and ongoing 3. 6, 19 4. 9 5. 9 6. 9, 24 7. 16 A process of assessment for prospective service users must be developed and implemented. 15(1)(2)( Each service user must have a a-d) written plan of care that sets out how their needs in respect of their health and welfare are to be met. Individual plans must be subject to regular review. 15(1) A means of monitoring the food intake of service users with dietary needs must be developed and implemented. 13(4)(c) A risk management plan must be developed and implemented for the service user whose individual plan identifies this as necessary. 13(4)(c) The risk assessment for the service user with mobility difficulties must be amended to include information about how to meet his needs in this area. 13(4)(a-c) The fire risk assessment must be 23(4)(c)(v reviewed and controls put in ) place to minimise risks to service users that smoke in their bedrooms. 12(1, 2, Service users must be offered a 3) key to the front door of the home. Any reason for not providing a key must be E54 S54608 Tudor Views V228098 190505 Stage 4.doc Within 1 week and ongoing Within 1 week Within 1 week Within 1 week Within 1 week Tudor Views Version 1.30 Page 22 8. 9. 9, 19 22 10. 11. 23 23 12. 13. 14. 24 24 34 15. 16. 36 36 17. 42 recorded within the individual plan and reviewed on a regular basis. 18(2) A protocol must be developed and implemented for service users that refuse medication. 22(7)(aThe complaints procedure must b) be developed to ensure service users are made aware they may make complaints directly to the CSCI. 18(1)(a) Staff must receive training in 13(6) adult protection. 13(6) The adult protection procedures must be reviewed to ensure they are presented in keeping with the guidance issued by Birmingham department of Social Care and Health. 23(2)(b) The broken heater in the lounge must be repaired or replaced. 13(4)(a-c) The broken tiles in the ground floor bathroom must be removed. 7, 9, 19 The registered person must Schedule ensure that recruitment records 2 17(2) are maintained according to the Schedule Care Homes Regulations (2001). 4(6)(a-f) 18(2) All staff must receive regular supervision by a person competent to do so. 8(2)(a-b) The registered provider must advise the CSCI in writing of the name and date of appointment of the new manager. 13(4)(a-c) Risk assessments must be completed for the control of Legionella and for food storage on the premises. Within 1 week Within 4 weeks Within 4 weeks Within 4 weeks Within 1 week Within 1 week Ongoing Within 2 weeks and ongoing Within 1 week Within 2 weeks RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 23 No. 1. Refer to Standard 19 Good Practice Recommendations The manner in which health care appointments are recorded should be considered to enable the reader to find the information without having to track through other records. Seating in the dining area should be reviewed as more service users move into the home. 2. 24 Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-4 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 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 Tudor Views E54 S54608 Tudor Views V228098 190505 Stage 4.doc Version 1.30 Page 25 - 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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