Inspection on 15/01/08 for 76 Holland Street

This inspection was carried out on 15th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

76 Holland Street 13/01/10

76 Holland Street 19/01/09

76 Holland Street 07/06/07

76 Holland Street 31/10/06

76 Holland Street 24/04/06

76 Holland Street 08/11/05

76 Holland Street 06/05/05

76 Holland Street 14/02/05

76 Holland Street 27/07/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Holland Street, 76 Sutton Coldfield West Midlands B72 1RR Lead Inspector Sarah Bennett Key Unannounced Inspection 15th and 17th January 2008 09:20 Holland Street, 76 DS0000033648.V356141.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 Holland Street, 76 DS0000033648.V356141.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. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holland Street, 76 Address Sutton Coldfield West Midlands B72 1RR 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) 0121 354 2789 0121 355 0832 Katy meakin @ Birmingham.gov.uk www.birmingham.gov.uk Social Care and Health Gillian Charmaine Gayle Care Home 22 Category(ies) of Learning disability (22), Physical disability (22) registration, with number of places Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the home is registered for 22 adults under 65 all in need of care for reasons of learning disability or physical disability. Registration category 22 (LD) (PD). That the home can continue to accommodate 2 named service users who are over 65 years of age. Minimum day staffing levels are maintained at: morning - 6 care assistants and 1 senior, afternoon - 6 care assistants and one senior. Where off-site day care is provided for five or more people, day staff levels can be reduced pro-rata between 09:00am and 4:00pm. Additionally to the above minimum staffing levels, at night 2 waking night care staff and a senior on sleeping-in duty Details of staffing numbers and deployment must be set out in the homes Statement of Purpose. Care manager hours and ancillary staff should be provided in addition to care hours. Maintenance schedule to progress at a pace, which is acceptable to CSCI to allow continuation of registration. Re- provision plans to progress at a pace, which is acceptable to CSCI to allow continuation of registration. 7th June 2007 – Key 22nd August 2007- Random 4. 5. 6. 7. 8. Date of last inspection Brief Description of the Service: The home is a large two-storey building of modern design and appearance, set within its own grounds, occupying a corner position. The home is located in a residential road in Sutton Coldfield with good access to shops and transport links. The gardens at the rear of the home are spacious and secluded. There is parking facilities to the front and rear of the building. The home currently provides accommodation to sixteen adults who have a learning disability; some people have additional physical disabilities and behaviour that may challenge. Each person living there has a single bedroom. The home is arranged over four different living areas. On the first floor people are supported to live more independently and are involved in meal planning, meal preparation, food shopping and household tasks. This part of the home is referred to as minimal care. The physical standards of the home do not meet the needs of people with additional physical disabilities. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 5 The manager said that CSCI inspection reports are on display on the notice board in the hallway and the outcome of inspections are shared with people living in the Home and staff during meetings. The service users guide stated that the fees charged each week to live there are £605. The amount and frequency of payments and individual’s contributions is calculated with the individual’s social worker. The items not covered by the fee include clothing, toiletries and activities. 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. Holland Street, 76 DS0000033648.V356141.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 inspection took place over two days by one inspector and the first day was unannounced. A random inspection visit took place in August 2007 to look at progress made since the previous key inspection dated June 2007. Due to the concerns raised during the last key inspection further action and formal notices were served on the provider relating to peoples care planning and health care monitoring. It was found at the random inspection that improvements had been made but additional requirements were made about staff training. Further improvements were noted at this inspection. The inspector met all the people living at the Home, spent time observing support and interactions from staff, looked at care records, health care records and medication management. Health and safety records and staffing records were also assessed. All information looked at was used to determine whether peoples varied needs are being effectively met. Due to peoples communication needs discussions with some people was limited. Four people were identified for close examination this included reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as “case tracking” where evidence is matched to outcomes for the people living there. Questionnaires were sent out to the relatives of the people living there as part of the fieldwork for this inspection. Two of these were completed. 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 and / or ways of communicating, visits a service with an inspector to help them 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’. What the service does well: There is a small core team of staff who know peoples needs well, which ensures that the needs of the people living there can be met in the right way. The service is being redeveloped and people are being supported to choose new homes they might like to live in that better meet their individual needs. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 7 People are supported to keep in contact with their family and friends and staff know that these relationships are important to them. The service user guide is written in a way that makes it easier to understand so the people living there know what is provided for them at the home. Some people’s bedroom have been painted and decorated and looked really nice. People said they were pleased with how their rooms now looked. What has improved since the last inspection? What they could do better: Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 8 Care plans should be developed further so that staff support people to meet all their needs and achieve their goals. It should be clear how each person is supported to make choices and decisions about all aspects of their day-to-day lives so that their care is based on what they want. People should be offered a choice of activities to do in house and in the local community. The people living there should be encouraged to develop their daily living skills. The kitchen in the flat should be refurbished. This will help people to become more independent. People who need support at mealtimes should be offered this to ensure they enjoy their mealtimes and can get the nutrition they need for a healthy diet. Peoples health care monitoring and support needs to be better so they get the care they need consistently. Health care monitoring is variable and could put people at risk. Staff must have training in diabetes so they know how to meet the needs of the people who have this. The way in which the people living there make a complaint should be accessible so they can make a complaint without staff having to help them. All staff should ensure that they interact with all the people living there so to ensure their self esteem and well being. All staff records should include the required recruitment records to ensure they are ‘suitable’ to do the job they are employed for. All staff that work at the home should have an awareness of autism and how to support the people living there who have this to ensure their needs are met. Quality assurance systems should be developed further so that people’s views are sought about the day-to-day running of the Home. Records no longer needed should be filed away and all records should be sorted out so that it is clear what care each person needs and what care they have been given to ensure their needs are being met. Staff should ensure that lights are switched on when needed to ensure the safety of the people living there. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 9 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. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 10 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 Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 11 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. The people living there have the information they need about the home so they know what is provided and what the terms and conditions of their stay are. EVIDENCE: The service users guide was produced using pictures and photographs making it easier to understand. Each page was laminated so it was clear and easier to open each page. Since the last inspection it had been updated to include the fees charged to live there. These are stated earlier in this report under ‘Brief Description of the Service.’ These standards could not be fully assessed due to the Home having a stable group of people and no recent new admissions. The provider has informed the Commission that the home will re- provide its service. As people are supported to move onto new living environments the number of registered beds will be reduced and no new admissions will be made. The people who live at Holland Street have done so for many years. Therefore it was not possible or relevant to assess the pre admission process. Occupancy levels at the time of the visit had reduced from twenty-two to sixteen people. Some people have been Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 12 supported to move to homes within the locality, some of the homes are supported living schemes providing people with greater independence and some people have moved to smaller registered provision. Since the last inspection there had been a meeting held with the relatives and representatives of the people living there about the re-provision of the service to inform them of the City Council’s plans. The manager said that they have not spoken to the people living there in detail about the re-provision until there is clear information about where the individual is moving to as this could increase people’s anxiety levels. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 13 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 more information in care plans and risk assessments so they know how to support individuals to meet their needs and take risks whilst being as safe as possible. Some further improvement is needed to ensure that people are always supported to make choices and decisions about their lives. EVIDENCE: The records of four of the people living there were looked at. The manager said that the Person Centred Planning (PCP) co-ordinator is working with the people living there to involve them in what they want for the future and where they would like to live. Records sampled included an individual care plan. This stated how staff are to support the individual to meet their needs and help them achieve their goals. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 14 Records also included a list of the gifts and skills of the individual. It is good that these have been recognised but it was not always clear how staff are to support the individual to ensure they used their gifts and developed their skills. The deputy manager discussed care plans with the inspector and the best way to do them so that it was clear for staff how to support individuals in all aspects of their care. The provider expects each person to have an Individual Service Statement (ISS). This is similar to a care plan but is not always an easy working document that a member of staff can pick up and know what support they need to give to an individual. Plans of care have been developed for each person. These clearly stated the personal care needs and daily routines of the individual. The deputy manager felt that these could lead staff to think that once they have followed the plan they have finished working with the individual. They said they plan to revisit the plans of care for each person to make sure they reflect all the person’s needs and then they plan to break down the individual’s ISS into small steps and put on a laminated sheet, which would help agency and new staff and give them a concise framework to work with each person. Care plans had been reviewed and records showed that the individual was involved in the review of these. Their response to their care plan was recorded in the way the individual is able to communicate. For some people this was by using body language and facial expressions, as they are not able to communicate verbally. Where people were able to they had signed their care plan to say they agreed to it. Since the last inspection care plans had been developed as to the support each person would need during the night. This included if they wanted to be checked by staff during the night and if so how often so as not to disturb their sleep but ensuring if they had a medical condition that needed monitoring they were safe. There were several records that stated the individual had chosen what they wanted to wear. One person’s care plan detailed how to support the person to choose their clothes to ensure they were able to do this. It also stated in what order they like to dress to ensure they do not become anxious, which could impact on their well being. Activity records showed that regular meetings with the people living there took place. The minutes of these were not looked at during this inspection. The ex by ex said, “ I don’t feel that people have a lot of choice that live in the home. People didn’t know what they were having for tea.” Several people did not know what was for lunch however, staff were observed offering people a choice of what they wanted to eat and drink. This should be developed so that people are informed of what is for the next meal and can choose what they want before they get to the table. Some people depending on their needs may not be able to do this so choice should continue to be offered at mealtimes. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 15 The ex by ex said, “One person said that they have sandwiches everyday for tea and that they were not happy with that. I witnessed that sandwiches were served at teatime as I was leaving.” Menus and food records sampled showed that the main meal is at lunch - time as the people who attend day centres have a main meal there. Sandwiches are offered at tea although there are other snack options but it is not clear how people are offered a choice of these. The ex by ex said, “ One lady said that she would like salad but said that we have to have ‘winter food’.” A variety of salad was available at lunch –time on both days but again it is not clear how individuals’ are offered a choice. Records sampled included individual risk assessments. These had been reviewed and developed further since the last inspection. These stated how staff are to support the individual to minimise the risks when making a drink, using their wheelchair, falling, going out in a car, having epilepsy, choking, using the toilet, walking, during the night support, going out in the community, having a bath and their behaviour. Staff had signed to say they have read each person’s care plans and risk assessments so they knew how to support the individual. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 16 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 are not always supported to experience a meaningful lifestyle. People are offered a varied and healthy diet but are not always supported appropriately at mealtimes. EVIDENCE: Some people attend day centres during the week. Other people stay at home. For these people there were not planned individual activities. Some people played games, did puzzles, watched TV and spent time talking to staff. Daily records and activity records sampled showed that during December 2007 the people living there went to a carol service, went out for a Christmas meal, celebrated two people’s birthdays, looked at catalogues, went to the residents meeting, listened to music, watched TV, went to the Gateway Club Christmas party, went shopping, played cards and games with staff, went to McDonalds, Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 17 went to a football match, went to church and had a Christmas party at the home. Three people who live there went away on holiday with the club that they go to. The ex by ex said: “There were no activities taking place in the home whilst I was there. People told me that they don’t do much at all.” A relative said, “I would like to see more leisure activities provided in place of the non-stop TV.” However, another relative said, “My relative’s social life is better than mine.” It was not clear from looking at records how it is decided who does what activity and when. Daily records sampled did indicate that individuals did the activities that it stated in their care plan they enjoyed doing but the frequency of how often they wanted to do this was not clear. One person told the ex by ex “I would love to go out everyday but I only get to go out now and then, I sometimes go to the local shop”. Another person said, “I just go to the centre and then stay in”. One person said that they help with the shopping on a Friday. The ex by ex said, “People need to be part of their local community and do more community based activities and staff need to do some sort of in- house activity for the people that spend their day in the home.” Staff said that people go on day trips, to pantomimes, shopping, McDonalds, to watch football matches, have parties, use the karaoke machine and play games. They said that the ‘Friends of Holland St’ donate towards day trips and also organise a couple of trips during the year. Records showed that three people went on holiday in September with the club they go to. A member of staff from the home also went with them. The manager said that this member of staff had used their annual leave to go, as there is not provision in the budget for staff to be able to accompany the people living there to go on holiday. Whilst this is to be commended it is not acceptable that staff have to do this so that people can go on holiday. Unless the other people living there have been away with their family they have not been away this year so they have not had the opportunity to have a break from the home and experience new things. From sampling records and from talking to the people living there it is evident that people are supported to keep in contact with their family and friends if they want to. This is through visits from and to their family and friends, telephone calls and meeting them in the town centre or going out for the day with them. The people living there cannot go into the main kitchen as it is a commercial kitchen and is not considered safe for the people living there. However, there are small kitchens where some people who are able to were observed making themselves drinks when they wanted to. One person told the ex by ex me that they go in to the kitchen to make a drink but that is about it. Staff are employed to clean the home and whilst good interaction was observed by these staff with the people living there it is not part of their role to encourage people in developing their daily living skills. Some of the people living there are Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 18 planning to move to more independent living and need an opportunity to develop their daily living skills. The ex by ex said, “The people that live there need to be encouraged to do more around the home.” Food records sampled showed that people are offered a variety of food that includes fruit and vegetables. The main meal is served at lunch - time as people who go out to day centres have their main meal there. The inspector had lunch with the people living there on both days. A choice of menu was available that was well presented and tasty. People were offered a choice of what to eat as well as a choice of drinks and a dessert if they wanted it. A variety of fresh fruit was available. Food records sampled showed and staff said that they were aware of individual’s dietary needs and how to meet these to ensure the person’s health and well being. On both days one person whose care plan stated that they needed staff to support them at mealtimes was not given this support. This meant that they had to eat some of their food with their fingers. Staff did support the person at the end of their meal so they could eat the last few mouthfuls that they were not able to reach. Staff said that the person does not like staff sitting with them to support them all the way through their meal but this was not clear in their care plan. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 19 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. The people living there are well supported with their personal care but their health needs are not always met. This could impact on their well being. The arrangements for the management of the medication ensure that the people living there have the right medication at the right time so that their health needs can be met. EVIDENCE: The people living there had been well supported with their personal care. People had individual styles of hair and dress and were dressed appropriately to their age, gender, the weather and the activities they were doing. One relative said, “My relative is always well dressed and all their hygiene needs are met. My relative gets more support that I could have ever have hoped for.” Staff were observed reassuring one person who was anxious about getting their bedroom rug back as it was being washed. Later in the morning this person said they had it back, which was “fantastic.” Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 20 Staff were observed supporting one person to go to their bedroom to have cream applied so that their privacy and dignity was maintained. Staff said they had moving and handling training in-house and if people’s needs change they can contact the moving and handling trainer for advice. Records sampled included individual moving and handling assessments so that staff know how to support people who need it to move around safely. One person requires 1:1 support from staff and was observed to have this support on both days of the inspection. Their daily records indicated that on two occasions in December 2007 they did not have this support. As a result they displayed behaviours, which could have presented a risk to themselves and the other people living there. Other records sampled showed that they had 1:1 support and staff had commented that this support was needed for the person’s well being. Two of the people living there have diabetes. A requirement was made at the last inspection for staff to have training in diabetes. The manager said that they had asked for this training but it was not yet available. Staff spoken to showed an awareness of diabetes and what individuals who need a special diet to manage their diabetes need. They also showed they knew what to look for to ensure that people did not suffer a hyper or hypoglycaemic attack and knew the differences between these. This is important as the action to take for each is different. Staff said they have discussed diabetes and other medical conditions at staff meetings and at handovers between shifts. They said that they liaise with kitchen staff to make sure people have the right diet. Staff said and records sampled showed that people who need to go to the diabetic clinic regularly. It was recommended that all staff are given information about diabetes at a staff meeting or handover and this is recorded until training becomes available so that there are always staff on duty who know about this. Records sampled showed that health professionals are involved in the care of individuals. Records showed that staff supported people to attend health appointments. Some people had been to check ups regularly with the dentist, optician and chiropodist if appropriate. However, some records sampled did not show this. It was difficult to track in records as they were not always in any order when people had been to appointments or what follow up action was needed. Often there did not seem to be a record but it was found later in the file. This does not make it easy to ensure that all staff know how to meet individual’s health needs and that they are being met. Records sampled showed that one person was anxious about going to a health appointment. Staff supported them to go but when they got there they found they had missed the appointment as the wrong time had been entered in the diary. The appointment had to be re-scheduled to another date. It is essential that appointment times are recorded and communicated effectively so that Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 21 people do not have to experience unnecessary anxiety, which could impact on their health and well being. Records sampled included an individual health action plan. This is a personal plan about what a person needs top stay healthy and what healthcare services they need to access. One person’s records sampled indicated that they had a health need and that staff needed to support them with this. However, this was not recorded in their health action plan, which could result in staff not supporting them appropriately. One person’s care plan stated that they were at risk of being constipated. As they were not able to communicate when they had a bowel movement the care plan stated that staff needed to record these. There were only records of this for seven days in November 2007 but they did not appear to have been recorded since. These need to be recorded to ensure the health of the individual. Two of the four records sampled included a weight chart that had been completed. One of these records showed that the person had lost five kilogram’s in nine months. Another showed that the person had gained one stone six pounds in six months. There were no further records kept of this person’s weight since October 2007. A significant loss or gain of weight can be an indicator of an underlying health need. There did not seem to be any monitoring of people’s weight records so that action could be taken to investigate why someone had lost or gained weight. One relative said, “When staff found that my relative had lost weight it did not trigger a response from management. It is sometimes necessary to raise my concerns with more than one member of the management team before action is taken.” It did not appear that weight records had been monitored to ensure that individual’s health needs are met. Boots supply the medication to the home using the monitored dosage system in blister packs. This means that the pharmacist prepares each person’s medication and puts it in a sealed pack so that it is easier for staff to know what to give and when to give it. There are two medication trolleys, one downstairs and one upstairs depending on where people’s bedrooms are. The medication in the trolley downstairs was looked at. At the front of each person Medication Administration Record (MAR) there was a photograph of the person so that unfamiliar staff would know who to give the medication to. Some people are prescribed as required (PRN) medication. For each of these medications there was a protocol so that staff knew when, why and how often the medication should be given to ensure the person’s health needs were being met appropriately. At the front of one person’s MAR it stated the time that the individual would like to have their medication in the evening. This indicated that people have a choice when they have their medication as long as this does not affect the effectiveness of the medication. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 22 All MAR were signed appropriately and these cross-referenced with the medication in the blister pack indicating that medication was given as prescribed. One person was prescribed an anti-coagulant tablet used to thin the person’s blood to prevent blood clots forming. These were not stored in blister packs as dependent on the results of blood tests the dose may need to be altered. Audits of these tablets showed that they had been given as prescribed. Records were kept of the changes of dose and showed that staff had followed the advice of the doctor to ensure the health needs of the individual were met. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 23 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): 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 show that the views of the people living there are listened to and acted on. Arrangements are in place to ensure that the people living there are protected from abuse. EVIDENCE: The ex by ex said that only one person they spoke to know how to make a complaint. This person told the ex by ex person to make a complaint, “You have to fill in a form, you tell staff what words to put in”. The ex by ex said, “I think that there needs to be an easy to read and complete complaints form on display in the home for people to use. These should contain pictures and maybe just tick boxes rather than writing.” The complaints procedure was produced using pictures making it easier to understand how to make a complaint but it did not suggest other ways of raising a complaint other than by telling someone. Some of the people living there cannot communicate verbally so would have to rely on others to do this. Some people who can communicate verbally may prefer a different way to communicate their complaint that they could do it without staff needing to help them. Since the last inspection the home had received five complaints about the service from relatives and the people living there. These related to personal care and health needs not being met, staff not supporting individuals appropriately and people paying for things that they should not have to pay for. Complaint records showed that four of the five complaints made had been Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 24 responded to appropriately and work had been done to improve the service provided. One complaint received in October 2007 did not show the outcome. The manager said they had investigated this and gave a satisfactory response to the outcome, which had involved ensuring that all staff know how to support one person appropriately and in the way they want to be supported. All complaints and their outcome should be recorded so it is clear that people’s views are being listened to and acted on. The Commission had received one complaint and this was passed to the provider to investigate. This related to people not receiving appropriate personal care, not having their health needs met, staff not having the skills and knowledge to meet individual’s needs, little planned activities taking place and the home not being clean. A representative of the provider investigated this and reported their findings back to the Commission and the complainant. From this recommendations had been made to improve the service provided. It was good to see at this inspection that these recommendations are being met and that the representative of the provider also monitors this during their monthly visits. There were two compliments received in December 2007 about the standard of care that staff had given to individuals during the year. Some people at times display behaviour that can be ‘challenging’ that may impact on their well being and that of the other people living there. Behaviour management guidelines were in place that stated how staff are to support the individual so that the impact of their behaviour is reduced. These were detailed and included diversion techniques so that people were diverted to other things that would be more positive for them. One person’s strategy explained to staff the reasons why the person may behave in this way so they could understand how the person’s disability has affected their life and consequently their behaviour. It also stated that after any incident staff need to spend time talking to the person about how they may have managed their behaviour better so developing their self awareness and possibly reducing further incidents. One person’s strategy was not dated so it was not clear when it had been developed and if it needed reviewing to ensure it was still effective. Staff said and records showed that since the last key inspection they had received training in adult protection and the prevention of abuse. Staff spoken with demonstrated that they had knowledge of what abuse was and what they would do if they witnessed any abuse to the people living there. People’s money is held safely in the home and individual records of the money they spend are kept. Finance records sampled cross – referenced with the money in individual’s records indicating that records are being made and people’s money is being spent appropriately. Receipts are kept of all purchases. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 25 Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 26 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are being made to ensure that people live in a homely, comfortable, safe and clean environment. EVIDENCE: The decorators started working in the home on the first day of the inspection so a tour of the premises was not done at this inspection. The manager said that she had been allocated £12,000 in her budget to redecorate. She had prioritised so that four bedrooms downstairs, the dining room, the lounges downstairs, the activities room and the lounge in the flat upstairs would be redecorated. This would ensure that these areas were more comfortable for people to live in. The people living there said that staff were helping them to choose the colour for their bedrooms to be redecorated. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 27 The manager said that there was a blockage in the kitchen of the flat upstairs. The maintenance team had been contacted but it could not be unblocked, as the pipes were boxed in. They managed to clear it after two months but they had to dismantle the kitchen to clear it and it had leaked to the downstairs lounge. This would be redecorated as part of the redecoration taking place. The manager said they had emailed the maintenance team the week before to ask when the kitchen would be refurbished. The people who live in the flat are using the main dining room to eat their meals. However, they may be planning to move on to more independent living so do not have the opportunity to prepare their own meals and develop their independence skills. Records sampled showed that where people had needed a new bed or mattress these had been purchased. The home was clean and there were no offensive odours. Domestic staff said that all bedrooms are cleaned everyday during the week. At weekends some of the people living there like to get up later so their bedrooms may not be cleaned but all the communal rooms are cleaned. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 28 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): 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development are variable, which could impact on the well being of the people living there. EVIDENCE: At previous inspections concerns had been raised about the number of staff vacancies and the impact that using agency staff had on the people living there. The manager said they had recently recruited five members of staff, four of whom would be starting to work at the home at the end of January. Some of these staff were already working at the home on a casual or agency basis but had now been successful in being appointed permanently. This means that some of the staff recruited already know the people living there and what support they need. Agency staff spoken to said they had an induction when they first started working there so they knew about the home and how to support the people living there. Rotas showed and staff said that there are always six staff plus a manager on each shift. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 29 The ex by ex said, “Staff don’t seem to engage much with the people they support at all. One staff member sat in the lounge opposite the dining room and he sat amongst the people that lived there and just watched the TV. I didn’t once see him interact with the people he was sitting by.” Throughout the inspection some staff were observed to interact with the people living there well but there were others who did not interact so well apart from to support them in daily living tasks. The ex by ex said, “I was not impressed by the fact that one lady asked the inspector to take her coat off because a staff member had wheeled her in to the lounge and left her there.” This was as people were coming home from the day centres and was discussed with the manager who said that she would ensure that staff support people appropriately. Relatives said that there are often agency staff working there and if there were not so many this could improve the service for the people living there. Now that more permanent staff are being recruited and senior staff are being allocated to oversee specific areas of the home this could improve. Staff said they have staff meetings about every two weeks. In these meetings they pass on information about the needs of the people living there and discuss any problems, issues or ideas for developing the service. Four records of the staff working there were looked at. These included evidence that a Criminal Records Bureau (CRB) check had been undertaken to ensure that ‘suitable’ people are employed to work there. Records included the other required records to show that checks had been made on the suitability of the person before they were employed however, two records did not include two written references about the person. One person did not have any references, the manager said that she had contacted the Human Resources Department about this and was told that these were not available for staff that had been employed for many years before regulations required this to be done. There was only one reference for the other person; the manager said she would contact Human Resources about this. A requirement was made at the last inspection for all staff to have training in mandatory areas and on autism, diabetes and communication. Since then staff said and training records showed that a lot of training has taken place or is booked for all staff in all these areas with the exception of diabetes. The manager said that they had asked for this training but it was not yet available. Staff spoken to showed an awareness of diabetes and this is discussed further under the ‘Personal and Healthcare Standards’ of this report. It was recommended that all staff are given information about diabetes at a staff meeting or handover and this is recorded until training becomes available so that there are always staff on duty who know about this. The manager agreed to notify the inspector of dates for in-house training and an update on formal training. This information had not been provided at the time of writing this report. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 30 Agency staff said they have training from the agency they work for. They had not received training in autism and did not know what autism was. They said that most of the time they work downstairs and not upstairs with two people who have autism. However, one person’s records sampled downstairs stated that they have autism. The manager said that she would discuss this with the agency and recommended that staff that they send to work at the home have autism awareness training. This is needed so that staff know how to work with people who have autism so they can be supported appropriately so reducing there anxiety which could impact on their well being. Staff spoken with said they had regular formal supervision and were supported in their role. Staff records sampled showed that in the last year staff had between two to five recorded supervision sessions with their manager. The standard to ensure that staff are well supported in their role so ensuring they can meet the needs of the people living there is six sessions in a year so the frequency should be increased. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress had been made in ensuring that the home is managed in a way so that people’s health and safety is promoted and protected. Further improvement is needed so this is maintained and does not result in people being put at risk. EVIDENCE: The manager was appointed as registered manager in December 2005 and has a number of year’s experience of working with people who have a learning disability. Training records showed that the manager has achieved a Diploma in the Management of Care Services so that she has the required management skills and knowledge. One relative said, “I feel this home is very well run, both Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 32 staff and residents all seem happy.” Another relative said, “It is sometimes difficult to get the information I want about my relative because of the shift system there seems to be a breakdown in communication between members of staff. Some staff are better than others about sharing information.” Concerns have been raised previously and some still remain at this inspection about the consistency of care provided in meeting the needs of individuals. The manager said that she has identified senior staff to be allocated to lead each shift on each area of the home (known as ‘wings’). She hopes that this will improve the care provided and ensure that all staff are consistent in meeting individual’s needs. This is planned to start from April 2008, as staff need to take annual leave before that which will not ensure consistency of seniors on each area. Further progress on meeting requirements had been made at this inspection to ensure that the home is well run for the people living there. Further improvements are needed and these are detailed throughout this report. Since September 2007 seniors have completed monthly audits. These have looked at the frequency of accidents, complaints, health and safety testing, how staff are meeting the health needs of individuals, activities, residents and staff meetings and risk assessments. A representative of the provider has visited the home monthly and completed a report of their visit to audit the service provided to the people living there. Reports sampled showed that they have looked at specific areas and made recommendations where appropriate to improve the service. These showed that they were considering the views of the people living there. A recommendation was made at the last inspection to develop the quality assurance system to ensure that the views of the people living there had been considered. Apart from the providers monthly reports making reference to this there was no evidence that this had been done. A lot of the records sampled were in plastic sleeves, which had several sheets of paper in them so they were not easily accessible. It was not always clear to see what support the people living there needed. Records were not clearly filed so the care needed by an individual and the care given could not be easily tracked. Some records in files were no longer applicable and could be archived to make it easier to see what is relevant to the individual now so that people get the support they need. Fire records showed that staff regularly test the fire equipment to make sure it is working. Since the last inspection the fire risk assessment had been reviewed so that the measures taken to reduce the risk of there being a fire are still effective. Training records showed that staff had received fire safety training. Regular fire drills take place to ensure that staff and the people living Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 33 there would know what to do if there was a fire. An engineer regularly services the fire equipment to make sure it is well maintained and works well. An electrician had completed the annual test of the portable electrical appliances in October 2007 to make sure these were safe to use. The annual test of the gas equipment to make sure it is safe to use was last completed in January 2007. The manager said she would check when this would be done this year. Staff test the water temperatures weekly to make sure that people are not at risk of scalding or they are not too cool. Records showed that they were within the recommended safe limits at the last test and where they had been below this the maintenance team were contacted to rectify these. The ex by ex said, “ The lights were not on in some rooms which could be a health and safety hazard.” As it got dark there were several rooms, particularly upstairs where staff had not turned the lights on to ensure that people were safe and not at risk of falling over. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 34 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 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 2 35 2 36 2 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 1 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 3 X 2 X 2 X 2 2 X Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes, one partially met. 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 YA19 Regulation 12 (1) (a) Requirement Individual’s weight must be monitored regularly and action taken where a person has lost or gained a significant amount of weight. This is to ensure that the health needs of the people living there are met. All staff records must include the required recruitment records to ensure they are ‘suitable’ to do the job they are employed for. Timescale for action 28/02/08 2. YA34 13 (6) 31/03/08 3. YA35 18 (1) (c) (i) 4. YA42 13 (4) (ac) Staff training is required in 31/03/08 diabetes so that staff that are competent and understand their needs supports people. Outstanding from last inspection. Staff must ensure that adequate 15/02/08 lighting is provided in all areas of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000033648.V356141.R01.S.doc Version 5.2 Page 36 Holland Street, 76 1. 2. Standard YA6 YA6 3. 4. YA7 YA8 5. YA12 6. 7. 8. 9. YA14 YA16 YA17 YA19 10. YA19 11. YA19 12. 13. 14. YA19 YA22 YA22 Care plans should be developed further so that staff support people to meet all their needs and achieve their goals. Gifts and skills lists should be developed for individuals so that staff know how to support individuals to use and develop these. This will help to raise individuals self esteem and improve their well being. It should be clear how each person is supported to make choices and decisions about all aspects of their day-to-day lives so that their care is based on what they want. Meetings with people who live in the home must be developed so that there is evidence that requests made have been listened to and acted upon. Not assessed at this inspection. The people living there should be offered a choice of activities. The range and choice of activities needs to be kept under review to ensure that people experience a meaningful lifestyle. The people living there should have the opportunity to go on holiday so they can experience new things and visit different places. The people living there should be encouraged to develop their daily living skills. This will help them to become more independent. People who need support at mealtimes should be offered this to ensure they enjoy their mealtimes and can get the nutrition they need for a healthy diet. Records should clearly indicate what health appointments people have attended and the outcome of these. This will ensure that staff know how to meet people’s health needs appropriately. All staff should be given information about diabetes to ensure they are aware of this until formal training becomes available. This will ensure that staff know how to meet the needs of those people who have diabetes. Care plans should be followed and appropriate records kept to ensure that people are not at risk of being constipated, which could have a serious impact on their health and well being. Health action plans should include all the health needs of the individual so that staff know how to support them to meet their health needs. The way in which the people living there make a complaint should be accessible so that they have an opportunity to make a complaint independent of staff. All complaints and their outcome should be recorded so it DS0000033648.V356141.R01.S.doc Version 5.2 Page 37 Holland Street, 76 15. 16. 17. 18. YA24 YA33 YA35 YA36 19. 20. 21. YA39 YA40 YA41 22. YA42 is clear that people’s views are being listened to and acted on. The kitchen in the flat should be refurbished so that the people living there can use it to develop their independence skills. All staff should ensure that they interact with all the people living there so to ensure their self esteem and well being. All staff that work at the home should have an awareness of autism and how to support the people living there who have this to ensure their needs are met. All staff should have recorded, formal supervision sessions at least six times a year to ensure they are supported in their role so they can meet the needs of the people living there. Quality assurance systems should be developed further so that people’s views are sought about the day-to-day running of the Home. Policies and procedures should be kept under review so they reflect current practice and legislation. Not assessed at this inspection. Records no longer applicable should be archived and all records should be sectioned appropriately so that it is clear what care each person needs and what care they have been given to ensure their needs are being met. The manager should ensure that a Corgi registered engineer tests the gas equipment annually to ensure that it is safe to use. Holland Street, 76 DS0000033648.V356141.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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