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Inspection on 31/10/06 for 76 Holland Street

Also see our care home review for 76 Holland Street for more information

This inspection was carried out on 31st October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a core team of staff who know service users needs well, which provides greater consistency in care given. Service users spoken to said they get on well with staff. Service users said they liked where the home is located and they are really close to lots of shops, pubs and places to eat out. Service users said "Its better now I do my own meals and the staff help me". and "I do my washing and ironing and help to do the cleaning".

What has improved since the last inspection?

It was positive to hear that some service users have been supported to move on to more independent living following the completion of person centre plans. These are care plans that start with the person, not the service and takes into account the individuals wishes about what they want to do and includes their requests on lots of things such as leisure, education and housing. Staff training opportunities and records of training achieved has been developed so that staff have the skills and knowledge they need to support service users. Service users who live on the "minimal care" on the first floor are being supported individually to prepare and cook their meal and promote theirindependent living skills. Service users received very good support and supervision from the staff member on duty at the time of the fieldwork. Some improvements had been made to the decoration of the bathroom areas, decorating of the entrance hall and hallway so that the home is more comfortable for service users.

What the care home could do better:

There is still a lot of work that must be done to make this a safe and comfortable home for the people who live at Holland Street. Many of the bedrooms need decorating and painting. The facilities are poor for people who have additional physical disabilities. Their bedrooms are small and lack space for equipment and to receive assistance from staff. The manager and staff must improve the care plans that they have developed for each person. These must tell the staff how to support each person. They must be clear about what help and support each person needs and what staff must do to support the individual. These must be kept up to date and changes made when peoples needs change. The home must improve how it says it will help service users reduce some of the risks that they may face in the home or when they go out on an activity or independently access the community. The staff must improve the way that service users health needs are recorded monitored and followed up. The way that information is recorded in Health Action Plans must be improved so that people`s health care needs can be tracked. It must be clear that people are getting the health care support they require. Manual handling assessments which detail how people must be supported with their moving and handling needs must be kept up to date. When changes are made the assessment must have the new information added on. This will ensure that staff know how to move people safely and in the way the person wants to be moved. Improvements must be made to the recording and logging of complaints so the manager can demonstrate that concerns raised by service users or relatives are acted upon. A lot of work is required to the building to make it a comfortable and safe place for service users. Many of the bedrooms need decorating and painting. The facilities are poor for people who have additional physical disabilities. Staff must receive Fire safety training so staff know how to support service users safely in the event of a fire.Staff must receive a minimum of six supervisions a year so that they receive the support and guidance they need to carry out their job.

CARE HOME ADULTS 18-65 Holland Street, 76 Sutton Coldfield West Midlands B72 1RR Lead Inspector Donna Ahern Unannounced Inspection 31st October & 3 November 2006 10:00 rd Holland Street, 76 DS0000033648.V313795.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.V313795.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.V313795.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 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.V313795.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 service users, 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 home’s 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. Reprovision plans to progress at a pace which is acceptable to CSCI to allow continuation of registration. 24th April 2006 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. 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 19 adults who have a learning disability; some people have additional physical disabilities and behaviour that may challenge. Each service user 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. Staff call this part of the home “minimal care”. The physical standards of the home do not meet the needs of people with additional physical disabilities. 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 service Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 5 users and staff during meetings. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork visit was unannounced involved one inspector and took place over two days lasting twelve hours. This was the homes second key inspection for the inspection year 2006-2007. During the fieldwork the inspector met at least ten service users, observed the opportunities and support provided to people, looked at the premises, and read records about care, staffing, and health and safety. Time was spent with the manager, senior support workers, and discussions took place with four care staff. The home is required to report incidents, accidents and other events that occur in the home to CSCI. These are called regulation 37 notifications. All information reported via a regulation 37 notifications since the last inspection was analysed prior to the fieldwork visit. What the service does well: What has improved since the last inspection? It was positive to hear that some service users have been supported to move on to more independent living following the completion of person centre plans. These are care plans that start with the person, not the service and takes into account the individuals wishes about what they want to do and includes their requests on lots of things such as leisure, education and housing. Staff training opportunities and records of training achieved has been developed so that staff have the skills and knowledge they need to support service users. Service users who live on the “minimal care” on the first floor are being supported individually to prepare and cook their meal and promote their Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 7 independent living skills. Service users received very good support and supervision from the staff member on duty at the time of the fieldwork. Some improvements had been made to the decoration of the bathroom areas, decorating of the entrance hall and hallway so that the home is more comfortable for service users. What they could do better: There is still a lot of work that must be done to make this a safe and comfortable home for the people who live at Holland Street. Many of the bedrooms need decorating and painting. The facilities are poor for people who have additional physical disabilities. Their bedrooms are small and lack space for equipment and to receive assistance from staff. The manager and staff must improve the care plans that they have developed for each person. These must tell the staff how to support each person. They must be clear about what help and support each person needs and what staff must do to support the individual. These must be kept up to date and changes made when peoples needs change. The home must improve how it says it will help service users reduce some of the risks that they may face in the home or when they go out on an activity or independently access the community. The staff must improve the way that service users health needs are recorded monitored and followed up. The way that information is recorded in Health Action Plans must be improved so that people’s health care needs can be tracked. It must be clear that people are getting the health care support they require. Manual handling assessments which detail how people must be supported with their moving and handling needs must be kept up to date. When changes are made the assessment must have the new information added on. This will ensure that staff know how to move people safely and in the way the person wants to be moved. Improvements must be made to the recording and logging of complaints so the manager can demonstrate that concerns raised by service users or relatives are acted upon. A lot of work is required to the building to make it a comfortable and safe place for service users. Many of the bedrooms need decorating and painting. The facilities are poor for people who have additional physical disabilities. Staff must receive Fire safety training so staff know how to support service users safely in the event of a fire. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 8 Staff must receive a minimum of six supervisions a year so that they receive the support and guidance they need to carry out their job. 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. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. 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 the service. Information about the home must be developed so that it is available in suitable formats for the people who live at Holland Street. EVIDENCE: The people who live at Holland Street have a learning disability some people have additional needs including physical disabilities and behaviours that challenge. Many of the people have lived at the home for a number of years and some people needs have deteriorated. Occupancy levels have reduced from twenty-two to nineteen. There have been no new admissions to the home since the previous inspection. Three service users have moved on to new homes. This includes registered homes and supported living. Two more people were exploring possible moves. The provider has indicated to CSCI that the home will reprovide its service. As service users are supported to move onto new living environments the number of registered beds will be reduced and no new admissions will be made. Therefore it was not possible or relevant to assess the preadmission process. The manager must explore how the Statement of Purpose and Service user Guide can be provided in a format that is suitable for the people who live at Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 11 Holland Street such as on audiotape so that service users receive all the information they need about the home. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 6, 7 and 9 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to the service. Care plans required updating and development so that a comprehensive plan is in place that details how service users assessed needs and goals will be met. EVIDENCE: Previous reports have raised concern about the shortfalls in the quality of service users individual care plans and that care plans were not being kept under review. Four peoples individual care plans were looked at. This included people who have complex needs and additional physical disabilities and people who are more independent. Two of the peoples care plans looked at have had significant changes in their care needs over the last twelve months. Both people had a review sheet on their file dated July 2006 that stated the care plan required review. One persons care plan was not in their main file and when located was still in the process of being updated. The other care plan remained as completed in Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 13 August 2005. This has the potential to put service users at risk and cause inconsistencies in care given if their care needs are not properly documented and monitored, as staff have no guidance to follow. Previous inspection reports raised that the care plan format does not provide comprehensive information. It should provide a support plan that details how peoples assessed needs and goals will be met. The action plan provided by the organisation in January 2006 stated that Holland Street was to be part of a pilot scheme to improve service user information, which would include development of peoples care plans. However, no progress has been made on this. Risk assessments were examined and significant development of these are required. Risk assessments must be implement in a number of areas that may pose a risk to individual service users. It is really positive that people on the first floor on what is called the “minimal care unit” are supported to develop their independence skills such as cooking, washing, ironing and household tasks. However there were no risk assessments in place to support this work. Service user must be supported to take acceptable risk and develop and maintain their skills within a risk assessment framework. When asked staff were unsure if this information was available and where it would be kept. Risk assessments in place for service users who access the community independently required further development to identify what action is needed to keep people safe. A generic risk assessment had been completed for six people but this was general and not specific to the individual. Some people travel independently and may be away from the home for long periods during the day. Other people stay within the local area. Staff consulted with service users during the fieldwork visit. Service users were encouraged to make their own decisions and choices about their life. They were asked about what they wanted to do during the day. Some service users went out independently to the shops. Other people were consulted about what activities they wanted to do and if they wanted to spend time with other service users or spend time in their own room. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users must be supported to be independent within a risk assessment framework so that the risks they face are well managed. Service user receives a choice of meals that reflect their cultural needs and provide a balanced diet. EVIDENCE: The previous inspection report raised concern about how people on the first floor were being supported to develop their independent living skills. Previously service users were involved with cooking, cleaning and general household skills but staff had taken over meal preparation. There was no clear plan or direction. Many of the people are looking at moving on to live in a more domestic style environment and are keen to live more independently but were not being supported to develop the required skills. It was positive that improvements had been made. Service users were supported individually to prepare and cook their meal. They received very good support and supervision Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 15 from the staff member on duty. One person said “Its better now I do my own meals and the staff help me”. Another service users said “I do my washing and ironing and help to do the cleaning”. Another service user said they were looking forward to moving into the flat on the first floor but was waiting for it to be painted. Risk assessments to evidence that service users are supported to be independent within a risk assessment framework had not been actioned as raised previously in this report. These must be implemented so that it is clear that possible risk have been looked at and there are plans in place how to support people to manage these risks and develop their skills. Many of the service users attend one of two local day centres and some people attend college. One person works two days a week at a farm. Some people receive no structured day care during the week and it was unclear how their activities are planned for. Service users said they would like to go out more but it depends on if there is staff on duty to support them. Some people require a high level of staff support to engage in suitable activities in the home and local community. It must be clear how service users are consulted and what activities are to be provided. Systems must be implemented for the evaluation of activities so that there is a way of monitoring what people have enjoyed and may like to do again. Service users said they enjoy going to the Gateway club on a Monday night with support from staff. They said that they have good access to a range of shops, pubs and places to eat in Sutton Coldfield Town Centre, which is a short, walk away. Service users said they could attend local churches or places of worship with their family or friends. The manager said that further work was taking place and links were being established with the local community so that people’s religious and culture needs could be met. On the day of the fieldwork visit one service users went out for lunch another person had been out shopping the day before. Staff said they do try to support people to go out when possible. A beauty therapist was visiting at the time of the fieldwork and was painting service users fingernails. This seemed very popular with people. Art sessions are organised by a staff member on alternative Thursday nights. Service users said they enjoyed these sessions and were working on producing Christmas decorations. Some of the service users live fairly independent lifestyles and come and go as needed. They are asked to inform the manager on duty of when they are due to return as a safety measure. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 16 Service users said they could go to bed and get up when they want to. People were seen choosing to spend time in their own rooms and freely accessing the communal areas of the home. Service users said they are supported to maintain links with their family and friends. Some service users said that they visit and stay with their relatives on a regular basis. One person was looking forward to spending the day with her mother and going out for something to eat. Relatives had helped out in the garden in the summer and produced some lovely hanging baskets and border plants so that the garden was more inviting for all service users to enjoy. A lunchtime meal was observed and service users were given appropriate support. One person requires total support to eat their meal. There was concern that the person care plan did not detail what their specific needs were and although advice had been sought from other professionals this had not been documented. Some meals are completely liquidised and some meals are not. This has the potential to place service user at risk and must be addressed. The manager was asked to address this immediately with the relevant professionals. Records of food served to service users were examined for October 2006 and were incomplete for several days. There must be an accurate record of what people have eaten so that staff can monitor that people are receiving a healthy and balanced diet. The menus reflect a choice of meals; the choices offered reflect the cultural needs of the service users. Holland Street, 76 DS0000033648.V313795.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to the service. Efficient systems are not in place to ensure that service users receive effective personal and healthcare support this has the potential to put service users at risk. EVIDENCE: It was positive that Health Action Plans had been implemented since the last inspection. However it was difficult to track and monitor heath information as outcomes of appointments were being recorded in different places. Some were on daily notes in the case file and others were on the Health Action Plan file. The Health Action Plans were not an accurate picture of people’s health care needs. This must be addressed so that service users health needs can be properly monitored. Manual handling risk assessments had not been kept under review. A service user needs had changed considerably. The manual handling assessment had been completed in September 2000 and reviewed annually up until June 2005. There was no evidence of review since this date although the person now required hoisting for all transfers. Advice and input had been sought from other professionals including the manual handling team who had advised via Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 18 email and a copy on the persons file said, “a risk assessment should be written and a detailed system of work implemented” (July 2006). There was no evidence that this had been acted upon. The lack of appropriate risk assessments in respect of moving and handling has the potential to place service users and staff at risk of harm. Generic risk assessments had been implemented for the use of wheelchairs. These require development, as they are not specific about the risk to an individual service user. Manufacture guidelines and instructions must be available for all wheelchairs. Further advice and a specific risk assessment must be implemented for one person who sometimes chooses to sleep in their wheelchair for short periods. It must be clear how the person is supported and monitored during this time so they are not put at risk. There were no records of people’s weight being monitored. One person had lost considerable weight and for another person the Doctor had requested they were weighed twice a week. The manager said this information was held at the clinic where the weighing takes place. Peoples Health Action Plans should be active documents where this information should be kept so that monitoring can take place and action can be taken to meet their needs. Care plans must incorporate what advice from other professionals has been sought and how this has been implemented this was unclear when reading people care plans. It was positive that the manager had instigated a multidisplinary meeting in respect of the service user with changing needs and minutes of the meeting were available. The manager acknowledged the difficulties the staff team were facing in meeting the persons needs. The support required by service users during the night must be risk assessed and any support required from staff and how this must be given must be documented. This will ensure that people receive the support they need and staff are clear how and when they check people. This requirement remains outstanding from the previous inspection report. One person is regularly refusing meals. Their food intake is recorded within the general daily records. Its is advise that this information is record separately so that it can be more easily monitored and evaluated. There must be a clear protocol in place regarding what action staff should take when meals are refused and how meals should be prepared. This should be based on advice from other professionals including the General Practitioner and Dietician. Due to deterioration in their health needs a service user gets very distressed on occasions when receiving personal care. Sometimes this results in physical aggression towards the care staff. Staff spoken with during the fieldwork were able to give really good insight into the persons needs and said the service user does not like the hoist. There must be guidelines in place so that staff provides support in a consistent manner that upholds the person’s dignity. The Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 19 guidelines must specify how to manage the situation when it becomes difficult for the service user and for the staff who give support. Some recordings seen on the persons care plan were inappropriate and raised concern about staffs attitude to the service user and included “cross” “just in a mood” “did not say sorry when wet the bed”. Sellotape was used to secure the “bedsides” in place to the side of the bed for a service user who had been assessed as requiring these for their own safety. The suitability and safety of these must be explored. Previous reports have highlighted that the bedrooms are not adequate to meet the needs of a person with additional physical disabilities. The rooms are cramped there is limited room for personal items and equipment and there is restricted turning space. Service users are hoisted from their bed along the corridor into the communal bathroom, as there are no ensuite facilities. The manager indicated at the previous inspection that as service users move from Holland Street there should be the opportunity to make some of the bedrooms bigger. No progress had been made on this and bedrooms remain not fit for purpose. Medication records seen for one person in September 2006 had several gaps that had not been explained. All other medication record sheets were up to date. Medicines received, admistered and disposed of are recorded. Medication practice had recently been reviewed. Service users are given their medication in the office away from the communal areas so that it is more private. It was required at the previous inspection that regular staff drug audits before and after a drug round must be undertaken by the manager to demonstrate staff competence in medicine management it was unclear if these had been implemented. Holland Street, 76 DS0000033648.V313795.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Improvements must be made to the recording and logging of complaints so the manager can demonstrate that concerns raised by service users or relatives are acted upon. EVIDENCE: The manager had received one complaint about the home since the last inspection and two compliments had been received from service users relatives. The complaint log had not been completed and there were no details of how the complaint had been dealt with or the outcome. When asked the manager was unable to find the information. There is a need to record each part of the complaint and the outcome. All letters sent to do with complaints must be kept in the file. Improvements in the recording and logging of complaints will ensure that information can be tracked and demonstrate that concerns raised by service users or relatives are taken seriously and acted upon. The organisation has a complaints procedure this must be produced in a format suitable for the people who live at Holland Street and the contact details must be updated to include the complaints divisions new contact details. These must be displayed and made available to service users. The Adult Protection policy was not assessed at this inspection. It was previously assessed as meeting the required standard. Staff spoken with Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 21 demonstrated that they would report any matters of concerns to their manager or senior manager. Holland Street, 76 DS0000033648.V313795.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is institutional in its layout and is not suitable for meeting service users needs. The facilities for people with additional physical disabilities are poor. Many areas of the home require decoration so that it is comfortable and homely for service users. EVIDENCE: Previous reports have raised concern regarding the physical standards of the home. The home is not suitable for the purpose of achieving its stated aims and objectives. Some work has been done since the previous inspection including some improvements to the bathroom areas and decorating of the entrance hall and hallway. There is a lack of space in the bedrooms that accommodate people with additional physical disabilities. This matter is also raised under standard 18. Some of the rooms have dividing partitions. The sound proofing between these bedrooms is inadequate and it was felt that this compromises the privacy of the people who occupy these rooms. There are no ensuite facilities. Individual Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 23 service users have personalised their own room and some are very homely and comfortable. There are mobile hoists available to assist people with moving and handling needs and these had been serviced as required so they are safe for people to use. There is no lift to the first floor so people who use a wheelchair or who have limited mobility are unable to visit friends or use facilities on the first floor. There is a choice of communal areas including a lounge on each of the four different living areas and a shared conservatory. There is a kitchen for service users use on both the ground and first floor. As previously stated as service users move on to alternative homes registered numbers for the home will reduce which will provide some flexibility for the use of bedrooms. Painting and decorating of people’s bedroom and some communal areas remains outstanding and is required so that service users have a homely and comfortable home. A planned maintenance and renewal programme for the building is required so that progress on outstanding work can be monitored. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff do not receive regular supervision and support sessions to enable them to do their job well and meet service users needs. Vacant posts must be appointed to so service user benefit from a stable team who know peoples needs. EVIDENCE: Staffing levels are a condition of registration. The home is required to have six support workers and a senior on each shift. At night there is two waking night staff on duty and a manager undertakes a sleep in shift to provide on call support. The required level of staff was on duty. Examination of the rota indicated that minimum staffing levels were being maintained and systems were in place to monitor the balance of permanent staff and agency staff on each shift. There are 202 care hours vacant, which the manager said were in the process of being appointed to. A number of agency staff were being used. Service users said, “there have been lots of staff changes” and “I don’t like it if I don’t know the staff”. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 25 The manager said consideration is given to the gender of staff working on the different areas of the home so that service user preferences about who delivers personal care are met. However, at the time of the fieldwork a service user was required to go to a different area of the home so that she could receive support with personal care from female staff. Staff Files had been reorganised so that information was easier to access. Four files were assessed. References were not available for one person. The CRB check for one staff member was a standard disclosure it must be an enhanced disclosure. Probationary records had not been completed for two people. These should be seen as an extension to recruitment. Staff records must be improved so that robust recruitment and induction systems are in place so that service users are protected by the organisations recruitment procedures. Staff’s training records had been improved. A training record was in place for each staff member detailing completed training. Updates on mandatory training had been booked where required and was taking place in forthcoming months. Autism and Epilepsy training sessions had been arranged for November, December and March 2007. This will ensure that staff have the required skills and knowledge to support service users. Fire safety training records had June 2005 as the last recorded date for training. Staff must receive the required training so they know how to support service users safely in the event of a fire. The frequency of staff supervision sessions, which are the opportunity for staff to receive feedback on their performance and to discuss staff development matters, were looked at. Of the three files sampled all staff had recently had a supervision session but prior to this had not received supervision for a year. Staff must receive a minimum of six supervisions a year so that they receive the support and supervision they need to carry out their job. Interactions between service users and staff were generally positive. Staff spent time talking to service users on a one to one. Service users spoke about staff who they said were good and they could talk to. Some service users said they did not like it when there was staff on duty that they didn’t know. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The implementation of policies and procedures in relation to care of service users do not ensure that people’s welfare and safety is protected. 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. The previous report highlighted that the manager was completing NVQ level 4 and the registered managers award so that she has the required management skills and knowledge. She has been unable to complete this training to date but was working towards achieving this. A temporary deputy has been in post for a number of months and feedback from staff and service users was generally favourable. It was said that he has Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 27 been able to support the manager and management team with the ongoing development of the home. There have been improvements made to the organisation and support given to people on the first floor who are being supported to develop their independent living skills. However a number of areas were assessed as of concern. Specific concern was raised about service users receiving effective healthcare support, care planning and the implementation of risk assessments and moving and handling assessments. Some of the difficulties have been around supporting service users who’s needs have changed. These shortfalls must be addressed so that service users health and welfare are protected. Quality assurance systems are in place and focus on monitoring the homes administration systems. The quality assurance system should be developed so that service users views are actively sought and acted upon. Service users meetings take place about every three to four months. Minutes of the most recent meetings in July 2006 and April 2006 were seen and mainly discussed what people would like to do. It is advised that the minutes of meetings are developed so that it is clear what action has been taken and by whom on matters raised by service users and how these fit into the development of the home. A number of general Health and Safety records were examined including electricity and gas safety and generally were in satisfactory order. However, random testing of water temperatures had not been completed since 8th October and should be completed weekly so that service users are protected from the risk of scalding. Accident and incidents are being logged on the required forms. Follow up action had been recorded and sent to the providers Health and Safety office for monitoring. Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 28 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 N/A 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 1 25 X 26 X 27 X 28 X 29 1 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 2 X 2 X X 1 X Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 (1) (2) Requirement The Service User Guide must be produced in a suitable accessible format for service users. Care plans required further development. They must be clear and specific about the support required by service users and kept under review. Outstanding requirement from previous inspection. Risk assessments must be further developed. They must be clear and specific about what the risks are and the action taken to minimize the risk. They must be kept under review. Outstanding requirement from previous inspection. Service users must be offered a choice of activities. The range and choice of activities must be kept under review. DS0000033648.V313795.R01.S.doc Timescale for action 31/12/06 2 YA6 15 (1) (2) 31/12/06 3 YA9 13 (4) a, b, c 31/12/06 4 YA12 16 (2) (m) 31/12/06 Holland Street, 76 Version 5.2 Page 30 5 YA13 16 (2) (m) 6 YA14 16 (2) (m) 7 YA17 16 (2) (I) 8 YA18 13 (4) 9 YA18 13 (5) It must be clear on care plans what opportunities are available for people who do not attend a structured day service. Opportunities should be in accordance with peoples assessed needs. Systems must be implemented for the evaluation of activities so that there is a way of monitoring what people have enjoyed and may like to do again. Records of food must include an accurate record of what service users have eaten. Risk assessments for service users who use wheelchairs and the use of posture and lap belts required further development. Manual handling risk assessments required further development. They must be kept under review. Outstanding requirement from previous inspection. The support service users require during the night must be risk assessed. Records of monitoring must reflect the risk assessment. Outstanding requirement from previous inspection. Monitoring of people weight must take place and a record must be kept in the home. 31/12/06 31/12/06 30/11/06 30/11/06 30/11/06 10 YA18 13 (4) a, b, c 30/11/06 11 YA19 12 (1) a & b 30/11/06 Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 31 12 YA19 YA17 12 (1) a & b 13 YA19 12 (1) a Care plans must 30/11/06 incorporate what advice from other professionals has been sought and how this has been implemented. Health care recording 30/11/06 must be improved. Outstanding requirement from previous inspection. Risk assessments were 30/11/06 required for service users with epilepsy. Outstanding requirement from previous inspection. Medication Record Sheets must be signed when medication is administered. Regular staff drug audits before and after a drug round must be undertaken by the manager to demonstrate staff competence in medicine management. Appropriate action must be taken when discrepancies are found. The complaints procedure must be made available in a format suitable to service users and include the organisations new contact details. A planned maintenance and renewal Programme for the building is required. Vacant posts must be appointed to. The home must have on each staff file all of the information as detailed in schedule 2. DS0000033648.V313795.R01.S.doc 14 YA19 12 (1) a 13 (4) 15 YA20 13 (2) 31/10/06 16 YA20 13(2) 09/12/06 17 YA22 22 (2) 31/12/06 18 YA24 23 (2) (b) 21/11/06 19 20 YA33 YA34 18 (1) a 7,9,19 Sch 2 31/12/06 31/12/06 Holland Street, 76 Version 5.2 Page 32 21 22 YA35 YA36 23 (4) (d) 18 (2) 23 24 YA39 YA42 24 13 (4) Fire Safety training is required for all staff. Staff must receive regular supervision at least six per year with records kept. Quality assurance systems require further development. Random testing of water outlets must recommence. 31/01/07 31/12/06 28/02/07 24/11/06 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 Standard Good Practice Recommendations Holland Street, 76 DS0000033648.V313795.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 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. 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