Inspection on 07/06/07 for 76 Holland Street

This inspection was carried out on 7th June 2007.

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 12 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 15/01/08

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 Donna Ahern Unannounced Inspection 7th June 2007 09:45 Holland Street, 76 DS0000033648.V339238.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.V339238.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.V339238.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 N/A 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.V339238.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. 31st October 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 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 17 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. 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. The manager said that CSCI inspection reports are on display on the notice Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 5 board in the hallway and the outcome of inspections are shared with people living in the Home and staff during meetings. The Fee level for the Home is set by Birmingham City council and there were no details of what they are at the time of completing the report. Items not covered by the fee include clothing, toiletries and activities. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one long day, was unannounced and involved two inspectors. A random inspection visit took place in February 2007 to look at progress made since the previous key inspection dated October 2006. The outcome of this was that some progress has been made but there was concern about improving people’s care plans and risk assessments so that comprehensive plans are in place for staff to follow. The inspector met all the people living at the Home, spent time observing support and interactions from staff, had a tour of the premises including peoples bedrooms, looked at care records and 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 service users 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 service users. The manager completed an AQAA (annual quality assurance assessment), which tells CSCI about how well the Home is performing and achieving outcomes for the people who live in the Home. It also provides some factual information about the Home. Information from the AQAA was used to help inform the inspection process. Reports of any accidents or incidents reported to CSCI involving people using the service were looked at, as part of the planning of the inspection. Questionnaires were not sent out to people living in the Home or their relatives as part of the fieldwork for this inspection. Due to the concerns raised during the inspection visit further action and formal notices were served on the provider relating to peoples care planning and health care monitoring. What the service does well: There is a small core team of staff who know peoples needs well, which provides greater consistency in care given. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 7 People living in the home said, “staff are nice” “ they help me” “I can talk to the staff”. People said they liked where the home is located and they are really close to lots of shops, pubs and places to eat out so they can go out if they want to. 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 and collective needs. People are supported to keep in contact with their family and friends and the importance of these relationships is recognised by staff. Some people have had their rooms decorated and said” I love my bedroom it is big and I have room for all my things. I can sit in the Flat and do my own thing”. What has improved since the last inspection? What they could do better: The Home must get better at meeting requirements so that the home operates within the law and provides care that meets peoples needs. There must be an up to date care plan in place for all of the people living in the Home so that staff know how to meet people assessed need consistently. These must be kept under review and changes made when peoples needs change so they receive the care and support they need. Risk assessments are not sufficient they do not say what the risk are and how they will be managed so people are safeguarded from harm. There is still a lot of work that must be done to make this a safe and comfortable home for the people. 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 safely. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 8 The shed in the garden must be made safe so that people don’t get hurt there is loose glass in the windows and gardening tools and paint stored in the shed. Peoples health care monitoring and support must be improved so they get the care they need consistently. Health care monitoring is variable and could put people at risk. People’s health action plans (these are plans that tell people what they must do to stay healthy and include information about health appointments and follow up needed) are not being kept up to date and do not provide staff with clear information to follow. The manager must make sure that arrangements are in place so that all staff has a clear understanding of adult protection and whistle blowing procedures. This is to ensure that people in the Home are not at risk of harm or abuse. Staff must receive training on Autism, diabetes so they know how to support people and understand their individual needs. People should be offered a choice of activities to do in house and in the local community. There should be enough staff on duty so people are safe and can do things they enjoy. People should be supported by staff who know and understand their needs so they are not put at risk. Improvements should be made to the medication procedure so that it protects people and ensures medication is given out safely. Meetings for people in the Home are not held very often and limit the opportunity for people to talk about things that are important to them. Manual handling assessments which detail how people must be supported with their moving and handling needs must improved and kept up to date. This will ensure that staff know how to move people safely and a way the person wants to be moved. 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.V339238.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.V339238.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People and their representatives do have information about the Home they live in which has been produced in an easy read and picture format so that it is easier for people to understand and help them understand the terms and conditions of their residence. EVIDENCE: 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 CSCI that the home will reprovide 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 seventeen people. Some people have been 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. The people who live at Holland Street have a learning disability some people have additional needs including physical disabilities, behaviours that challenge Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 11 and some peoples care needs have increased and their assessed needs have changed. It was really positive that the service user guide had been developed since the previous inspection and is now available in an easy read format that is more suitable for the people who live at Holland Street. It is advised that this document is dated to so that it can be kept under review and details of fees and any additional charges must be included. A move for one of the people was imminent; on the day of the fieldwork they had been out with staff from the day centre to pick the floor covering for their new home and indicated that they are really looking forward to the move. Holland Street, 76 DS0000033648.V339238.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. 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 this service. Care plans and risk assessments in place do not fully demonstrate that staff can effectively plan to meet people assessed needs and reduce the risk to people. This may mean that people are not provided with the care and support they require. EVIDENCE: Previous reports have raised concern about the shortfalls in the quality of peoples individual care plans and that care plans were not being kept under review. As previously highlighted people have complex needs and some peoples needs have changed considerably so it is essential that there is a clear care plan in place for people to follow so that needs are planned for and met in a consistent way. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 13 A random inspection took place in February 2007 to monitor progress made on requirements following the Key inspection October 2006. The outcome of the Random inspection was that progress had been made on two of the three care plans looked at and further work was required. No progress had been made on risk assessments and how to reduce the risks to people. Four service users 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 service users. Some improvement had been made on accessing information within peoples care plan and an index had been created making it easier to find information. The individual profile for one of the people case tracked was not dated and there were no details of a review date so it was not clear that staff have current information about people. The person’s personal care and preferences were recorded but this was not in sufficient detail so that staff would know how to meet these needs. This persons has no verbal communication so is unable to direct their care. However, there was some information on the care plan about how the person communicates. The “Gifts and Skills” section of their plan was not dated so making it difficult to know if this information is still relevant for the person. Another persons care plan was dated 1998 and had been updated in 1999 and December 2000. Again changes had been made and information crossed through but not dated or signed. There is quick reference information but this had been completed in pencil this could be problematic when reviewing information and legal information must not be made in pencil. Letters were seen on people’s case files about interventions from other professionals such as speech and language therapy. Where there had been significant changes in peoples care needs this information was not detailed on the care plan and has the potential for people to not receive the care and support they require. Specific examples are detailed in the health and personal care section of the report. One of the people has had major changes in their care and was being supported by staff on the first floor (minimum care) none of this information was on their care plan or how the change in support and environment may impact on their needs. Peoples care plans had not been updated or reviewed following periods of stay in hospital; this is raised in more detail under the health and personal care section of the report. Peoples care plans should be kept up to date so that staff can follow the care plan and give people the care and support they need to meet their assessed needs. The home uses a high level of bank and agency staff who are reliant on clear care plans to follow. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 14 Staff spoken to expressed some concern about meeting people’s needs. Staff recognise that communication is essential and that people need to understand the persons needs. Two staff expressed concern about some of the staff team not understanding the needs of a person who is autistic and expressed concern about the negative impact of a high level of agency staff working in the Home has on meeting peoples needs. There was no evidence on care plans looked at that they were being developed with the involvement of the person. The care plan should be written in a way that makes the care plan accessible to the person. It would be good if photographs and pictures were used within the care plan making it more assessable to the person especially for people who are not able to read. Risk assessments in place to support people with daily living tasks require further development. A risk assessment for the use of electrical appliances says “D to be supported to use electrical appliances safely” “staff to support” and “electrical test to be done”. They do not say what the risks are to the individual and are not underpinned with a basic skills assessment, which would identify what support is required to enable the person to develop the required skills. Risk assessments recently implemented (March 07) for a person who was displaying behaviour that was challenging to other people these did not detail what the risk are. The care plan states the person needs 1:1 support from care staff at all times. The behaviour guidelines in place had not been dated or kept under review. This means that staff do not have sufficient guidance to reduce the risks to the individual. During the visit some staff were observed encouraging people to make choices about day-to-day matters, such as what they wanted to do on that day, if they wanted to go out, where they wanted to spend some time such as their own room or the communal areas of the Home. People’s ability to exercise choice and to make informed decisions is variable, according to their degree of learning disability. Staff spoken with were able to describe how people’s views were sought and choices were offered to people. This was not always reflected within care plans or daily records looked at so that agency staff who do not know the person so well have the information they need to support people. Meetings with the people who live in the Home are held infrequently, minutes were available to read from a meeting held in January 2007. The assistant manager said a meeting had taken place very recently and an advocate now chairs the meetings. This is a positive development and hopefully will ensure that such meetings take place on a more regular basis. These meetings should be developed so that they are another opportunity for people to express their views make decisions about the home and evidence that people have been listened to and consulted on a regular basis. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 15 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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples varied and individual lifestyles are not being fully met. Communication systems must be developed so that people can make more meaningful choices about their lifestyle. EVIDENCE: Many of the people attend one of two local day centres and some people attend college. Some people receive no structured day care during the week and a concern of the previous inspection was that it was unclear how their activities are planned for. Some progress had been made on this by implementing a system for the evaluation of activities. However, when looked at nothing had been recorded since 22nd April 2007, information recorded related to different people and it was difficult to find any real valuable Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 16 information. Comments included “could of done with more staff” “activity was expensive”. Some people said they would like to go out more but it depends on if there is enough staff on duty to support them. An activity person has been employed on a casual basis since the previous inspection. Their role is to support people with activities on a group or individual basis in the local community. There was no information available in the Home regarding their input the inspector only became aware of their role during the feedback session with the manager following the visit. Some people require a high level of staff support to engage in suitable activities in the home and the local community. As previously raised in inspection reports, it must be clear how people are consulted about the range of activities and leisure pursuits provided within the Home and the local community particularly for those who are dependent on staff support. Any system implemented for evaluating activities should have a clear purpose and inform any planning in a meaningful and purposeful way. Service users meetings minutes were looked at and although activities are discussed these meetings take place very infrequently, about every six months so do not provide a regular and consistent way for people to discuss and plan what they want to do. It was pleasing to hear from a person living in the home that they will soon be attending college two days a week they said “ I am really looking forward to going to college on Friday”. People spoken with said they enjoy going to the Gateway club on a Monday night with support from staff. Some people go out daily independently they said that they have good access to a range of shops and places to eat in Sutton Coldfield Town Centre, which is a short, walk away. Some people spoken with said they could attend local churches or places of worship with their family or friends. On the day of the visit two people who do not attend day centres went out for a walk. Another person was supported by their relative to go to a hydrotherapy session. Many of the people have support from their relatives and some people have very regular contact. One person said that they were looking forward to their birthday and had different things planned with their family including a trip to a theme park. Another person said that they enjoy coffee and cakes at a café every weekend with their relative. One of the people with limited communication indicated to the staff that they wanted to say something. The staff member explained that staff had recently traced the person’s relative and contact had been made and the person now has monthly contact. The person indicated that they were really pleased about this and waved their arms in excitement. Another person said “they were sad and upset because they miss one of their friends who use to live at the Home”. The Home welcomes visits from people’s family and friends and details of peoples family contact is Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 17 detailed in their care plan. The compliment log had details of people’s families sending compliments to the staff team for the support and care of their relative. Staff spoken with demonstrated that they recognised the importance of people having friendships and relationships with people close to them. The two previous CSCI inspection reports had looked at how people living on the minimum support part of the Home on the first floor were being supported to gain and develop life skills so they could live more independent lives. The report of November 2006 stated that satisfactory improvements had bee made to ensure people were getting the support they require. Due to time restraints the minimum support was not looked at in great detail during this inspection but indications were that people are being supported to develop their skills. Another person had moved out to live in a supported living flat since the last inspection. A person has moved within the Home to share the Flat with another resident. They said they were “really pleased” and “I love my bedroom it is big and I have room for all my things. I can sit in the Flat and do my own thing”. Concern was expressed about the kitchen on the first floor being locked due to the impact of one of the people’s needs and the taking of food items. This must be reviewed it is not acceptable to restrict access to other people living on what is a minimum care unit. The lunchtime meal was served in two dining areas on the ground floor. The inspector observed the support given to people in one of the dining areas. The meal was well presented and people said the food was “very nice”. One person requires full assistance from staff at meal times. A requirement of the previous inspection was that the persons eating and drinking needs required an assessment from Speech and Language Therapy. This had been actioned and a follow up assessment had recently taken place. Guidelines were in place for staff to follow to make sure people get the right support. People who need breakfast before setting off for day centres are supported first with their personal care and breakfast. For people who are at Home for the day or going out later breakfast time is flexiable. The main meal of the day is now served at lunchtime. Records of food served to people were examined there were gaps on several entries looked at. 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 people living in the Home. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 18 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 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Efficient systems are not in place to ensure that people receive effective personal and healthcare support. This may put the health and welfare of people at risk. EVIDENCE: People have lived at Holland Street for many years and some peoples needs have changed. Some people have experienced reduced mobility and some people’s needs and health care needs have become more complex resulting in a change in how they are supported by care staff. Reassessment of peoples needs must take place to ensure that the Home can still meet people’s needs. In feedback with the manager she agreed to raise this with Social Care and Health. The previous inspection raised concern about health care recording, it was not easy to track and find information making it difficult to monitor people’s health Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 19 care. The AQAA returned to CSCI stated that Health Action Plans were in place. These are health plans that include details of people’s health care needs and details of any treatment, appointments and intervention from other professionals. The Health Action Plans for the people case tracked were looked at and a number of concerns were identified. For one person who staff confirmed, has had considerable changes in their health needs their health action plan was not available. It had been left at a Home they moved to on a temporary basis following a discharge from hospital (January 2007). This has resulted in information becoming fragmented and some inconsistencies in monitoring their health care. It was of concern that attempts hadn’t been made to retrieve this information. This means that staff do not have accurate up to date information to monitor and support this person. Another person had recently been discharged form hospital where they had undergone medical intervention. There was no information in the person Health Action Plan or on their care plan (Individual service statement) in relation to the surgery they received and how this may impact on the care they need. The care plan or health action plan had not been reviewed following their discharge from hospital. The inspectors were made aware of the information following a discussion with one of the staff members. The care plan and health action plan for a person who had diabetes was looked at. The file had details about how this is managed by diet, but it was not mentioned in their care plan (Individual Service Statement). The person had recently been admitted to hospital with a diabetic coma. There were no guidelines in place for staff to follow regarding what staff should be observing for a hypo/hyper glycaemia so they could act competently and efficiently in the event of a coma occurring. A significant number of falls had been appropriately reported to CSCI in respect of one of the people living at the home. However there was no mention of the falls and the monitoring of these within their care plan or health notes or strategies to try and reduce the risks of falls. One of the senior staff was asked about the persons care needs and some medical appointments that had taken place and what the outcome of these were. The staff member said that the person’s relative supports the person on a lot of the appointments and they would have this information. There was evidence from letters on their file that the person was having input from other professionals including physiotherapist and occupational therapist. People’s health care records need to be a full and accurate account of their needs so that monitoring and any follow up action can take place. The previous Key inspection raised concern about the implementing of risk assessments, concern was again expressed following the Random inspection in February 2007 where it was stated that no progress had been made on risk Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 20 assessments. Risk assessments looked at during the fieldwork again raised concern. A risk assessment for the use of a shower trolley failed as a risk assessment it did not specify what the risk were or how these would be managed. The risk assessment stated that “the information within the risk assessment was still valid” but there was no evidence of the information it was referring to. A risk assessment for a bed guard again did not detail the potential risks to the person. The “degree of risk “ section states mild to severe depending on the circumstances but it does not say what the circumstances are. Previous reports raised significant concern about the condition of the bed guards covers, which had been sellotaped on to prevent the person pulling them off and was still in this condition at the time of this inspection visit. However during the fieldwork a reassessment of equipment required to meet the person’s needs took place and a new bed and bedsides have now been ordered. The risk assessments implemented for the use of wheelchairs required further development they were not specific about the risk to the individual. Manufacture guidelines and instructions must be available for all wheelchairs. There was evidence of improvement in the risk assessments in place for one of the people case tracked at the previous key inspection. There was risk assessments for the use of, wheelchair, hoist and mobilising these had been reviewed and had details of the sling used to support the person. However the risk assessment for the use of a lap belt on the wheelchair was generic as raised above and did not detail the specific needs of the individual. During discussions with staff the inspectors were made aware of a person who is refusing support from night staff and is wet during the night but unable to mobilise. There was nothing in the persons care plan regarding this and there was an odour from the person’s bedroom. The support required by people during the night must be risk assessed and any support required from staff and how this must be given must be documented or if care is offered and refused. This will ensure that people receive the support they need and staff are clear how and when they check people. There is a small core team of staff who know peoples care needs well. However there is now a high reliance on agency staff. Some of the people living in the home said they don’t like it when they don’t know who is working in the Home but they made positive comments about the staff they know. Care plans required further development so they detail peoples preference about how personal care should be delivered this is especially important for people who can not verbally direct their own care. Some staff raised concern about the negative impact of a high level of agency staff and that people in the home do not like being supported by someone they don’t know. During the visit a staff member walked into a person’s bedroom without knocking before entering this does not demonstrate that peoples privacy is respected. A message from a senior staff member about a persons care needs had been typed and printed off and six copies of the message was stuck around the person’s bedroom on Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 21 A4 pieces of paper. Staff said it was to remind them of a specific care need. There was also a message on a wipe board in the corridor with the person initials on. This kind of practice questions staff understanding of privacy and dignity issues of the people living in the Home. The manager said that the reason for this was that staff were not following instructions, this should be dealt with in an appropriate way and not in a way that impinges on peoples privacy and dignity. Medication is stored in a medical trolley in a locked office. None of the people have been assessed as being able to take their own medication. The medication administration charts were looked at for June 2007 and were well maintained. The charts for the three previous months were examined and some discrepancies were found. On a medication record chart the amount of medication supplied, a date and the number had been changed, it is possible that there was a cross over of when the charts were used but this is not clearly identified and is problematic when trying to audit peoples medication. This should have been picked up by one of the managers and action taken to rectify the error. The staff member dispensing medication on the day of the visit used a code that does not comply with the codes in use at the bottom of the page, which again could be problematic when auditing medication. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems in place do not effectively protect people from abuse and these failings may well increase the risk to people living in the Home. The complaint procedure if followed would ensure that people or their representatives would be listened to and concerns acted upon. EVIDENCE: Since the last visit the Home had received no complaints and two compliments had been received from peoples relatives. CSCI have received no complaints. The complaint log is now being maintained as required at the previous fieldwork visit. When looking through documentation a copy of some minutes from a meeting with a relative were found filed with the staff meeting minutes. The content of the minutes related to general care concerns such as meeting their relative’s personal care needs. The minutes were dated January 2007 and the meeting had been lead by the registered manager. It is unclear why this was not logged as a complaint. The manager in feedback explained that the meeting was set up to resolve issues and the relative said it was not a complaint. The manager Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 23 said as good practice she would log the information and action taken on the complaints log. 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 division’s new contact details. These should be displayed and made available to service users. The adult protection policy had been seen at previous inspection to the Home it could not be located during this fieldwork visit. The inspector was advised that the policy had recently been updated. This information should be available for people to access and follow should an incident occur in the Home. Staff spoken with during the fieldwork gave variable responses to what they would do if they identified a concern in the Home impacting on the care of people living in the Home. Staff training records looked at indicated that some training had taken place. The outcome of the general discussions with staff and the lack of a procedure to follow raised the need for the manager to ensure that arrangements are in place so that all staff has a clear understanding of adult protection and whistle blowing procedures. This is to ensure that people in the Home are not at risk of harm or abuse and staff have the confidence and knowledge to identify issues of concern and notify the relevant people in the event of alleged or actual abuse so that people are protected. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 24 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The facilities, aids and adaptations of the Home do not meet the needs of all the people living at Holland Street and impacts on their privacy, dignity and independence. EVIDENCE: Previous reports have raised concern regarding the physical standards of the Holland Street and areas of the Home have been identified as not fit for purpose. Some work had been done since the previous fieldwork including the painting and decorating of four people’s bedrooms and some further work to people’s bedrooms is planned so that they have a more comfortable place to live in. There is a lack of space in the bedrooms that accommodate people with additional physical disabilities. The bedrooms have restricted space for the use Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 25 of a hoist, which is problematic for the individual and also the staff member supporting and potentially places them at risk. 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. People have personalised their own room with support from staff and many are very homely and comfortable. One bedroom seen as part of the case tracking was in a poor condition with heavily soiled walls and is bare and is neglected in appearance this requires attention so that it is acceptable for someone to sleep-in. Another bedroom seen had poor access to the person’s personal belongings and there was evidence of an odour from the carpet, which would make this unpleasant for the person who occupies the bedroom. Another person has a ¾ size mattress on a double bed and this could present a safety risk to the person if they slipped from the mattress against the wall or floor. 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. The clinical waste bins were being stored in the bathroom and there was an odour coming from them, which is unpleasant and unhygienic for the people using the bathroom. These arrangements should be reviewed and alternatives considered such as an outside- secured area designated for clinical waste bins. There is a choice of communal areas including a lounge on each of the four different living areas and a shared conservatory. The conservatory is not welcoming as an area to sit in items were being stored in there and there is no heating or covers on the windows. Some of the chairs and footstools in use in the communal areas are soiled and ripped and unhygienic for people to use. There is a kitchen for people’s use on both the ground and first floor. The locking of the kitchen on the first floor is raise under lifestyles standards and should be reviewed. The shed in the rear garden had paint and garden equipment stored in it. The glass in some of the windows was loose and had no evidence of a safety mark. This should all be reviewed as in its present state it presents as a health and safety hazard to people living in the 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.V339238.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. People are often not supported by regular staff that know them, or are in the right numbers to meet people assessed needs. EVIDENCE: Examination of rotas and discussions with staff and managers indicated that the staffing situation has been very difficult. Birmingham City council who are the registered owners are not employing any new staff when posts become vacant due to the Home eventually reproviding. This has resulted in a number of agency and bank staff working in the Home. Some of the agency staff have been employed on a three-month contract. Rotas looked at indicated that minimum staffing levels is six per shift across the day however there are several occasions when this is not achieved, sometimes this is due to staff sickness. Due to changes in peoples needs two people require 1:1 support, for one of the people this is being achieved by an additional agency member of staff being employed the other person is being supported through the Homes own resources. Staff expressed concern about the staffing levels on specific occasions and managers spoken with during the fieldwork confirmed this. One Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 27 of the assistant managers said on one occasion they were the only permanent member of staff on shift. There is concern about how this impacts on the people living in the Home and is further complicated by a lack of care plans and guidelines for agency and casual staff to follow as raised in previous sections of this report. In recent weeks staffing levels have been as low as two staff on and then staff have been called in to help, on these occasions it was due to staff sickness at short notice. The staff rotas and allocations were examined for a five-week period prior to the inspection. There were at least seven days when staffing fell below the minimum level of six staff on duty. It was of significant concern that for at least 16 shifts the amount of agency staff working in the Home was higher than the amount of permanent staff and on at least three shifts the balance of agency staff was five to one permanent staff. The AQAA completed by the manager stated that it has been very difficult regarding staffing and is proving difficult to maintain a balance of permanent and agency staff. The manager had identified that she needs to re-establish the role of team leaders to monitor staff’s performance. The staffing situation is clearly of concern and has a direct impact on peoples care. Many of the people have complex needs and their needs have changed therefore requiring more staff in put from people who know and understand their needs. One of the people has by choice taken themselves to be supported in another part of the Home and spends the whole day there returning for food and to sleep. Staff said that due to their assessed needs the person doesn’t respond well to many changes and likes to be around familiar staff. It is fortunate that this person can physically remove themselves to somewhere that they do feel secure however many of the people at Holland street are not be able to do this due to their physical needs. There has been no new staff employed since the last fieldwork visit, the staff files for the people on duty were looked at and the file of one agency worker. All staff had been deemed suitable to work with vulnerable people following criminal record bureau checks. The file for the agency person contained no details of their experience and training, thus presenting difficulties for managers when placing them to work within the Home. Permanent staff spoken said the frequency of staff supervision has improved as required at the previous visit. This was confirmed by examining the frequency of supervisions recorded on individual files. Staff supervision is allocated one to one time to talk about care practice issues and staff development issues such as training they might need to do their job. The Homes supervision policy has changed and now any of the assistant managers can carry out a staff members supervision, staff will not have a consistent supervisor carrying out this task the inspector wondered if this will prove to be an effective strategy. The staff training records were looked at. There was so much information on file it was difficult to look through and gain an overview. Some dates had not been entered onto staff individual records; however there were notes at the front of the file clearly indicating this and this was considered by the inspector Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 28 when assessing. The records of five staff members were looked at. Three required updates on food hygiene, three required updates on adult protection and one required an update on challenging behaviour. In addition to the updates on mandatory areas training is required on autism, diabetes and communication so that staff can support people with meeting their assessed needs. The manager was able to confirm that only one person had received autism training. Although training on manual handling has been provided the visit identified some significant areas where further training must be done so people are supported in a way that meets their needs. The manager needs to complete a staff training needs audit to ensure that staff have the required training, skills and knowledge to meet people needs. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 29 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Home has not demonstrated that it is managed in a way that peoples health and safety is promoted and protected this could result in peoples 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. 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 is currently working towards achieving this. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 30 Only minor progress has been made on previous requirements. A number of areas remain of concern. As raised in previous CSCI inspection reports there is specific concern about people 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 people whose assessed needs have changed. These shortfalls have remained of concern for a considerable amount of time and must be addressed so that people are not put at further risk. Many of the systems that are in place are not effective and as a result people are experiencing variable outcomes. It is of concern that there is no evidence in the Home that the provider has carried out monitoring visits of the Home when discussions should take place with people living in the home and a tour of the premises should be made to form an opinion about how the Home is being run. The last report available was dated June 2006. Given that this home has failed to provide good outcomes for people it is important that the owner has good oversight of the areas for development so they can influence change. The Home is due to reprovide but there is no timescale in place for this to take place. People are and have been supported to move on to other Homes in the locality. There is no clear development plan in place for the interim period and no clear information about what work will be done to the physical standards of the Home so that it is safe and comfortable for people. Staff training and updates are required in mandatory areas so that staff have the skills and knowledge and can work safely with people. Quality assurance systems have not been developed any further since the previous fieldwork visit and has not been implemented as a core management tool, and people’s views on the Home are not been sought. Policies and procedures have not been reviewed for a considerable amount of time These included the dealing with aggression policy dated 1999, control of infection 1999, Health and safety policy 1999. It is unclear if these are the most recent copies. It would be helpful if there were a list of policies and procedures detailing implementation dates and dates when they are due for review so that the manager can ensure they comply with current legislation so that peoples best interest are safeguarded. Safety checks were looked at including hot water temperature checks, gas safety testing, fire safety checks and work place fire risk assessments which ensure regular testing and service of equipment take place as required, to protect the safety and well being of people living at the Home. The recording of fire drills should be developed so that it is clear when these tests have taken place and that all staff working in the Home know how to safely support people in the event of the alarm being activated. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 31 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. The work place fire risk assessment was dated 2003 and the date of the last review was 21/04/05. The manager has the responsibility to ensure that in consultation with West Midland Fire an effective work place fire risk assessment is in place so that people’s safety is promoted and protected. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 32 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 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 2 1 1 1 X 2 X Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 33 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 YA6 Regulation 15 (1) (2) Requirement A comprehensive support plan must be in place for each person detailing how the staff team will meet his or her assessed needs. This must be kept under review so that it provides clear guidance on the person’s current needs. Outstanding requirement from previous inspection. Unmet timescale 31/03/07. 2 YA7 15(1) (2) Behaviour guidelines must be dated and kept under review so that staff know how to support the person safely. 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. Unmet timescale 28/02/07. 4 YA18 14 (2) a,b Reassessments of people who needs have changed, must take place to ensure that the Home DS0000033648.V339238.R01.S.doc Timescale for action 16/08/07 16/08/07 3 YA9 13 (4) a, b, c 16/08/07 31/08/07 Holland Street, 76 Version 5.2 Page 34 5 YA18 13 (4) can still meet peoples assessed needs. Manual handling risk assessments required further development they must be clear about how a person should be safely transferred so people are not put at risk. Outstanding from previous inspection. Unmet timescale 16/02/07. 16/08/07 6 YA19 12 (1) a, b 7 YA23 13 (6) 8 YA24 13 (4) a, b, c There must be proper provision 31/07/07 for the health and welfare of people so their health needs are monitored and planned for. Failure to do so puts people at risk. Arrangements must be made to 31/07/07 ensure that all staff have a clear understanding of adult protection and whistle blowing procedures. This is to ensure that people are not put at risk. The shed in the rear garden had 31/07/07 paint and garden equipment stored in it. And was unlocked. The glass in some of the windows was loose and had no evidence of a safety mark. This should be made safe as in its present state it presents as a health and safety hazard to people living in the Home. One of the people’s bedroom is in a poor condition it must be decorated and made comfortable for the person so it is acceptable for them to sleep in. There must be adequate numbers of staff at all times to meet peoples assessed needs. Staff training is required in mandatory areas and on autism, diabetes and communication so that people are supported by DS0000033648.V339238.R01.S.doc 9 YA24 23 (2) (b) 31/07/07 10 11 YA33 YA35 18 (1) a, b, 18 (1) (c) (i) 21/07/07 31/10/07 Holland Street, 76 Version 5.2 Page 35 12 YA39 26 staff that are competent and understand their needs. The owner representative must do monitoring visits of the Home when discussions should take place with people living in the home and they inspect the premises so that they can form an opinion about the standard of care provided to people and produce a report on the outcome. 30/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 Refer to Standard YA1 YA6 YA6 YA7 YA8 YA8 YA8 YA12 YA16 Good Practice Recommendations Service user guide should include details of fees and additional charges People who live in the Home should be supported to be involved in the development of their support plan. Person centred plans should be implemented in a format suitable for the individual so that it is meaningful and personal to them. Daily records should be developed so that peoples needs can be properly monitored. Communication systems within the Home must be developed so that people living in the Home receive the support and assistance they need. There should be evidence that peoples goals and aspirations have been followed through so that the Home can demonstrate that people have been listened to. 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. People living in the Home must be offered a choice of activities. The range and choice of activities must be kept under review. The risk assessment in place for the kitchen on the first floor must be reviewed and the practice in place must not restrict other people from using this facility. DS0000033648.V339238.R01.S.doc Version 5.2 Page 36 Holland Street, 76 10 11 12 YA17 YA18 YA20 13 14 15 16 17 18 YA20 YA22 YA23 YA24 YA24 YA24 19 20 21 22 23 24 YA24 YA24 YA34 YA38 YA40 YA42 Food records must be maintained so that there is evidence that peoples dietary needs are being met. Care plans must incorporate what advice from other professionals has been sought and how this has been implemented. There should be systems in place to ensure that medication received into the Home can be audited, so errors can be identified and people receive medication in a way that meets their needs. Codes used on medication record sheets must be reviewed so they comply with the Homes procedures and safeguard people. The complaints procedure must be made available in a format suitable for the people living in the home so they know and understand how to make a complaint. The adult protection procedure must be available in the Home for staff to follow and refer to should an incident occur so people are protected. A planned maintenance and renewal Programme for the building is required. So CSCI know what is happening and when so progress can be monitored. A new mattress that fits the bed base is required so the person is safe and comfortable when sleeping. An odour from the carpet in a person’s room should be dealt with so the person can be comfortable in their room and any potential infection control hazards should be managed. Any soiled or damaged furniture should be made safe/clean for peoples use so that people are safe and comfortable. The arrangements for the storage of clinical waste should be reviewed so that there is no risk or hazards to people living in the Home. There should be profiles detailing agency staff experience and training so that the manager can ensure staff allocation meets peoples needs. Quality assurance systems require further development so 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. The fire risk assessments must be kept under review so any risk to people in the home is minimised. Holland Street, 76 DS0000033648.V339238.R01.S.doc Version 5.2 Page 37 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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