Inspection on 10/03/09 for Katherine House

This inspection was carried out on 10th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Katherine House 02/09/08

Katherine House 17/05/07

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 19/06/2009.

CARE HOME ADULTS 18-65 Katherine House Katherine House 91 - 93 Sutton Road Erdington Birmingham West Midlands B23 5XA Lead Inspector Donna Ahern Key Unannounced Inspection 10th March 2009 09:40 Katherine House DS0000068481.V374223.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 Katherine House DS0000068481.V374223.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. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Katherine House Address 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) Katherine House 91 - 93 Sutton Road Erdington Birmingham West Midlands B23 5XA 07834977180 Pharus Care Limited Ms Sheila Claybur Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only Care Home only To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability 10 The maximum number of service users to be accommodated is 10. Date of last inspection 2nd September 2008 Brief Description of the Service: Katherine House is a large detached house and provides twenty-four hour care and support for ten people with Learning Disabilities, Autism and behaviour that can be difficult to manage. Nine people were living at the Home at the time of the Inspection. The home is close to the centre of Erdington where there are a variety of shops, restaurants, transport links and leisure facilities. There are ten single bedrooms, each one with an en-suite bathroom with either a bath or shower. One of the bedrooms is on the ground floor and is accessible to a person with limited mobility. All other bedrooms are on the first floor. There is no lift so people would need to be fully mobile to access the first and second floor. On the second floor there are two semi-independent flats, with separate lounge and bathroom. There are two large lounges on the ground floor a large dining room, conservatory, extended kitchen, office and a separate laundry. To the rear of the Home is a large garden with lawned area and patio, and to the front of the Home there is off street parking. The statement of purpose seen did not contain details of fees. Up to date information can be sought from the Home. Previous inspection reports were available in the hall for people to read. The dates of the previous inspections were Key inspection 2nd September and Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 5 Random inspection 26th November 2008. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is ONE star. This means the people who use this service experience ADEQUATE quality outcomes. Two inspectors carried out this inspection over one day; the home did not know we were going to visit. This was the homes second key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Following concerns identified at a Key inspection on 2nd September 2008 we did a Random inspection on 26th November. We were concerned at the Random visit that progress had not been made on previous requirements in respect of medication practice, recruitment practice and meeting peoples health care needs. A specialist pharmacy inspector visited the Home on 4th March to monitor compliance with medication requirements. At the time of this inspection nine people were living at the home. All people have a learning disability and have some behaviors that challenge the service. We case tracked three peoples care this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The owner, deputy manager and four staff on duty were spoken to. We looked around some parts of the Home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the home. These are reports about things that have happened in the home that the must tell us about. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 7 The manager was on planned annual leave; the deputy manager and one of the team leaders assisted us and were supportive of the process. We gave feedback about the outcome of our findings at the end of the inspection to the owner. We sent out 10 surveys to people living in the Home to seek their views and opinions, 10 to staff and 6 to professionals. We received 6 completed surveys from people living at Katherine House, 9 from staff and 5 from professionals. People living in the Home received help from staff to complete their questionnaires. Comments received are contained in the main body of the report. What the service does well: What has improved since the last inspection? What they could do better: Care plans should continue to be improved so staff have all the information they need to meet peoples personal and health care needs. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 8 Risk assessments should be improved so people are supported to be safe. Peoples views should be acted upon to demonstrate that they are listened to. Medication administered must be as prescribed by the doctor at all times so people receive the medication they need. Arrangements for reviewing accident and incidents should be improved so people are protected and known risks are planned for. Not all people are getting the same opportunity to take part in activities. This should be improved so ensuring people lead fulfilled lifestyles that reflect personal interest and tastes. The arrangements for monitoring what people are eating should be improved so staff can take action when people are not eating well and ensure all people eat a healthy diet. Systems in place to support people with difficult to manage behaviour must be improved so people are safe. When people go out in the community they should receive the support from staff they need to ensure they are safe. The level of first aid training for staff should be assessed so people are supported by staff that are suitably trained. The running of the home needs to get better to ensure that each person has their needs met, and the negative impact of one person on another is minimised. 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. Katherine House DS0000068481.V374223.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 Katherine House DS0000068481.V374223.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): 1,2 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives would have most of the information that they need to know so they could make an informed choice about whether they wanted to live at the home. EVIDENCE: The service user guide and statement of purpose was written in an easy read format so it is easier for people living there to understand. It contained the necessary information, and gave the reader a feel of the opportunities available in the home. It had been updated to include information about emergency placements. The range of fee levels and details of any additional charges should be included in the documents so people know what the fee includes and the details of any additional charges. At the previous visit we found that assessments were lengthy but not comprehensive. As there had been no new admission since our last visit we were not able to fully assess the pre assessment process. There is a pre Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 11 assessment procedure in place that includes the opportunity to visit the home and stay over night if people wish before deciding whether to move in. One of the people told us that they will be moving to another home soon and that they have a social worker that is helping them to find somewhere else to live. Another person said they liked living at Katherine House and they liked their bedroom. Comments received in surveys completed by people living in the home included: My family came and had a look with me and I liked it I came to visit the Home several times before moving in I had an advocate who showed me pictures of my new home Katherine House DS0000068481.V374223.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 adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments do not have all the information staff need to fully support people to meet their assessed needs and protect them from the risk of harm. EVIDENCE: We looked at three care plans. Care plans explain what each person needs are and the care and support they require to make sure these needs are met. The people who live at Katherine House all have multiple and complex needs. It was positive that a lot of work had been done to improve peoples care plans. We found that the files looked at gave information about how staff should support the person in order to meet their individual needs in relation to personal care, communication, health care and social activities. However we found some of the information confusing. Which may mean that people do not always get the support they require from staff. Where a care plan had been Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 13 written to support a person with a particular difficulty, information had been written in the wrong sections of the plan so it was difficult to know what should be done to support the person. We also saw on one persons plan the name of another person living in the Home had wrongly been written in. Two large files have been developed for each person and that there is a lot of information to look through to find what you need to know. Some of the files would benefit from having information that is now not needed on a daily basis filed away so that it is easier to find the more important information. We spoke to some members of staff who support each of the people and they demonstrated knowledge of peoples individual needs. Staff arrange for “Talk time to be held. This is a meeting in which people can feedback their experiences of the home, and any hopes or changes they would like to see occur. We looked at the written notes for some of these meetings. It was really positive that people were being asked about what they like to do and the food they enjoy and the outcome of these discussions were clearly recorded. However we could not see how this information was then acted upon which would demonstrate that the views of people living at Katherine House were being listened to. We looked at a number of risk assessments including assessments for knife injury, throwing objects, scolding, toilet use, domestic skills. All case files had very similar risk assessments in place suggesting that these are not person centred. It was unclear why some risk assessments for individuals had been put in place. We saw risk assessments for people who require considerable support to access the community safely. These had been reviewed but the review did not include any analysis of incidents that had occurred in relation to the risk assessment and information in risk assessments were not consistent with peoples care plans. The risk assessments for one-person whos support we case tracked were not available for us to look at and a note on their file said these were being worked on. Although care plans and behaviour management plans are reviewed on a monthly basis, we saw no evidence that a full analysis of incidents had taken place that should then inform the care plan and how the person is supported which could put people at risk of harm. Comments received in staff surveys were as follows; We are kept up to date about peoples care plans Sometimes we have to actively look for the information we need on service users. Katherine House DS0000068481.V374223.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16, and 17 Quality in this outcome area is adequate. Activities are available so people are kept busy if they want to. Arrangements in place do not always ensure that people are offered a varied and nutritional diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to three staff members and observed care and support on the day. We could see from the daily notes that people undertake a wide range of activities in the community including college courses, shopping, meals out, local parks and pursing personal interest such as visiting local charity shops. People told us I like going shopping to the fort and having lunch out I like going to bingo and sometimes I win money I like going for a walk and for a Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 15 drive in the car. The home has two vehicles for people to use and this really helps with community access. On the day of our visit some people went out shopping at the Fort retail park, some people were supported to go to a local pub for lunch and some were supported to attend medical appointments and later went out for something to eat. The activity plans we looked at were repetitive with the same activity planned for the same day each week. Some activity plans included personal care and household task such as vacuuming and it was unclear why these were on peoples personal activity plans. It was also sometimes unclear how activities had been chosen. We saw that people were asked their views about activities in their talk time however we could not see that what people had said had been followed through. We were concerned about the support people get to access the community safely and refer to this in other sections of this report. There was some good information in place to support home based activities so staff would know how to support the person to get the best out of the activity but there was a lack of evidence of evaluating activities which helps with future planning. Staff made the following comments in completed surveys; More in house activities are needed and More in house activities especially in the winter are needed. We saw some good interactions during the day with staff giving one to one support to people to take part in home based activities. Some of this work included promoting peoples senses and the stimulation of touch and smell, which were activities, that people were known to enjoy. We saw that staff were caring and patient. However we also saw that some people who find it more difficult to engage with people spent long periods of time away from the communal areas spending a lot of time in their own bedroom. We spoke to staff about this to see if it was the persons choice. Staff explained that this was sometimes due to the behaviour of other people living in the home. We saw that the home went from feeling calm relaxed and organised to chaotic and tense when people returned from activities and some peoples behaviour impacted negatively of the home. One of the people said in their survey I go home to see my mum and family at weekends my family come to have dinner at Katherine House. It was pleasing to see that family members are welcomed into the home, and we met with one persons relative during the visit. Staff told us that people are supported to maintain the relationships that are important to them. Some progress had been made on recording people’s wishes in the area of sexuality and gender but we did not explore this area in great detail during this visit. We saw staff asking people if they would like a drink and staff supporting individuals to get their own drink or snack. People told us I can have a drink when I want one. We saw that people are asked about planning the menus Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 16 and a written and picture menu is available. People told us the staff are good at cooking I like baked potatoes with cheese We saw a range of tinned, frozen and fresh food in the kitchen and store cupboards. The daily records we looked at indicated that peoples food and drink intake is not always recorded daily. One person had no meals recorded for two days. We saw that one of the people with specific cultural dietary needs was offered the same meal of pizza on a very frequent basis and up to four times in one week. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements in place are not always effective to meet peoples personal and health care needs. EVIDENCE: Care plans that we looked at had some detail about how to meet peoples personal care needs. We saw that people were dressed in age appropriate clothing and people were well groomed, this indicates that people are supported to maintain a good self-image. We met eight of the nine people who live in the home and saw that staff were prompt to offer personal care as needed throughout the day. We found that the range of needs of the people living at Katherine House were very complex and diverse. These included a range of difficult to manage behaviours, autism, aspergers, mental ill health and additional medical conditions. Some progress had been made on developing peoples care plans so Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 18 staff know best how to meet peoples needs but further work is required. We were concerned that the weight-monitoring chart completed each month recorded that a person had refused to be weighed. Refused was entered for six consecutive months. When the person was finally weighed the recording showed that they had gained a considerable amount of weight. There was nothing in the person care plan to indicate what action had been taken to firstly address why the person may have been refusing to be weighed and to explore other options such as visiting a drop in weight clinic or what action was taken following the noted increase. We saw that Health action plans, which are, were in the process of being completed for each person. In the previous inspection report we raised concerns about epilepsy management and said we were not confident that the staff could support people safely or effectively in the event of a seizure occurring. We spoke to a visiting health care professional who told us that she has been working with staff over several months to review guidelines for people with epilepsy and to provide staff training so staff know how to support people safely. She was pleased with the progress that had been made. When we spoke to staff they confirmed that they knew how to support this person and the guidelines in place. We received surveys from health care professionals who made the following comments. The Home does not always appear to actively seek advice, awaits a professional to identify and recommend. Difficult client mix and a lot of time spent deescalating challenging behaviour. Staff seem caring and responsive to residents Very busy home due to complexities of client group The commissions pharmacy inspector visited the home on March 4th 2009as we were concerned about medication practice at the last visit. The pharmacy inspector made the following report. The pharmacist inspection lasted two hours. Four people who live in the home, medicines were looked at, together with their Medicine Administration Record (MAR) chart, health and care plans. The four out of the five requirements left at the last inspection had been met, one remained outstanding and one requirement was made at this inspection. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 19 The manager has worked hard to improve the medicine management in the home. A Controlled Drug (CD) cabinet has been installed and all CD transactions were correct. The staff now see the prescriptions prior to dispensing but they still had failed to identify that two medicines had not been prescribed in time. This resulted in the resident not receiving their prescribed medication for one day, until the new dispensed supply had been received. Had staff properly checked the prescriptions before they were sent to the pharmacy and identified this earlier, this would not have happened. Quantities of all medicines were recorded, which enabled accurate audits to take place to see whether the medicines had been administered as prescribed and records reflected practice. Audits indicated that the majority of medicines had been administered as prescribed. This was commended. Concern was raised that staff did not apply one cream prescribed by the doctor, as they thought that the two creams prescribed were both steroid creams and were bad for the resident. They made the decision to only apply one cream. They were not both steroid creams and each had a different mode of action. One medicine had been prescribed and a 30 day supply received to administer. Because the new 28 day cycle occurred half way through this course, staff made the clinical judgement to discontinue this without consulting the doctor or pharmacist first. The decision was only made because the new 28 day MAR chart was to be used and not based on any other reason. It is the responsibility of the care assistants to apply or administer the medicines as prescribed by the doctor and if any doubt exists they must discuss this first with the doctor and not make clinical judgements alone. The health plans had improved. Care plans detailing what to do in the case of a clinical emergency, for example, and epileptic fit were clear and detailed. External healthcare professional communication had been recorded in the majority of cases. A chart had been devised to record what medicines had been given to family/friends who cared for the resident during social leave. This was commended, as it was possible to track all medication leaving the premise and what had returned and also what had been administered whilst away. The manager had installed a quality assurance system to ensure that the medicines had been administered as prescribed and records reflected practice. This had resulted in staff administering most of the medicines correctly. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to deal with complaints. The arrangements in place to protect people from the risk of harm do not ensure people are fully protected. EVIDENCE: The Commission received two complaints about staff conduct at work impacting on the care of people at Katherine House in October 2008. These were referred to the provider, and a detailed response was provided. The home has provided information in formats as accessible as possible to the people living at Katherine House regards what to do if they wish to make a complaint. We saw an easy read with pictures complaints procedure on display in the hallway, and a document what to do if you don’t like something. We spoke to people who said if they are not happy they can speak to staff the manager or owner. One person told us that they have access to the managers and owners mobile numbers so they can speak to them even if they are not on duty. Some of the people would need considerable support to make a complaint. Surveys completed by people included the following comments: I would let you know if I wasnt happy with something. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 21 I would be able to make a complaint with assistance. A complaint form in my folder has a special format for me to understand I can speak to my mum and Social worker I would speak to the manager or a support worker I can speak to X the highest one (owner) or manager. At the previous visit we were informed that a Safeguarding matter had arisen on the day prior to our inspection. This matter was referred to Birmingham Social Services Learning Disability team to investigate. At the time of writing this report the safeguarding matter in respect of individuals living there is closed but remains open in respect of the Home. We saw a copy of the safeguarding guidelines on display in the office. Staff could refer to this if an incident occurred in the home. We looked at the minutes of staff meetings and read that all staff have had a copy of the whistle blowing policy. We saw that the majority of staff had training in Protection of Vulnerable Adults (POVA) so they know how to identify different types of abuse and what to do if abuse is happening so they can protect the people living there. We saw that further training for staff who hadn’t completed is already scheduled. Information regarding abuse was also available in easy read format with pictures on display in the home and guidelines for reporting. Staff we spoke to demonstrated a general understanding of their duty to safeguard people and how to report concerns on to the manager. Some people who live there demonstrate behaviour that determines staff must work with them in a particular way to help keep them safe and well. The Home was at times calm and organised and at other times when people were all at home we observed and heard that often one persons experience would upset other people living at Katherine House causing a domino effect of behaviour that can be challenging. We read about incidents where people were causing or threatening to cause damage to property and restraint was used to manage this behaviour. We saw on the day that staff tried to protect the property when one of the people became anxious and upset which escalated the situation. The persons management strategies guided staff to distract the person this happened initially but as the person became more anxious staff ignored the behaviour. We read some of the risk assessment plans and these had not been updated following serious incidents in the community, which could place people at risk of harm, as control measures in place had not been reviewed. We did not see any evidence that a system for analysing incidents is in place so that the home is pro-active as possible in meeting each person’s individual needs in a timely way, which possibly could prevent escalation and subsequent harm or risk of harm. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a spacious home, which is safe and comfortable and meets peoples needs. EVIDENCE: Katherine House is located near to local shops with public transport routes close by. There is limited off road parking to the front of the house. To the rear of the Home there is a garden that people have direct access to. We looked at the shared areas of the Home and the bedrooms of the people whose care we had case tracked. There were no unpleasant odours, which would indicate good standards of hygiene practice are in place. Katherine House is furnished and decorated in a homely and comfortable way. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 23 We were pleased to find that although wear and tear is already evident throughout the building there are plans in place to paint the interior of the house. A conservatory and kitchen extension provides additional communal space for people to pursue their interests. Three people kindly showed us their bedroom. They all had lots of their personal items to help it feel homely. There is one bedroom on the ground floor, which would be suitable for a person who may have some mobility difficulties. All other bedrooms are on the first and second floor and are accessed by steep stairway and would not be suitable for people with mobility difficulties. There is no lift. A carpet in one of the bedrooms was heavily soiled and needed replacement. Roller blind cords on the first floor windows required risk assessing to reduce or remove any potential risks to people. The ground floor toilet was out of use on the day of our visit and we were told the repair would be completed the next day, unfortunately visitors to the home were required to use a toilet in the vacant bedroom on the second floor. The staff toilet on the ground floor was also out of use. We looked at the maintenance book, which indicated that repairs are usually dealt with within one to two days. There is a separate laundry room, which was clean and organised. We saw substances such as cleaning products that could cause harm to people had been locked safely away. Katherine House DS0000068481.V374223.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. 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 this service. Arrangements for staffing do not always ensure the safety and well being of people. Recruitment practice now ensures that people are protected by the Homes procedures. EVIDENCE: We saw some positive interactions where people seemed comfortable and relaxed with the staff supporting them. We also saw times when people were anxious and upset and staff did not seem fully comfortable with what to do or how to manage the situation. At our last visit we were worried that we could not establish that the home had enough staff with the very specialist knowledge and skills required to meet the needs of this group. At this visit we spoke to the deputy manager about staffing arrangements and we looked at the staffing rota for the week of the visit and previous weeks. These showed that there is eight staff across the working day dropping to seven for some days when people are visiting Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 25 relatives for overnight stays. At night there are two waking night staff. We were told that five new staff have been recruited, subject to recruitment checks. Some bank and agency staff are being used to support the rota until the appointments have been confirmed. We were concerned that some staff are working two double shifts (14 hour shifts) in a row and that this may have some impact on staff being able to work effectively over consecutive days with people who have such high support needs. We saw staff support people at times of challenges with different levels of confidence. We reported in the random inspection report (November 2008) that a persons risk assessment plan had not been updated following a serious incident in the community. We read that other incidents have occurred since, yet documentation had not been fully reviewed to reflect this. We read that the person should have two staff supporting them in the community so they are safe. On other guidelines for the same person it says one staff should support. We asked staff what the arrangements were and again we received confused information with some saying one to one support is in place yet senior staff told us that two staff would be needed but another person from the home would be supported at the same time to achieve the safe level of staffing. We looked at the behaviour management strategies for this person, which should show staff how to work with people in a positive way that can reduce the likelihood of the person displaying certain behaviours. We saw that the guidelines said that x can become aggressive towards staff and members of the public however there was no mention in the guidelines how the person should be supported when accessing the community despite a number of incidents occurring. Arrangements must be clarified so people receive the support they need and are not put at risk of harm. We looked at staff recruitment records for the two most recently employed people. One of the staffs Records Bureau checks (CRB) had been lost and a new application had been made, we saw that a risk assessment was in place confirming the staff member would not work alone until the replacement CRB was received. Written references, job descriptions and health declarations were in place indicated that only staff suitable to work in the Home are employed. We found it difficult to assess staff training overall as the information is presented on a large poster type matrix on the office wall that was not fully reflective of what had been achieved and had not been updated to show staff who had left or were bank staff. Some staff need training or training updates on safeguarding, NVCI and makaton. We could see that these had been scheduled in over the next few months. It was pleasing that training had also taken place on epilepsy, tuberous sclerosis, sensory deprivation, healthy eating, infection control and health and safety to so staff have specific information and training on the needs of the people they support. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 26 Staff supervisions matrix indicates that these sessions are generally regular and staff confirmed this when we spoke to them. It was pleasing to see that bank staff also receives supervision. Staff meetings are fairly regular and minutes seen indicate that work practice issues are discussed. The minutes did not however give any updates about actions from previous meetings. Comments received from staff surveys included: Supervision could be done more often We always have staff meetings and supervision Training has been good Staff very helpful when I started my induction covered all areas Induction very helpful and offered additional training Service is very good we work as a team We could improve by having better team work Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements in place for the management of peoples health, safety and welfare does not always ensure that these are well met. EVIDENCE: The manager was on planned annual leave; the deputy manager and one of the team leaders assisted us and were supportive of the process. We gave feedback about the outcome of our findings at the end of the inspection to the owner. The visit established that improvements have been made to staff recruitment, staff training, care planning and medication practice. However there remains concern about the managers responsibility to ensure safe working practices Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 28 are promoted and people are protected. At the random visit we were worried about the lack of action taken to review peoples guidelines and risk assessments following serious incidents. At this visit we saw that further incidents had occurred but again found a lack of progress to review peoples documentation following such incidents to ensure that the safe guards in place are still relevant. This could place people at risk of harm. We saw that accidents and incidents are recorded but no analysis of the information takes place to minimise or prevent further occurrence. We saw that sixteen staff had completed first aid training but no staff had completed appointed first aid. We asked that a risk assessment is completed to assess the level of first aid training that the Home needs. The assessment should include the needs of the people living in the home, their likely needs and the kind of first aid training that might be required. We requested evidence of a Quality Assurance system. An annual report of the service was completed in early 2008 and this was made available to us following the last inspection. We were advised that another report is due soon. We spoke with the owner about how he seeks the views of relatives, people living in the Home and other professionals. He advised us that although he meets with relatives and professionals there is no formal process in place at present for recording their views. We saw that the owner had completed monthly visits as required and sampled some of the reports of the findings. It reports on areas for attention such as updating peoples care plans but was limited in its content. We were told that a new format is to be used. We looked at records to see that peoples health and safety is being promoted. The fire alarm system had been tested and serviced on a regular basis. Fire detection for the conservatory was not in place but scheduled to take place in the next few weeks. We saw that one of the peoples fire risk assessment advised staff to leave the person for the fire service to evacuate. There were no details about how the person had respond to fire drills that the Home had planned. We discussed that the home could explore possible adaptations for the bedroom of one of the people who is hearing impaired and suggested that further advice is sought from West Midland Fire Service. Comments received form professional surveys Excellent home very well managed Change of manager resulted in less professional response when a concern was raised. Previous manager more experienced in supporting people with autism. Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 29 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 3 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 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 1 X Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA9 YA23 YA23 Regulation 13 (4) 13 (4) c (7) 12 (1) a,b 13(2) Requirement Arrangements must be in place so people are protected from the risk of harm. Behaviour management plans and guidelines must be clear about how people will be supported by staff so they are safe. All medicines must be administered as prescribed by the doctor at all times. Any change in clinical condition must be discussed first with the clinician before any decision is made to discontinue the medication. This is to ensure that all medicines are administered as prescribed at all times as the doctor intended. Timescale for action 30/04/09 30/04/09 3 YA20 04/04/09 4 YA35 18 (1) c 5 YA42 13 (4) b, A risk assessment should be completed to assess the level of first aid training the home needs to meet peoples needs and keep them safe. Arrangements must be in place DS0000068481.V374223.R01.S.doc 30/04/09 30/04/09 Page 31 Katherine House Version 5.2 c so that incidents and accidents are analysed and steps taken to prevent further occurrence so people are protected. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The statement of purpose should be amended to include the level of fees and any additional charges. So people have all of all the information they need to know to make an informed decision about whether they want to live there and how much it is going to cost them. The pre-admission assessment be reviewed to ensure this is comprehensive, and that findings are kept under review. Not assessed as no new admissions. Care plans should continue to be developed so that all people have a comprehensive care plan. Consideration should be given to presenting information about meeting peoples needs in a way so it is easy to find the most important information. Talk time should be reviewed to ensure all peoples views are heard, and that information collected is used in the development of the service. Arrangements should be in place to ensure that activities provided are monitored and evaluated. Activities for people with more complex behaviour should reflect individual needs and references. Peoples daily food intake should be monitored to ensure they are receiving the nutrition required to maintain their health and well being. The menu choice offered to people should be monitored so that they are offered a varied and nutritional diet. All staff must be trained to understand the indications and side effects of the medicines they handle. Arrangements should be in place so that people receive the support they need to monitor their weight and get any DS0000068481.V374223.R01.S.doc Version 5.2 Page 32 2. YA1 3. 4 5 YA6 YA6 YA8 6 7 8 9 10 11 YA12 YA12 YA17 YA17 YA20 YA19 Katherine House 12. YA24 follow up support and advice that they may require. Roller blind chords should be risk assessed and any identified action taken to ensure risks to people and staff are reduced or removed. The carpet in a persons bedroom should be cleaned or replaced so it is hygienic for the person. Painting and decoration throughout the home should take place so that standards of decoration are maintained Arrangements should be in place to ensure that staff on duty at all times have the specialist skills required to support people. Consideration should be given to staff not working backto-back long shifts, as this may long term impact on their ability to support people. Arrangements must be in place to ensure that when people go out in the community they receive the support they need. Consideration should be given to how staff training records is presented so an accurate up to date record of what has been achieved is available. Staff must receive any training updates they need so they have the skills and knowledge to support people. The Home must be managed in a way that it achieves its aims and objectives. Service users views should be sought and included in Quality Assurance. It is recommended that an implementation plan be developed following a quality assurance audit. It is advised that consideration is given to finding out about how the fire safety needs of people with hearing impairment could be better met. Arrangements should be in place to review individual fire risk assessments so that in the event of a fire people are not placed at risk of harm. Arrangements must be in place to identify peoples response to fire alarms so that individual plans are reflecting known behaviour. 13 14 15 16 17 18 19 20 21 YA24 YA24 YA32 YA33 YA33 YA35 YA35 YA37 YA39 22 23 24 YA42 YA42 YA42 Katherine House DS0000068481.V374223.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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