Inspection on 27/10/08 for Kathleen House

This inspection was carried out on 27th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kathleen House 07/11/07

Kathleen House 19/12/06

Kathleen House 10/11/05

Kathleen House 21/07/05

Kathleen House 10/01/05

Kathleen House 06/04/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

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Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kathleen House 59-61 Addison Road Brierley Hill Dudley West Midlands DY5 3RR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Webb     Date: 2 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Kathleen House 59-61 Addison Road Brierley Hill Dudley West Midlands DY5 3RR 0138470187 0138470187 kathhouse@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Dawn Welding Type of registration: Number of places registered: Mr P Murray,Mr R Murray care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Existing service users using the service over the age of 65 years may continue to be accommodated for short respite, for as long as the home can demonstrate it can meet the service users assessed needs, with a maximum of 5 LD(E) at any one time. No service users who are wheelchair users be accommodated at 59a Addison Road. Service users to include up to 15 PD and up to 15 LD, not exceeding the total number registered for. Date of last inspection Brief description of the care home Kathleen House is a purpose built Home, opened in 1995. It provides residential care on a short-term respite basis for up to fifteen younger adults with learning/physical disabilities, at any one time. The Home comprises three self-contained bungalows, each accommodating up to five people. Located in a residential area, it blends in well Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 15 15 Brief description of the care home and has easy access to local amenities and public transport with links to towns such as Brierley Hill, Dudley and the Merry Hill shopping centre. Externally the property is well maintained, with car parking at the frontage and space between the bungalows. To the sides and rear of the premises are well-maintained gardens, with small patios, lawned areas, mature trees and shrubs. The interiors of the bungalows are domestic in style, promoting a homely environment and maintained to high standards. Beds at the Home are block purchased by Dudley Social Services Department. In excess of one hundred and forty guests use the service. Information regarding fees charged for using this service is not included in the homes Statement of Purpose. Interested parties should contact the registered provider for this information. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector carried out this visit over one day. The home was not informed that we would be visiting. We spent time examining records, talking to guests and staff and observing care practices, before giving feedback on our findings to the registered manager. Prior to our visit the home supplied information to the commission in the form of its Annual Quality Assurance Assessment (AQAA). Information from this was also used when forming judgments on the quality of service provided at the home. The people who access this service have a variety of needs. We took this into consideration when case tracking 3 individuals care provided by the home. For example the people chosen consisted of both male and female and have differing communication and care needs. Care Homes for Adults (18-65 years) Page 6 of 32 The atmosphere within the home was welcoming. We would like to thank everyone for their assistance and co-operation. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission procedures ensure prospective guests needs are identified before placements are offered. Evidence: We sampled the files of three people who are currently accessing the respite service and found all to contain assessment profiles that help identify needs of people who access the service. As part of the pre-admission processes undertaken by the home prospective guests undertake a number of tea visits so that further information can be gained on the needs of individuals. In addition to this records for some guests also evidence overnigh stays, again giving the opportunity for people to find out more about the service. Information regarding this process is now included in the homes statement of purpose. This meets a previous recommendation. Care Homes for Adults (18-65 years) Page 10 of 32 Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main care planning meets individuals expectations. Further opportunities should be given for individuals to be involved in planning the support they need and in decision making processes. Evidence: The home uses the term personal profile to refer to the care plan because of the short term nature of the service provided by this home. Although fairly basic in content, for example not including short and long term goals and aims, these appear appropriate to the service provided. The personal profiles generally contain a summary including preferred name, personal care, preferred daily routines, times of rising and retiring and sleeping patterns. Details of likes, dislikes, favorite foods and preferred activities and friendships are also recorded. Personal profiles give staff guidance about each persons preferred routines for personal care and bedtimes. Recommendations were made at the previous inspection to develop personal profiles Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: to be person centred and to ensure that reviews are undertaken at least annually or as needs change at the next respite visit. The registered manager confirmed that action has been taken to address these issues with some profiles now in a person centred format and priority now being given to ensure those who access the service on a regular basis having their profiles reviewed. There is risk assessment system in place for each guest. These include activities within the home environment and outside. In the main those sampled evidenced risks are unidentified and where possible reduced. We did note that on some occasions the Dudley Metropolitan Borough Council hazard identification form that compliments the councils care assessment/plan identifies risks that have not been included in the homes profile or risk assessment. For example one persons hazard identification form states that due to having epilepsy they are at risk of falls but the homes falls risk assessment states they are not at risk in this area. It is recommended that both the local authority and the homes care management documentation work in conjunction to promote a holistic approach to care management. There is evidence that efforts are made so that guests are involved in some decision making about the home, such as day to day living and social activities. As one guest explained to us, you are given a choice of what room you want to use when staying here and offered a key to your room,. However areas where guests can affect change in the service may be limited. As at the previous inspection the registered manager confirmed that service user surveys are completed annually in order to obtain their views and that on one occasion guests had sat in a staff meeting. A recommendation was made at the last inspection that meetings be arranged twice a year specifically for guests and their representatives in order that processes support individuals further in decision-making. The registered manager confirmed these have not taken place, stating I do not think going to work. As we explained, meetings should be offered for guests and their representatives and the effectiveness of these evaluated before deciding if they are beneficial to guests. As at the previous inspection staff demonstrated a good understanding of the communication needs of guests. For example when we were introduced to people accessing the service during our visit a member of staff explained the specific communication needs of individuals and were seen to interact with them effectively. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main guests are supported to participate in a range of activities that meet their individual needs. A choice of meals are provided that guests enjoy. Evidence: We observed care practices, talked to guests and staff and examined records and found that in the main people accessing the service are supported to undertake activities that meet their individual needs and expectations. For example one guest explained, last time I was in they took us to Brierly Hill, tonight I am out with a friend. The majority of people who use the respite service continue to access their regular day care services whilst staying at the home. The homes assessment profiles ask guests if they would like to go swimming. Despite some guests expressing a preference to undertake this activity we found no evidence of this occurring. As we explained to the registered manager if this activity is being offered as a service then Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: action should be taken to ensure those wishing to participate can do so. For those who remain at the home during the day a programme has been implemented to ensure a variety of activities are offered. As at the previous inspection staff were observed to be warm and friendly as well as being respectful towards guests. Members of staff were heard using each guests preferred name. The home does not employ separate kitchen staff, with care workers undertaking cooking responsibilities. It was recommended at our last inspection that staff received training in nutrition and diet to ensure they can be confident they have the appropriate knowledge to support guests with specific dietary needs. The registered manager informed us training in this areas has not yet been undertaken. As we explained, people who access the respite service have a range of dietary needs and training for staff would help ensure these are met. All guests that we spoke to confirmed their enjoyment of meals provided by the home. Comments include, the food is lovely and lovely jubbley. Care Homes for Adults (18-65 years) Page 15 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main the personal care and health needs of guests are met. Further work should be undertaken to ensure all practices are person centred. Evidence: As at previous inspections we found guests receive personal support in the way they prefer and require. For example preferences about how they are moved and supported are recorded and individuals were seen being given personal support in the privacy of their bedrooms. We did note that night staff undertake checks on all residents even when there is no identified, recorded need. We discussed this with the registered manager who explained this practice has always been in place at the home and is seen as a role to protect guests. As we explained, this practice is not person centred and should be reviewed. Checks throughout the night should only take place for guests with identified needs otherwise this practice could compromise guests rights to privacy. As already mentioned times for rising and retiring, meals and other activities are flexible according to individuals needs and preferences. There is good written evidence of personal care as part of each guests daily notes. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Individuals are fully supported to access health care facilities during their respite stay and on occasions this has included emergency treatment at hospital. As well as daily records we found that fluid intake charts are completed for all guests. We noted that these do not include the specific amounts of fluids taken and explained to the registered manager this detracts from their value as they cannot be used to monitor if adequate fluids are taken. We also noted that fluid intake charts are completed for guests who do not have any documented need for this practice. The registered manager informed us she has implemented monitoring of fluids for all guests as problems have previously occurred when staff have not completed these for guests with identified needs. We expressed the view that this practice is not person centred and that if staff have not been completing records appropriately this should be addressed as a separate issue. As Kathleen House offers a respite service a monitored dosage system for the management of medication cannot be used. The records and medication for 4 guests were examined and found to be correct. A recommendation was made at our last inspection to ensure the homes medication policies and procedures are specific to the service provided by Kathleen House. Action has not been taken to address this and it is strongly recommended these be amended to ensure staff have accurate information to refer to and to offer greater protection to guests. Also as at the last inspection it is recommended that the temperature in the medication cabinets be monitored to ensure medication is stored as per manufactures guidelines. Care Homes for Adults (18-65 years) Page 17 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place that support people to raise concerns and protect them from harm. Evidence: The home has a complaints policy that covers complaints made by members of the public, staff and family members. This is on display in each bungalow so that people have access if they wish to raise concerns. There is also a complaints log. We found some improvement with regard to the records maintained of complaints but that further work should continue. For example one complaint that has been investigated by the registered manager is not recorded in full in the complaints log. It is recommended this be addressed to ensure the home complies with its own procedure and to ensure complainants are fully informed. All guests that we spoke to stated they would feel happy to raise concerns and named staff working at the home who they would approach. For example one guest explained, if I was unhappy I would go to someone and tell them and another If I am unhappy I talk to staff, they sort things out. We issued an immediate requirement at our last inspection instructing that the local authority safeguarding procedures must be followed for all incidents of aggression between guests. This is now met in full. Since our last inspection we have been notified in line with Regulation 37 of the Care Home Regulations 2001 each time an Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: incident has occurred between guests. This practice offers greater protection to people receiving a service. The home has comprehensive policies and procedures relating to adult protection and a copy of the multi-agency policy and procedure for the protection of vulnerable adults Safeguard and Protect available for staff guidance. There has been a high turnover of staff since our last inspection resulting in many staff now working at the home needing to undertake protection training. This should happen to offer further safeguards to guests. Care Homes for Adults (18-65 years) Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main the environment meets guests needs and is maintained and furnished to a good standard. Evidence: Kathleen House comprises three separate bungalows set in well-maintained gardens, with ample off-road car parking in the grounds. The bungalows are purpose-built to provide a comfortable, home like and safe environment for younger adults to have enjoyable respite stays. We undertook a tour of the premises, including looking at some of the bedrooms with the consent of guests occupying them. Some were found to be quiet sparse with little or no forms of decoration. Attempts should be made to create more welcoming bedrooms by the use of pictures and decorative ornaments. We also noted that no bedrooms have bedside lamps. We discussed this with staff on duty who informed us this was due to 2 near misses when the bungalows first opened when guests put items on top that could have caused a fire. As we explained other forms of lighting should be explored and an assessment undertaken for each guest to determine if they are at risk from the provision of a side light. This will promote person centred support. The exteriors and interiors continue to be maintained to good standards. Each Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: bungalow has an assisted communal bathroom and communal toilets in addition to the bathing and toilet facilities in each en-suite bedroom. The bathrooms are clean, tidy and attractively decorated with stencils or seascapes. At our last inspection we recommended action be taken to repair the faulty secondary glazing in one of the bungalows in order that the building continues to be maintained to a good standard. The registered manager confirmed this has not taken place but said she would chase it up with the registered proprietor. All bungalows have separate lounges and dining rooms that are decorated to a good standard and furnished with sufficient seating. Infection control appears good at this home with all parts of the home seen to be hygienic, clean and tidy. There is a separate laundry in each of the three bungalows, all of which appear appropriately furnished. Care Homes for Adults (18-65 years) Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The high turnover of staff working at the home means results in guests not being supported by suitably qualified staff. At times guests are being supported by staff who work excessive hours. This increases the risks to guests as staff maybe too tired to carry out their duties safely. Induction processes do not currently ensure new staff are supported to understand their roles and responsibilities. Evidence: Since our last inspection there has been a high turnover of staff leaving the home, resulting in 3 full time night staff vacancies and 4 part time weekend positions. The registered manager informed us that 3 full time posts and a part time position have recently been recruited for (with staff due to take up position when all required checks have been completed). Due to these shortages some staff who work at the home have been undertaking additional shifts as well as bank workers from other homes within the organization. When examining staff rotas and overtime sheets we were concerned to find some staff working excessive hours on a regular basis. For example one member of staff has undertaken hours ranging from 59.5 to 87.5 a week. Another member of staff has undertaken hours ranging from 56 to 97.5 a week. As we explained to the registered manager this amount of hours is unacceptable due to the potential risks posed to guests if they are supported by staff who may be tired and Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: incapable of completing their duties safely. Rather than staff undertaking such excessive hours agency workers should be sought in order that the risks to guests are reduced. The turnover in staff has also reduced the numbers of staff working at the home who hold a National Vocational Qualification (NVQ). The registered manager informed us that of the 29 people who undertake shifts at the home 3 hold a NVQ and 5 have been registered to undertake this qualification. A number of other staff have undertaken the Learning Disability Award Framework accredited training. This is foundation training that can be accredited towards the NVQ qualification. We advised the registered manager that greater numbers of staff should undertake the NVQ qualification in order that guests are supported by suitably qualified staff. The registered manager informed us that the homes staffing levels are 7 staff in the mornings until guests have left or are attending day services. At this point staffing is reduced to 2. From 4pm staffing is increased back to 7 and during the night there are 4 staff on duty (one allocated to each bungalow and a float). We had some difficulty assessing if staffing levels have been maintained to the agreed numbers due to the amount of correction fluid used on staff rotas. We advised the registered manager to cease the practice of using correction fluid as this could bring into question the authenticity of these documents. The recruitment records of the four newest members of staff were examined to assess if practices safeguard guests. All files contained a completed application form, satisfactory references, POVA first disclosures and a copy of the interview questions and answers. It is recommended that a photograph of each person be obtained to add further safeguards to guests. When examining the recruitment records for staff we noted that one person is employed as a night worker who 18 years old. There is a night worker allocated to each bungalow with a supervisor who floats between buildings according to need. We strongly advised the registered manager to seek legal advice and also to check with the homes insurers regarding this person working nights and at times being unsupervised. We also noted that a number of staff have commenced work with a POVA first only. Risk assessments have been completed for this, as is good practice however the contents of these are not being complied with. For example the risk assessments state staff without full CRB should work supernumerary to required staffing levels. Examination of staff rotas and discussion with the registered manager confirm this practice is not happening. As we explained by not complying with the contents of the risk assessment residents are being placed at undue risk. Also if an incident were to occur that involved the members of staff it is highly unlikely the home would be covered by its insurers. Again we strongly recommended advice is sought. Health declarations have been completed by new staff. For some these identify health needs. We found no risk assessments completed that demonstrate the health needs of staff will be managed safely whilst they support Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: guests. The high turnover in staff has impacted on the numbers of staff who are suitably qualified to support guests. Of the 29 staff working at the home (this includes regular bank workers) 16 have undertaken equal opportunities training. No staff have received diabetes training or person centred care training. It is recommended that arrangements be made for sufficient numbers of staff to undertake this training to ensure knowledge and practices reflect current good practice guidelines. Training relating to health and safety is discussed further in the management section of this report. There are systems in place for new workers to receive an induction into the service that will ensure they are supported when first commencing work at the home. Records indicate these processes are currently not being followed. For example staff have not been undertaking shifts in a shadowing capacity and performance reviews have not always been occurring. The registered manager confirmed that the deterioration in this area is due to the staffing situation with regards to the high turnover of staff. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally management of the home ensures guests safety is monitored. Improvements to some aspects of health and safety will reduce risks to guests further. In the main quality monitoring systems allow the home to measure if it is meeting its aims and objectives. Evidence: Generally the registered manager continues to provide clear leadership within the home. Throughout our inspection she demonstrated understanding of her role and a commitment to making improvements where needed. When giving feedback to the registered manager about our inspection findings we advised that priority should be given to addressing the staffing situation within the home to ensure the quality of service guests receive does not diminish. The registered manager agreed with us. There are quality monitoring systems in place that include consulting guests about the service provided. These include a development plan for the home and audits by other managers from within the organization. Surveys have been sent to families and Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: stakeholders in the community, an analysis of findings undertaken and outcomes forwarded to the CSCI. Regulation 26 visits are undertaken, but records indicate these are still not occurring monthly. The registered manager informed us these do take place monthly but that records have not been received for all visits. It is recommended that reports of these visits are sent to the home on a regular basis in order that the registered manager can take any remedial action needed. Prior to this inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. This was brief in parts and gave minimal information about the service provided to guests. We discussed this with the registered manager advising greater detail is included when next requested by CSCI. A random sample of maintenance and service checks demonstrates areas such as gas appliances, fire equipment and water outlets are being checked. Since our last visit thermostatic valves have been fitted in 2 of the bungalows, reducing the risk of scalding to guests. The registered manager was not aware when these will be fitted in the remaining bungalow, but informed us she would chase up. There are a number of risk assessments in place for the management of health and safety. Those that we sampled all stated they should be reviewed January 2008, however we could find no evidence of this occurring. It is recommended risk assessments are reviewed to ensure risks to individuals are monitored. The registered manager could not locate a electrical wiring certificate for the bungalows. As we explained, this is needed to ensure wiring within the home is safe. Since our last visit the registered manager arranged for West Midlands Fire Service to visit the home (meeting a previous recommendation). As a result a new fire risk assessment is now in place that meets current good practice guidelines. As mentioned previously in the staffing section of this report, there has been a high turnover of staff since our last inspection. This has resulted in a deterioration in numbers working at the home who have undertaken the required training. As we explained to the registered manager, the home should be able to demonstrate there is at least one qualified first aider on each shift and that any member of staff who is involved with moving and handling has received training to do so. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 18 In line with Regulation 18(1) 17/11/2008 permanent staff must not work excessive hours on a regular basis. Agency workers must be sought to cover shifts rather than permanent staff working excessive hours. This practice must stop to ensure guests are supported by staff who can carry out their duties safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Work should continue to develop personal profiles to be person centred and in alternative formats according to each persons capabilities. Work should continue to ensure all personal profiles are reviewed and updated at least annually or as needs change in order that the home can be confident it meets the changing needs of individuals. Care Homes for Adults (18-65 years) Page 28 of 32 2 7 Meetings should be arranged twice a year specifically for guests and their representatives in order that processes support individuals further in decision making. That the local authority and the homes care planning and risk managment documentation work in conjuction with one another to ensure a holistic approach to care management. Arrangements should be made for guests to go swimming as indicated on the homes assessment profile. Staff should receive training in nutrition and diet to ensure they have the appropriate knowledge to support guests with specific dietary needs. The practice of checking all guests throughout the night should be reviewed to promote person centred care. Checks throughout the night should only be undertaken if it can be demonstrated a guest has an identified need. This will ensure their rights to privacy are not compromised. The system for recording fluid intake of guests should be reviewed to ensure specific amounts of fluid are recorded. This will allow for effective monitoring of fluid intakes. The homes medication policies and procedures should be amended to reflect practices within the home and to ensure staff have accurate information to refer to. The temperature in medication cabinets should be monitored to ensure medication is stored as per manufacturers guidelines. A photograph should be maintained with each guests medication to reduce the risk of miss-administration. 3 9 4 5 14 17 6 18 7 19 8 20 9 10 11 22 23 24 Complaints should be notified in writing of outcomes to concerns and a record maintained in the home. Greater numbers of staff should receive protection training to offer further safeguards to guests. The faulty secondary glazing in bungalow 59 should be repaired in order that the building continues to be maintained to a good standard. Efforts should be made to ensure all bedrooms are decorated and furnished in a way that creates a homely feel. Alternative forms if bedside lighting should be explored and assessments undertaken for each guest with regard to risk. Bedside lights should be provided to guests who wish to have these provided. Care Homes for Adults (18-65 years) Page 29 of 32 12 33 Greater numbers of staff should undertake the NVQ qualification to ensure guests are supported by suitably qualified staff. Correction fluid should not be used on staff rotas to ensure their authenticity can be maintained. 13 34 A photograph should be maintained with staffs recruitment records as a further safeguard to guests. It is strongly advised the registered manager to seek legal advice and also checks with the homes insurers regarding staff who are 18 years old working nights and at times being unsupervised. The home should comply with the contents of its risk assessments with regard to staff working without receipt of a full enhanced CRB to reduce risks to guests. Risk assessments should be completed for any staff that declare health needs when commencing work at the home. These should demonstrate the health needs of staff will be managed safely whilst they support guests. 14 35 Staff should be provided with diabetes and person centred care training so that they have sufficient knowledge to support guests. New staff should receive structured induction that includes shadowing staff when they are not included in the staffing numbers for shifts. New staff should receive performance reviews as detailed in the homes induction processes. 15 39 Copies of Regulation 26 reports should be given to the registered manager each month (and maintained in the home) so that any remedial action can be taken promptly. Greater detail should be included in the AQAA when next requested so that the home can evidence quality outcomes for guests. 16 42 Action should be taken to fit thermostatic valves in the remaining bungalow to reduce risks of scalding. A electrical wiring certificate should be obtained to ensure wiring in the home does not pose any risks to guests. Risk assessments should be reviewed on a regular basis to ensure potential risks are reduced. Care Homes for Adults (18-65 years) Page 30 of 32 The home should be able to demonstrate that there is at least one qualified first aider on each shift and that any member of staff involved with moving and handling of guests is suitably qualified. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 We want people to be able to access this information. 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