Inspection on 02/07/07 for The Laurels

This inspection was carried out on 2nd July 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Laurels 14/07/08

The Laurels 22/11/06

The Laurels 06/06/06

The Laurels 15/02/06

The Laurels 23/09/05

The Laurels 31/01/05

The Laurels 27/10/04

The Laurels 23/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Laurels, The 65 Frederick Road Stechford Birmingham B33 8AE Lead Inspector Susan Scully Key Unannounced Inspection 2nd July 2007 09:45 Laurels, The DS0000033658.V336484.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 Laurels, The DS0000033658.V336484.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. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurels, The Address 65 Frederick Road Stechford Birmingham B33 8AE 0121 784 5222 0121 784 5232 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) www.birmingham.gov.uk/adoptionandfostering. bcc Social Care and Health Warren Mark Powell Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: are under review 1. 2. 3. 4. 5. That the home is registered to accommodate 17 adults under the age of 65 for reasons of learning disability. That the home can continue to accommodate 3 named service users who are now over 65 years of age. That minimum staffing levels are 7.00am - 10.00pm 3 care assistants and a suitably qualified and competent designated shift leader. The Care Managers hours must be supernumerary to care hours. Service users are admitted to the home for respite care and not longterm care. Long-Those residents who have been at the home for a longer period will be found alternative appropriate places at the earliest opportunity. Maintenance schedule to progress at a pace, which is acceptable to CSCI to allow continuation of registration. Reprovision plans to progress at a pace which is acceptable to CSCI to allow continuation of registration. 22nd November 2006 6. 7. Date of last inspection Brief Description of the Service: The Laurels is a large two-storey purpose built Local Authority Home, accommodating up to 17 adults who have a learning disability on a respite only basis. This means the people who stay at the home do so temporally for up to two weeks at a time then they would go home. The Home has nine ground floor bedrooms and the remainder of the bedrooms are on the first floor, which can be accessed via a shaft lift. There are a number of communal areas on both floors. There are bathroom and toilet facilities on both floors. The Home does not meet the National Minimum Standards in terms of accommodation provided. All but two bedrooms are below minimum spatial standards. Five bedrooms are without wash hand basins. The number of toilets is not adequate for the number of service users accommodated. The home ensures a number of adaptations to the bathrooms and toilet if required by the service user these include assisted bathing facilities and toilet seat raisers. The Home is situated in a quiet cul-de-sac in Stechford, close to local shopping facilities, a train station and bus routes. To the front of the building is a car Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 5 park area and to the rear is a garden to enable people to sit and socialise. The fees payable at the Laurels depend on the length of stay, and range from £65 per week. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for the people who use the service and their views of the service provided, meaning they tell us if the agency is meeting their needs, if the agency is flexible and suits their life style, and if the agency enables them to maintain their independence, preferences and choice of how they want to be supported. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development The inspection was completed over one day by two inspectors. The home did not know that an inspection of the service was taking place so the staff at the home did not know the inspector was coming. As part of the inspection process two people were case tracked this involves establishing individuals experiences of the service provided or observing practises of individual staff and how they have been trained to deliver a service that promotes the person well being and choices. We also discuss people’s care and look at care files focusing on outcomes for people. Case tracking can help us understand the experiences of people who use the service. In addition to this, information is looked at during the inspection such as polices and procedures, and the general operation of the home to ensure the when people go into the home their needs are met and people are safely looked after. The home is also required to complete an annual quality assurance assessment (AQAA). The Commission sends this document to the provider before the inspection. The AQAA asks the provider to give information to the Commission about the service they for provide people and what they think they are doing well and what they could improve on. In March 2007 the Commission for Social Care Inspection in relation to breaches of the Care Homes Regulations 2001 issued Statutory Notices. It was pleasing to see that the notices issued had been met. The manager and staff had implemented systems, that involved each person who stays at the home to ensure their changing needs were reviewed with up to date information to enable the home to meet each person needs individually. The service is currently under re provision. This means Birmingham City Council is looking at alternative accommodation for the respite unit. The staff and Birmingham City Council ensure all the people who use the service are consulted with on a regular basis about the future plans of the service. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: There are still some areas in care plans that need further development to include information about past life history to make each care plan more individualised and build on the persons strength. This will mean the information gathered about each person will create their personal identity how they can be supported to make choices and decisions of how they want to be cared for while staying at the home. Activity records need to show how each person has been given the opportunity to continue with a wide range of normal activities that they would normally do while at home, particular activities they have been familiar with in the past. This will reflect their choices and opportunity of taking up new activities. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 8 Risk assessments need to be further developed to ensure all risks are known and managed to reduce the risk further, so people are safe. More attention to issues brought up at meetings, should be recorded to ensure the views of the people who use the service are listen to and any issues or suggestions are either met or an explanation given to the people when they are not. Bedrooms that have odours must be addressed to ensure the person using the room is comfortable during their stay at the home. A District Nurse or General Practitioner must verify medical conditions. Staff must not solely rely on information provided from a third party. This will ensure the people who use the service receive medical attention promptly and maintain their health and well-being. 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. Laurels, The DS0000033658.V336484.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 Laurels, The DS0000033658.V336484.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, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available to people is sufficient to enable them to reach an informed decision about whether the home will be able to meet their needs. EVIDENCE: The home had a Statement of Purpose and Service Users Guide that included all necessary information and was available in the reception area of the home; this included information about the organisational structure, with names of staff, their roles and qualifications. Information about the home and services and facilities were also given, together with advice on the application and admission procedure. Both documents need to be available also in different formats, such as audiotape, large print or in a format suitable to each person needs when as part of their assessment. This will ensure each person has equal access to information about the home and this needs to be available without having to wait for it to be produced. There has been improvement in recording information about each person when they come in to the home for respite care. The pre-admission assessment documents for two of the people who have recently started using the service were sampled. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 11 There was evidence that the homes own pre-admission assessment form had been used, and this included information on the physical and psychological health of the prospective person receiving respite care. As the home is a respite placement and people have been coming for many years care plans are not always fully completed. It is necessary for the home to constantly review and monitor each person care needs when they come into the home. This is because they may have not stayed at the home for a long time and their needs have changed. By reviewing each person care needs this will ensure people’s needs are known and can still be met by the service provided. There had been a recent visit to the home for one person to see if home could meet their needs and to see if this was the right placement for them. Information was recorded about the visit and how the person responded to staff and other people staying at the home. This will ensure both parties are happy for the placement to go ahead. The manager informed the inspectors there would be no more people that will use the respite service apart from the ones who currently have access due to the homes re-provision. Laurels, The DS0000033658.V336484.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, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual plans of care include good information about how support should be given. More attention to detail would enhance the plans of care further. Risk assessments need more detail to the control measures in place to minimise the risk. This will ensure people who use the service are not placed at risk from injury or harm. EVIDENCE: Two individual peoples care plans were looked at and showed evidence of ongoing improvement and development in the recording of information to ensure their needs, health and well being was met. Support staff have worked alongside each person to implement individual care plans so that they know what the person preferences are and the way they want to be supported. Some information in care plans need further calcification as it is not clear where this information had come from and how the person was involved. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 13 For example on each file there was information about the persons strengths it was not clear who had identified this information whether it had been said by the person using the service, relatives, staff, or from an assessments. It was also not clear how the staff would use this information, what benefit their strength would have on the care they received. This information needs to be further developed to show how it would be incorporated into their choices and preferences during their stay at the home and identify where this information has come from to ensure the person agrees with what others see as their strength and if the information is relevant. There are some differences in the style and content of the individual plans. One of the plans looked at appropriately cross-referenced to relevant risk assessments to give information to other staff of how to keep the person safe, and what contribution the person could make to the care delivered. One individual plan seen was last reviewed in March 2006 and was now due to be reviewed so that the information for staff to follow is accurate and reflects the person’s current needs. Care plans need attention to details, as on both care plans and risk assessments staff continued to record the word regular giving no guidance of what is meant by this. Risk assessments had been appropriately implemented to cover identified risks such as independent travel, medication and emergency situations in the home. There is still need to improve risk assessments further to ensure the people who use the service are safe. For example when a person is at risk of chocking the information in risk assessment need to identify if the person has to avoid certain foods, is the food to be cut up, is this a medical condition or is the person only having a soft diet. The information recorded in the risk assessment seen said “at risk from choking’’. This is not a comprehensive risk assessment and places the person at risk of harm. One risk assessment said bed rails were to be fitted when the person comes into the home. The information recorded in the risk assessment did not detail who would fit the bed rails, or if the person had to be qualified, what the bedrails were for, and why they needed to be fitted. Clear guidance must be recorded on risk assessments to make sure the person is safe. Daily records varied in contents some recordings were very detailed and included the daily activities of the person such as outings, attending the day centre, going to the pub, swimming, visiting friends, how the person had contributed to their personal care and how they had been in general during the day. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 14 Other daily records sampled needed further development. For example staff had identified a person nails were long and looked infected, there was no further information to say if the staff had contacted a chiropodist, district nurse of general practitioner to ensure the persons did not suffer unduly and ensure medical attention was sought. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements in place for socialising and activities available to ensure the people who use the service experience a varied lifestyle that meets their expectations and personal preference. EVIDENCE: Information recorded in activity records show the people who stay at the home are given the opportunity to take part in a variety of activities both within the home and in the community. Information had been gathered in meeting about what activities people would like to do as a group and individually. This information was recorded on the document called ‘life and choice’ that each person has as part of their assessed needs. The staff gather information on community based events and people have the choice if they want to attend. The records could be further improved to include the outcomes from suggestions people have raised in meetings, such as when someone suggests Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 16 a destination for a trip. This would evidence that people views are listened to their suggestions, choices and contribution are important in ensuring the home meet their expectation, aspiration of leading an activity social life. Because the home is a respite unit where people stay on occasions, the people maintain very strong links with family and the local community. Their stay at the home mean they can continue with activities they would normally do at home. The menus show a balanced diet is offered there is plenty of food available to have a choice if the person did not want what was on the menu for a particular day. Comments from the people who use the service include, “I love my meals, they are very good and I can have what I want’’. “ You don’t have to have what is on the menu if you don’t like it, you can have what you want’’. “ You can do your own cooking now in the new kitchen if you want’’. There is a kitchen specifically for people to learn basic cooking skills if they choose. As the people who use the service have different cultural needs the home tends to consults some people on a daily basis about food and caters for individual preferences. As part of one persons assessed needs all meals need to be recorded to ensure a balanced diet is being taken. The records seen are not always completed. This information is important because its reflects the person cultural needs as well meeting the person medical condition. The person could become unwell if the intake of food consumed is not recorded to show whether the person is getting enough to eat to maintain their health and wellbeing because of a medical condition they have. The manager must ensure when instruction have been given to staff in particular to ensure a nutritional diet is taken when a medical condition has been identified as part of their assessed needs. The food intake must be recorded so staff can monitor their medical condition and seek professional help if needed. Laurels, The DS0000033658.V336484.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, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service have access to healthcare professionals to meet their assessed needs The medication administration system was well managed so people who have their medication administered as part of their assessed needs receive their medication on time, safely and as prescribe by the General Practitioner. EVIDENCE: There needs to be further improvement in recording information about each person health care needs. While there was some good information in daily records about hospital appointment, doctor’s visits, community psychiatric nurses, and medication reviews, not all potential medical problems are followed up. For example it was recorded in a person daily records that they had long nails and the nails looked infected. There was no further information to say if the person had been referred for medical treatment. The manager said that a District Nurse who treated the problem had seen the person, however confirmed that the information was not detailed to ensure good communication between the staff team. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 18 It is very important when medical treatment has been received the outcome are recorded to ensure any follow up treated needed or out patience appointments are attended. The medication system in the home was well managed and included, copies of prescriptions for when people come into the home, there was risk assessments if a person had an allergies to certain medication such as penicillin. All staff that administers medication had received training in the safe handling and administration of medication. Assessments were in place where a person self administer their own medication showing what support staff would provide to the person if needed, The staff monitor and discuss with the person any concerns they had or if they needed further supplies, to ensure the person did not run out of medication during their stay at in the home. There were procedures for PRN (as required) medication, with details of the suitability of the medication to each person, this ensures possible adverse reaction with the current medication people are taken are minimised. The staff spoken to were able to demonstrate awareness of the circumstances under which such medicines should be given. All medication that came into the home was recorded and appropriately signed for. This means people receive their medication safely from experienced staff. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 19 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, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The views of the people who use the service are listened to and acted on appropriately. This means people can voice their concerns and know action will be taken to address them. Risk assessments require further development to fully protect the people who use the service and make sure they are safe from injury or harm. EVIDENCE: Copies of the complaints procedure are made available to the people who use the service, however the copy is not always in a suitable format. This may mean that for some people they would not fully understand the procedure to take if they wanted to raise a concern or complaint, however people spoken to knew who contact if they had any concerns because staff talk to them in their reviews and on a day to day basis There had been no complaints received at the Commission since the last inspection for this service and no complaints were recorded by the home. The complaints records showed that where complaints had been made on behalf of people, a record was maintained to show what action had been taken to resolve this, and a letter of the outcome sent to the complainant. The service has policies and procedure for adult protection, which follows the multi agency guidelines published by Birmingham Social Care & Health. Staff were knowledgeable and demonstrated that they know their responsibilities in protecting vulnerable people. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 20 Risk assessments are completed but require further development to show how the risks are managed and action to take to reduce the risk to safeguard the people who use the service. For example a risk assessments for one person said bedrails would be fitted when the person stayed at the home. The action was to be fitted by the allocated support worker but did not say who this was or if the person had to be trained in fitting bedrails. There was no information to say what type of bedrails they were or why they needed to be fitted. The lack of information contained in the risk assessment may place the person at risk of injury if clear instructions are not given. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is more comfortable for the people who use the service now that decoration has been completed. The home is currently under re provision, as the building does not meet the National Minimum Standards. EVIDENCE: There has been improvement in the environment to make the home more comfortable; decoration has taken place, which makes the home look fresh and clean. The building its self does not meet the needs of the people using the service because lack of space and furniture in bedroom and communal areas. Bedroom are small and furnished with minimal furniture as there is not enough room space to accommodate all the furnishing to make the bedroom more comfortable, such as bedside cupboard chests of draws bedside lamps, comfortable chairs. This means the people who use the service can only bring a minimum amount of belongings with them when they stay at the home for respite care. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 22 There is a wardrobe in each room that has a curtain across, because there would not be enough room in the bedroom to have a door that opens this is very small and would only accommodate a small amount of the person clothes. This restricts the choice of clothing each person can bring to the home during there stay. People spoken to who use the service said the rooms would be better if they were bigger, and then they could bring more things. There has been a new kitchen refurbished to enable the people who use the service to use this facility for making snacks, drinks or cooking basis meals if they choose. There is spacious bathrooms on the ground and first floor, which allows room for those who may require assistance and these are fitted with equipment such as grab rails, toilet raisers and a shower with shower cubical. This enables the people who use the service to be more independent in their personal care, which means their dignity is promoted. The home does not have an on-going maintenance programme in place. Essential maintenance is only done when a problem has already arisen and it can take a few weeks to resolve the problem, meaning that toilets can be out of use, or bulbs are not replaced within a suitable time scale leaving areas out of use and restricting facilities for the people who use the service. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 23 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, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate numbers of regular staff are now available and some training has been undertaken to ensure they have the required skills and knowledge to meet the needs of the people who use the service. EVIDENCE: The staff team had a good knowledge of the support required for people who use the service but on occasions failed to recorded information in care plans that and risk assessments that would ensure needs were known and met. Failure to recorded relevant information in care plans and risk assessments has the potential to place the people who use the service at risk of injury or harm. The management team have commenced a training matrix that shows when staff are due to have updates in training to ensure the people who use the service are appropriate qualified to meet people needs. Training records showed training had been delivered in health and safety, first aid, medication, Epilepsy, infection control, adult protection awareness, and food hygiene. A significant number of staff have not received updated training in manual handling so the people who use the service may be a risk of injury if staff use Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 24 incorrect procedure to assist people who required manual handling as part of their assessed needs. The manager said requests have been sent to Birmingham City Council Human Resource department for staff to attend the next training course available. The Birmingham Social Care and Health complete recruitment of staff and records kept at head office, copies are then sent to the home to be placed on the individual file of each staff. The organisation informs the management team that a clear Criminal record bureau check (CRB) has been completed and a letter confirming this is sent to the home. Staff file sampled showed all the relevant check had been completed people are looked after by staff who are suitable to work with vulnerable people. Formal supervision has commenced to provide staff with a platform in which their practice can be appraised as well as providing a sense of direction in their work. This will benefit the people who use the service by having staff who are monitored in their practises of delivering care. People spoken to who use the service were very complementary of staff and how they support them during their stay at the home. One person said all staff a lovely. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 25 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, 42 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Health and Safety of the people who use the service is safeguarded by routine servicing and testing, but needs to improve in the areas of risk assessments and plans of care to ensure people needs are met and safe. EVIDENCE: Staff meetings provide a sense of direction for staff in undertaking their role and responsibilities. The arrangements for ensuring safe working practices require closer monitoring and improvement. Staff have received appropriate training in these areas but this is compromised by the lack of including the outcome of risk assessments in care plans. On the day of the inspection there was an electicial failure and when inspectors tested the water temperatures in the shower room these were found to be hot, it is not known wheather the elcetical faliure was at fault. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 26 The home complete regaulr checks of water temperature to ensure people are not placed at risk of scalds . The manager said he would carry out a test later that day to ensure there was no fault. Fire records showed that an engineer regularly services the fire equipment. Regular fire drills are held so people live in a safe environment and know what to do if there is a fire. The staff check the fire equipment regularly to make sure it is working properly. The fire risk assessment is regularly reviewed to minimise the risk of fire as much as possible. A Corgi registered engineer tested the gas equipment and stated that it was in a satisfactory condition. An engineer regularly services the hoists and the passenger lift to make sure they are safe to use. The staff test the fridge and freezer temperatures daily and records showed that these were within the limits for safe food storage. The home dose not have a quality assurance sytem in place that looks at the quality of the care provided or outcomes for people using the service. This means the service cannot identify where they need to improve or what they do well. The manager receives regular support and supervision from his line manager and copies of the Regulation 26 visit reports were available for inspection. The manager was very aware of those areas in the home, which needed to be improved, and is working towards proposed actions to address these. Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 27 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 X 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 3 23 2 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 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 2 2 3 3 2 X Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(1) Requirement All plans of care must be reviewed at least on a six monthly basis and any changes recorded and action taken to ensure the changing needs of the person is known and can be met. Information must be available to show how the people who use the service are given choice and their preferences of support required to enhance their quality of life during there stay at the home. Risk assessments must be reviewed when the person needs change and clear instruction given to staff to ensure the people who use the service are cared for safely. Where a person has a medical condition that requires monitoring of food intake information must be recorded, to ensure a healthy balanced diet is maintained as part of their assessed needs. Significant information must be available to show how the identified needs of residents are met on a daily basis. DS0000033658.V336484.R01.S.doc Timescale for action 01/09/07 2 YA7 14(2) 01/09/07 3 YA9 YA42 YA23 4 YA17 13(4)(c) 01/09/07 16(i) 01/09/07 5 YA18 YA19 14(1)(a-c) 01/09/07 Laurels, The Version 5.2 Page 29 6 YA32 YA35 18(1)(i) 7 YA39 15(2)(c) The information must be clear to ensure good communication between the staff team. This will ensure no health issues are overlooked and action taken when needed. Refresher course in all mandatory training must be provided to ensure people who use the service are protected and care is provided by qualified staff. A quality monitoring system must be in place that seeks the views of those using the service to enable them to identify areas where the may improve. 01/09/07 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Laurels, The DS0000033658.V336484.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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