This inspection was carried out on 4th January 2006.
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 10 statutory requirements (actions the home must comply with) as a result of this inspection.
CARE HOME ADULTS 18-65
Liberty House Care Homes 55 Copeley Hill Erdington Birmingham West Midlands B23 7PH Lead Inspector
Joe O`Connor Unannounced Inspection 4th January 2006 10:40 Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 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 Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 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. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Liberty House Care Homes Address 55 Copeley Hill Erdington Birmingham West Midlands B23 7PH 0121 327 0671 0121 327 0671 liberty55@btconnect.com 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) Liberty House Care Homes Ltd Miss Sonia Thompson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered to accommodate 6 persons with a learning disability. Service users must be under 65 years of age. Date of last inspection 13th July 2005 Brief Description of the Service: The property is a large Victorian house at the end of a cul-de-sac, off a main road and adjacent to the Aston Expressway in the Erdington area of Birmingham. Public transport is close by and the service has its own vehicle. All community amenities including places of worship are accessible within a short distance of the premises. Liberty House offers accommodation to six service users with a learning disability. Accommodation is provided on both floors. To the front of the premises there are ramps provided. The service is in the process of having some refurbishment to the front of the exterior and driveway. There is an en-suite bedroom on the ground floor. Two bedrooms on the first floor have en-suite facilities and there is a bathroom and WC facilities on the first floor. The ground floor has a WC. There is a spacious lounge with separate dining area. Kitchen facilities are also available and there is a separate laundry area. There is an extensive garden to the rear of the property, which is well laid out and maintained. It includes a barbeque area. The garden slopes upwards and includes ramp and handrail facilities. Situated to the side of the garden is a large building, which the Registered Manager stated she is considering conversion to supported living accommodation. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day. The Inspector had opportunity to talk to two service users. There were a number who had limited verbal communication and were unable to express their views on life at Liberty House. Service users care plans and risk assessments were inspected. A number of health and safety records were also examined. The Inspector had opportunity to talk to the Registered Manager. For a full overview of the service the report is to be read in conjunction with the unannounced inspection report from 7 July 2005. What the service does well: What has improved since the last inspection?
The manager has addressed a number of the requirements from the previous inspection. Service users bedrooms have been fitted with additional double electrical sockets and three have been provided with television sets so they can watch their favourite programme without having to share the one in the lounge. One service user’s bedroom has new furniture including a wardrobe and chest of drawers. A new refrigerator had been bought for the kitchen.
Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 6 The manager has obtained a quality assurance system that will be developed so that the manager can review the performance of the home and periodically seeks views about if the service is doing well from service users, relatives, staff and professionals involved in supporting the service users. A record has been developed to show what service users have eaten during the day. Amendments have been made to the medication procedure to say that the CSCI must be contacted if any medication errors occur. The complaints procedure has been amended to inform service users they can contact the CSCI at anytime and no one will be victimised for making a complaint. The Risk assessment for the prevention of fire has been reviewed and the electrical hard wiring of the premises had been inspected and serviced. What they could do better: 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. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 7 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 Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Service users needs are currently met and the manager responds to any changes in individual circumstances appropriately. EVIDENCE: There have been no admissions to the service since the last inspection. At the time of this inspection two service users were up and about while another was still in bed. Both service users stated they had a nice Christmas break spent part of it with their relatives. The manager stated two service users who are brothers spent Christmas Day with her family, as their brother and sister could not accommodate them this year. One service user was seen using his new keyboard instrument, which he was very pleased with. Service users appeared well cared for and dressed in clothing that was appropriate to their age. When examining the staff meetings minutes there was reference made by the manager informing staff of positive comments made by a relative for a service user who expressed satisfaction with is son’s development. In discussion with the manager she spoke about one service user whose behaviour had changed during the last two months and she was considering whether the service could meet this particular individual needs. Written evidence seen confirmed that the service user was shortly due a mental health review and at the time of this inspection the manager was contacting a psychologist for advice. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9 Care plans are still in need of improvement ensuring they provide a holistic picture of how their needs are to be addressed. Service users are involved in decisions about their lives through service users meetings, but these are not held frequently. Service users have risk assessments but these need further development ensuring service users safety when out in the community. EVIDENCE: Since the last inspection the manager has been working to review the current format of the care plans. One referred to the service user getting up and going to bed at a certain time while another referred to the service user whose diabetes was controlled by medication. Another care plan examined referred to one service user what behavioural problems the service user had but there were no details of how these problems were to be addressed. It is recognised that the manager has been developing the care plans into a more person centred document but work is still required to show how service users needs are to be met and provide more specific details of service users leisure interests. The manager stated she would be making contact with Birmingham Social Care & Health Person Centred Team for input with developing the care plans.
Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 10 Two service users were asked if they had any meetings and both replied yes but one was unsure how often these were held. There were minutes seen of meetings and it was noted there was discussions about future activities and meals. However, the meetings were not held on a monthly basis. Risk assessments were in place for service users and these did refer to how service users should be supported in the home. However, there was no reference as to how service users should be escorted in the community and how many staff is required. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 17 Service users have access to leisure activities in the community and receive organised activities provided by other agencies. Service users records of meals consumed are recorded regularly as part of their nutritious well being. EVIDENCE: Two service users records examined contained references to what activities they had participated in the community. One service user said that during the summer he went to Blackpool for the day and had enjoyed the trip. There was evidence that service users had gone for meals to places such as Pizza Hut and one had accessed the local library on a number of occasions. One service user said he had started with a new employment /learning scheme provided by Birmingham Rathbone doing music, drama and computers. Another service user said he went to college once a week to help him with his reading and writing. Two service users records indicated they were involved in shopping for food and this was confirmed when speaking the service users who were present during this visit. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 12 Discussion was held with the manager of the need to develop for each service user an Individual Health Action Plan in line with the Department of Health’s Valuing People Guidelines. A sample of the records of meals eaten by service users found these were completed on a regular basis and two service users stated they were happy with the food being provided for them. Service users were observed to make themselves drinks during the day. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Service users healthcare is appropriately managed by staff but improvements are required in developing suitable guidelines around management of service users who have epilepsy. Medication management is good but some improvements are required. Service users weight is not recorded monthly as part of their nutritional well being. EVIDENCE: Three care records examined indicated where service users had completed their personal care or had assistance to do this. Each service user has a manual handling assessment but these were now overdue for review. Service users have access to community healthcare services such as GP, dentist, optician and chiropodist. An examination of one service user’s care records found that a service user who had epilepsy was having a record maintained whenever they had a seizure. A written protocol is required to inform staff as to what action should be taken in the event of a seizure. Improvements were still required for the monthly recording of service users weight, as one service user had not been weighed during November and December this year. The management of medication was of a good standard and improvements had been made with containers of creams and ointments that had their labels
Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 14 dated from when they were opened. An examination of the Medicines Administration Records (MAR Charts) indicated there were no gaps in recording but it was noted that one service user who was being prescribed PRN medication or when required did not have a written protocol why this was required and when it should be given. The manager had amended the medication procedure to include contacting the CSCI should medication errors occur. An examination of one of the service users’ care records confirmed they had regular medication reviews. The MAR charts had photographs of each service user. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Service users have access to a complaints procedure that informs about the CSCI and they will not be subject to any victimisation. Work is still required in ensuring the adult protection policy and procedure is within the spirit of the Department of Health Guidelines. EVIDENCE: Neither the service nor the CSCI have received any complaints since the last inspection. An examination of the complaints procedure confirmed the manager had made amendments to the procedure stating service users could contact the CSCI at anytime and no would be victimised for making a complaint. A photograph of the Inspector was on display in the hallway. Since the last inspection the manager and two members of staff had updated their training in adult protection and challenging behaviour. There was an up to date copy of the Multi Agency Guidelines on adult protection published by Birmingham Social Care & Health. There was a leaflet on display in the dining room also published by Birmingham Social Care & Health about who service users can contact if there was any concern about their safety. An examination of service users’ personal allowances was undertaken during this visit. Each service user has their own individual record of expenditure and their monies are held separately. The records indicated where monies were coming in and what had been spent and for what purpose. Receipts were being maintained and these had numbered to enable cross referencing the records. There was evidence confirming service users had their own bank accounts. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Service users live in a clean hygienic, warm and homely environment with improvements being made to enhance their quality of life. EVIDENCE: The premises was warm, clean and tidy at the time of this inspection. A number of service users’ bedrooms were viewed to confirm additional double electrical sockets had been installed since the last inspection. Television sets had been provided to those who previously did not have any and the manager had provided new furniture including a table lamp and wardrobe and the bedroom was generally made more homely for the service user. The first floor bathroom was undergoing refurbishment. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 Service users receive continuity of care with appropriate levels of staff on duty. Improvements have not been made to the frequency of staff supervision since the last inspection. EVIDENCE: At the time of this inspection the current levels of staffing were found to be adequate and an examination of the staff rota indicated appropriate levels were being maintained during the day. One new member of staff has been recruited since the last inspection to undertake night waking care duties. An examination of the staff’ members recruitment record indicated there was appropriate documentation in place including job application form, two references, proof of identity and CRB check. There was also evidence of an induction checklist. Two service users spoken with stated they thought the staff were friendly and spoke politely to them. Staff supervision was not within the required levels of frequency, which should be once every two months. Standard 35 was not assessed in depth but it was noted the manager and two members of staff had completed adult protection and challenging behaviour training. One member of staff had completed basic first aid. One member of staff had completed NVQ Level 2 since the last inspection. The manager stated
Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 18 that two staff had put themselves forward to undertake training towards the Learning Disability Award Framework. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 Service users live in a home that is run by a qualified and competent manger who is committed to improving good practice. Service users benefit from a relaxed and friendly atmosphere. A quality assurance system is in place that will consult service users about the management of the service. Records are appropriately maintained and stored protecting service users interests. Service users health and safety is adequately promoted and maintained. EVIDENCE: The Registered Manager was present during this inspection and was able to demonstrate evidence of which requirements had been addressed since the previous inspection. Since the last inspection the manager had purchased a Quality Assurance system with an undertaking that this will be implemented during the next inspection year. The atmosphere was relaxed and friendly during this visit and two service users stated they would be able to approach the manager if they had any problems or concerns. Comments made during this inspection were received positively. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 20 The records held on the premises were generally up to date and held in a secure facility. Records with regard to health and safety were satisfactory. There was evidence confirming the testing of the fire alarm was being completed every week and the emergency lighting every month. The manager had reviewed the risk assessment for the prevention of fire that was a requirement from the previous inspection. Another previous requirement addressed was the inspection and testing of the electrical hard wiring on the premises. There was a proof of worthiness certificate in place, which confirmed the work, had been completed. The accident book was examined and it was good to see that none had occurred since the last inspection. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 21 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 N/A 2 N/A 3 3 4 N/A 5 N/A 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 3 25 N/A 26 N/A 27 N/A 28 N/A 29 N/A 30 3 STAFFING Standard No Score 31 N/A 32 N/A 33 3 34 N/A 35 N/A 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 N/A 2 2 N/A LIFESTYLES Standard No Score 11 N/A 12 3 13 3 14 N/A 15 N/A 16 N/A 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 N/A 3 3 3 N/A 3 3 N/A Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 22 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)(2) Requirement Timescale for action 04/02/06 2. 3. YA8 YA9 12(2)(3) 13(4) 4. YA18 13(5) The Registered Person must ensure that individual care plans have sufficient detail as to how the needs of service users are to be met and by whom including personal care needs. They must also have more detail with regard to their daily routines and specify their leisure interests. Outstanding Requirement. Timescale 13 September 2005 not met. The Registered Person must 04/02/06 ensure service users meetings occur on a monthly basis. The Registered Person must 04/02/06 ensure service users risk assessments include how risks should be minimized when escorting service users in the community. The Registered Person must 04/02/06 ensure manual handling assessments are reviewed to reflect current service users’ requirements. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 23 5. YA19 12(1)(b) 6. YA19 12(1)(b) 7. YA19 12(1)(b)(2,3) 8. YA20 13(2) 9. YA23 13(6) 10. YA36 18(2) The Registered Person must ensure service users weight is recorded every month. Any reasons why this has not been done must be documented. Outstanding Requirement. Timescale 13 August 2005 not met. The Registered Person must ensure written protocols are in place for how service users with epilepsy should be managed during and following a seizure. The Registered Person must ensure each service user has an Individual Health Action Plan in line with the Department of Health’s Valuing People Guidelines. The Registered Person must ensure service users who are prescribed PRN medication have a written protocol for its use. The Registered Person must ensure that the adult protection procedure is amended and is within the spirit of the D.OH. Guidelines No Secrets. Outstanding Requirement. Timescale 13 September 2005 not met. The Registered Person must ensure that staff receives supervision every two months. Outstanding Requirement. Timescale 13 September 2005 not met. 04/02/06 04/02/06 04/03/06 04/02/06 04/02/06 04/02/06 Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 24 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 YA24 Good Practice Recommendations It is recommended that the Registered Person forward to the CSCI a plan of future refurbishment and re-decoration of the premises. Liberty House Care Homes DS0000062432.V275835.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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