Inspection on 08/08/06 for Liberty House Care Homes

This inspection was carried out on 8th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

Liberty House Care Homes 05/08/09

Liberty House Care Homes 07/08/07

Liberty House Care Homes 04/01/06

Liberty House Care Homes 13/07/05

Liberty House Care Homes 15/03/05

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 Liberty House Care Homes 55 Copeley Hill Erdington Birmingham West Midlands B23 7PH Lead Inspector Joe O’Connor Unannounced Key Inspection 8th August 2006 10:45 Liberty House Care Homes DS0000062432.V302667.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 Liberty House Care Homes DS0000062432.V302667.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. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Liberty House Care Homes Address 55 Copeley Hill Erdington Birmingham West Midlands B23 7PH 0121 327 0671 F/P 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.V302667.R01.S.doc Version 5.2 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 4th January 2006 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 has recently seen refurbishment to the front of the exterior and driveway. There is an ensuite bedroom on the ground floor. Two bedrooms on the first floor have ensuite 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. The fees charged by the service range from £731.78-£853.75 per week. Additional costs not covered by the fees include dry cleaning, hairdressing, Sky TV, telephone calls, toiletries and personal activities. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over a day and the fieldwork visit was unannounced. The Inspector had opportunity to talk two people who live in the home and a senior member of staff on duty. Comments were received from two service users, three staff and a healthcare professional who had completed CSCI survey forms. A partial tour of the premises was undertaken. Care records including care plans, risk assessments and daily reports were also examined. Health and safety records were examined during this visit. Additional information was seen from the pre inspection questionnaire that is sent out to the home before the fieldwork visit a long with a service history including any significant events. Some observations of care practice were undertaken. To see how the service has performed since the last inspection then the report is to be read with the unannounced inspection report 4 January 2006. What the service does well: The people who live in the home where its external features are similar in design to that of neighbouring properties and its purpose as a care home isn’t known. It generally provides a clean, tidy, homely environment that is part of the local community which the people who live there said was clean and tidy. Two people gave their views about what it was like living in the home. One commented, I’m very happy here and have got a new bed and TV”. Another said, “The staff are alright I can talk to them, everything is fine at the moment although staff don’t always make curries which is one of my favourite meals”. Comments were received from a senior community dentist who said, “The residents are extremely well cared for and I am impressed with the high level of commitment of the staff and manager, it is rewarding to work with such a supportive and professional team of carers”. It was good to see that people who have particular needs because of their culture and religion are well catered for by staff. For example one of the people who live in the home is an Asian female and her care plan states that every Sunday when she visits her parents she must dressed in clothes that reflects her cultural background. She also has access to Asian films on video. The care plan also states she is a Muslim and must have a Halal diet. An examination of the food records found this was always being provided on a daily basis including vegetarian meals. The menus and food records seen during this visit found that people were getting a healthy and balanced diet. The management of medication was being carried out to a good standard and people were getting their medication at the time when it was required. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There is one person who goes out to see his mother independently by taxi. However, there was no risk assessment in place to show whether this was safe as the person concerned has epilepsy and is prone to seizures. A number of risk assessments for the other people had not been completed. The meetings for the people to talk about what they would like to eat and what to do should be held every month. The care plans have greatly improved but additional information such as how people’s continence needs are to be managed should be included. It is also important that the care plans make clear the male service users’ preferences about who they prefer to have support with their personal care as the majority of care staff working in the home are female. The care plans must also make clear whether people are having their feet cared for by staff or are visiting a chiropodist. They must show whether people have been involved in their development and review. Individual contracts for each person must be clearer in explaining whether the home provides a holiday and which costs are met by the company and person. The service user guide must also follow what the individual contract says as the information about what is covered by the fee is not clear. The manager of the home provided copies of the revised service user guide and statement of terms and conditions following the inspection to confirm what amendments had been made and these were found to be satisfactory. The manager must ensure that when she is not on duty and an inspection takes place in her absence, that the records for staff recruitment and training are available for inspection when this is requested by the CSCI. Staff must stop Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 7 the practice of using Tippex correcting fluid to alter care records, which is unacceptable. Staff must be better at informing the CSCI of any accident in the care home without delay. 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.V302667.R01.S.doc Version 5.2 Page 8 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.V302667.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3 & 5 Quality outcome in this area is good. This judgement has been based on available evidence including a visit to the service. Information for prospective service users has been amended and updated ensuring they understand what they are contributing towards their care. Service users needs are being reassessed ensuring the service continues to meet any changes in individual circumstances. EVIDENCE: The service has a statement of purpose, which had been reviewed in March 2006. However, this will need amending as it was referring to the National Care Standards Commission, which no longer exists. There is a service user guide, which again was referring to the NCSC and did not have information about the fees charged by the service, which should no be included following amendments to the Care Homes Regulations 2001 from 1 July 2006. The statement of terms and condition referred stated that costs for transport would come out of service users’ DLA Mobility Component but did not refer to the exact amount depending on whether the individual was receiving the lower or higher rate. It was noted that the individual service users’ contracts did not refer to transport costs. The service user guide and contract did not refer to the home’s position in providing holidays. Both documents must be amended so that prospective service users are given clear and consistent information. At the time of publication of this report the manager provided copies of the amended service user guide and contract and these were found to be satisfactory. The statement of purpose and service user guide would benefit in having some photographs to improve accessibility. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 10 The service has had no new admissions since the last inspection. An examination of three care records sampled indicated staff were reviewing and updating previous assessments. The senior carer on duty stated that the service users had recently been reviewed by Birmingham Social Care & Health as part of their financial review. No assessments from these visits were on file although the senior carer stated there had so far been no feedback from the social workers and they had not left copies of the support hours assessment tool. Two service users spoken with provided the following comments. “The staff are alright I can talk to them, everything is fine at the moment although staff don’t always make curries which is one of my favourite meals”. Another said, “I’m very happy here and have got a new bed and TV”. Two CSCI service users surveys received following this inspection were generally positive in their comments about the service although one ticked a box to say that only sometimes carers would listen and act on what they said. Comments received from a senior community visiting dentist included, “The residents are extremely well cared for and I am impressed with the high level of commitment of the staff and manager, it is rewarding to work with such a supportive and professional team of carers”. A relative who also provided comments stated,” The staff have worked very hard with my son and as long as he is happy I am happy”. Three members of staff provided comments on a survey form and stated they thought overall the quality of the service being provided was good. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 11 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, 7, & 9 Quality outcome in this area is adequate. This judgement has been based on available evidence. Improvements have been made with the development of the service users care plans providing more information as to how their needs should be met. Service users are encouraged to make decisions about their lives but service users meetings must occur monthly. Service users risk assessments do not show enough evidence in minimising risks for service users’ travelling in the community. EVIDENCE: Three service users’ care plans were examined during this inspection. There had been improvements in their detail. There was essential information about the service user such as their next of kin, professionals involved in their care and details of their religion. The care plans had more information about the service users’ daily routines. One seen referred to the service user’s preferred time for getting up and going to bed. The care plan also referred to the service user’s likes such as going bowling and “likes to choose his own clothes”. Another care plan referred to the service user enjoying watching Asian videos and likes having her hair washed. There was information on the care plans informing staff how they should approach service users who were anxious or agitated. Some additional information was still for one care plan to include that they had to use a level access shower in their bedroom with a shower chair. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 12 Another care plan referred to a service user as being incontinent but did not say how this was being managed including what kind of pads were being used. Two service users stated they had meetings to talk about the menu and what they wanted to do. There were minutes for these but it was noted these did not appear to show that the meetings were regular. The senior carer stated they were introducing a one to one consultation for the service users in addition to the group meetings. There was one evaluation sheet seen for one of the service user’s who had recently been to the cinema, which recorded feedback about the activity and about the choice of a holiday to Minehead. One of the minutes seen for a service users’ meeting prior to this inspection centred on a discussion around about their final wishes. Two service users commented that they would like to have a burial and have music played by ABBA and the Spice Girls. The manager must now look at developing these individual wishes into a living will with a recommendation that an advocate is involved for those who are unable to express their wishes verbally. An examination of the service users records found there had been a change of the risk assessment formats. However, it was noted one was not in place for one of the service user’s travelling to his mother’s by taxi. The service user is prone to seizures because of their epilepsy, which are not under full control. The senior carer on duty recognised that this should be done as a matter of urgency. The CSCI does not wish to restrict service user’s rights to being independent but robust safeguards must be in place to ensure service users’ safety when travelling in the community. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 13 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, 14, 15,16 & 17 Quality outcome in this area is good. This judgement has been based on available evidence including a visit to the service. Service users have access to leisure activities in the community and receive organised activities by other agencies. Service users maintain positive relationships with their relatives and staff. Service users daily routines are known and set out in their care plans. Service users are provided with a nutritious balanced diet where specific dietary needs are met. Service users personal expenditure records must state more clearly what is being contributed towards annual holidays or short breaks. EVIDENCE: Three service users records examined referred to what activities service users had participated in the community. One service user said he goes to college once a week to learn how to read and write. He enjoyed the guest speakers that came to the college included the Army and Fire Service. Another service user said he enjoyed going to Birmingham Rathbone to learn computers and essential skills. However, the same service user did say that he chose not to participate in any other activities. Among the activities service users had been involved in included visits to the cinema, local library, Cannon Hill Park and Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 14 McDonalds. Three of the other service users attend day services provided by the Local Authority. This year all but one of the service users went on holiday to Minehead, which they enjoyed. The service user stated he chose not to go. It was noted when examining service users finances that they had paid towards the cost of the holiday. However, there was no clear evidence to indicate what exactly were they contributing as there were no receipts available. The manager must be mindful that as a minimum the option of a seven day holiday should be provided as part of the basic contract price. The service users have access to their own TV, DVD and music systems and have the option of accessing Sky TV. Two service users had new wide screen TV sets, which they were both pleased with. One of the service users’ who is an Asian female had posters on the wall of Asian film stars and has Asian films on Video. The senior carer on duty said the service user would soon have a DVD player. There were photographs on the wall where the service user had attended a recent wedding for one her relatives and she was dressed in clothes reflecting her cultural background. This was stated in the service user’s care plan. An examination of the service users’ records indicated they were maintaining contact with their relatives. Some service users go on home leave to their parents. Two service users who are siblings maintain contact with their father every Sunday who is in a care home. The senior carer on duty stated the home had been very supportive towards the service users and meals were provided during their visit. The service users have access to a public payphone by the lounge, which is partially screened for privacy. Observation at the time of this inspection indicated the service users were able to access the premises freely and the interaction between staff and the service users was good. There was more information in the service users’ care plans regarding their daily routines. A number chose to spend time in their bedroom. It was good to see the staff were encouraging one of the service users to visit his mother independently travelling by taxi but as previously mentioned a robust risk assessment must be in place for this. An examination of the menus for the previous four weeks indicated the service users were being offered a choice of nutritious meals. Records of food eaten were being maintained daily. One service user commented he enjoyed the meals provided while another said sometimes the food was good. One service user’s care plan stated that service user must have a Halal diet because she is a Muslim. An examination of the food records confirmed when Halal meals had been provided along with vegetarian dishes. An examination of the food cupboards, refrigerator and freezer indicated these were well stocked with fresh fruit and vegetables available. One service user commented he was able Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 15 to make hot drinks and sandwiches and made a drink for the Inspector. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 16 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 Quality outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Service users healthcare is appropriately managed by staff, but individual personal care preferences need to be included on their care plans and how their foot care is managed. Medication management is to a good standard promoting service users’ good health. EVIDENCE: Three service users care records examined indicated where service users had completed or had assistance with their personal care. Each service user has a manual handling assessment, which had been reviewed since the last inspection. It was noted one needed some amending to state how one service user should be lifted in and out of the shower. One of the service users said that staff would sometimes manage his foot care. There were records in place indicating when service users had declined support with their personal care. The service currently accommodates five males three of whom are White English and two are Afro Caribbean. There is one Asian female. It was noted that the care plan for the female service user stated all aspects with her personal care must be dealt with by female staff but there were no references to the male service users’ gender care requirements. The current staff team are pre-dominantly female Afro-Caribbean with one Afro-Caribbean male. In discussion with the senior carer on duty she stated the manager has Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 17 acknowledged that white male staff would be of benefit to those service users. An examination of the service users care records indicated they had access to community healthcare services such as a GP, Dentist and a visiting Optician. It was noted however, there was no evidence whether the service users had seen a Chiropodist or whether staff were managing this. One service user stated he went to the Doctor every month to have Depot injection. Two out of the three care records sampled found a record of service users’ weight had been documented every month but one seen had no weight recorded since April 2006 with no reason why this had not been done. New individual health assessments have been introduced but how these individual health needs are to be addressed must be developed into health action plans in line with the Valuing People White Paper. As previously mentioned comments were received from a senior community dentist who stated that staff were well informed and have the confidence of the service user. There were also very good levels of communication and that the manager and staff would always advise her of any relevant changes in medical condition. One of the service users who has epilepsy has a record maintained of any seizures that have occurred. A written protocol is in place setting out how the service user should be supported when he has a seizure. The management of medication was to a good standard and an examination of the Medicines Administration Records (MAR Charts) indicated there were no gaps in the recording. There were photocopies of prescriptions but these were not attached to the individual MAR sheets. There was written evidence reviews of service users’ medication undertaken by a Consultant Psychiatrist. A requirement from the previous inspection for a service user to have a written PRN protocol had been addressed. Another service user had a protocol in place for the use of Rectal Diazepam. An examination of the staff training matrix board indicated six members of staff had completed medication training. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 18 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 Quality outcome in this area is good. This judgement has been based on available evidence including a visit to the service. Service users have access to a complaints procedure, which informs them about the CSCI and they will not be subject to any victimisation. Service users personal monies are managed appropriately with some minor improvements needed. EVIDENCE: Two service users stated that they would be able to go to the manager if they had any concerns. Neither the CSCI nor the service has received any complaints since the last inspection. A revised complaints procedure has been drawn up and the senior carer on duty stated the manager was working with a representative from an advocacy organisation to develop a complaints procedure that is more accessible. A photograph of the Inspector was on display in the corridor of the building. An examination of the staff training matrix board in the office found that all but three members of staff had completed training in adult protection. There is a copy of the latest multi agency guidelines published by Birmingham Social Care & Health. The manager had developed a procedure for physical intervention since the last inspection, which referred to contacting the CSCI if physical intervention had been used as a last resort. Two service users personal monies records were examined during this inspection. Each service user has their own individual record of expenditure and monies are held separately. The records indicated to a certain extent where monies were coming in and what had been spent and for what purpose. There were receipts being maintained and individually numbered. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 19 A concern was raised with the senior carer regarding two withdrawals made by one service user with regard to their holiday in Minehead. There was no evidence on the individual’s financial record to confirm what the service user was contributing towards the holiday. The senior carer on duty was advised that the service user should not have been paying towards the whole cost of the holiday if this had been the case. At the time of publication of this report the Registered Provider had sought advice from Social Care’s Service Contract Team who has advised that service users under the current contract arrangements 2000 should pay for their own holiday as funding is not provided under the terms and conditions of the contract with the home. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 20 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 Quality outcome in this area is good. This judgement has been based on available evidence. Service users live in a clean, tidy and homely environment with some minor improvements needed. EVIDENCE: The premises was generally clean and tidy with no offensive odour apparent. Improvements have been made to the building since the last inspection. The front of the building had been painted. Work was in progress to re-furbish the bathroom. A new shower had been installed along with a toilet and wash hand basin. New showers had been fitted to three service users bedrooms. Two service users had new beds while another had a new set of wardrobes and chest of drawers, which he commented how please he was with these. When the viewing the service users bedrooms it was noted additional double electrical sockets were installed since the last inspection. It was noted that in one of the service users’ bedrooms the wallpaper was in poor condition peeling away by the wash hand basin. Two CSCI service users surveys received following the inspection indicated they were satisfied with the cleanliness of the premises. The kitchen was clean and tidy during this inspection and there are procedures in place for the control of infection. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 21 Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 22 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): 32, 33, 34, 35 & 36 Quality outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Service users receive continuity of care with appropriate levels of staff on duty. Service users are supported by staff who receive appropriate training to undertake their duties effectively, with more frequent supervision. Staff recruitment records should be made available for inspection when the Commission requests this. Standard 34 not assessed EVIDENCE: The staff recruitment and individual training records were not available during this inspection. The senior carer on duty stated the manager was the only one who had access to these. Therefore the only evidence available with regard to staff training was what had been written in the pre-inspection questionnaire and from a training matrix board in the office. The pre inspection questionnaire stated that out of ten care staff employed five were qualified to NVQ Level 2 and above. This is 50 of the workforce. The pre inspection questionnaire stated that training in fire safety, first aid, managing aggression and adult protection had been completed. An examination of the staff training matrix board indicated three staff had yet to complete adult protection training and that updated training was needed in areas such as food hygiene and manual handling. The manager wrote in the pre-inspection questionnaire that she had been making arrangements with the local PCT to arrange training in epilepsy. The pre –inspection questionnaire stated that three members of staff had left Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 23 employment with the service since the last inspection. The posts had been recruited to and the senior carer on duty stated there was only a part time vacancy left. One member of staff was currently on compassionate leave and would be returning to work in October. At the time of the inspection there were two members of staff on duty. An examination of the staff rotas for the previous four weeks indicated there were enough staff on duty. The rotas also indicated when a senior member of staff was on duty along with an appointed first aider. Two service users commented they felt there was enough staff on duty. The senior carer on duty provided some examples of staff supervision records that had been completed and these indicated the frequency of supervision had improved. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 24 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, 39, 41 & 42 Quality outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Service users have been supported by a manager who is improving the service, but some issues around health and safety and access to records for inspection need addressing. EVIDENCE: The Registered Manager was on annual leave at the time of this inspection. A senior carer was on duty and was very co-operative during the inspection process. The senior carer was qualified at NVQ Level 3.Comments made were received positively and the senior carer acknowledged that some aspects of the care records needed addressing. It was evident that since the last inspection the Registered Manager had made improvements addressing most of the requirements from the previous inspection. The manager has introduced a number of questionnaires for the service users including one relating to equality and diversity. The questions asked service users if they felt the service was meeting their cultural needs. The responses seen for these were positive. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 25 The records viewed during this inspection were generally up to date. However, as previously mentioned the Inspector was unable to view the staff recruitment and training records. The manager must be mindful of her responsibility under Sections 31 & 32 Care Standards Act 2000 that allows Inspectors to view any documents held on the premises. It was also noted that a number of care records had been altered with the use of Tippex, which is unacceptable practice. Records for health and safety were satisfactory. There was evidence confirming the fire alarms were being tested every week and the emergency lighting every month. A fire drill had occurred prior to this inspection. Staff had also received fire training. The risk assessment for the prevention of fire had been reviewed since the last inspection. The gas equipment had recently been serviced but there was no copy of a Gas Landlords safety certificate. At the time of publication of this report the registered provider had forwarded a copy of the current certificate. A portable appliances test had occurred prior to this inspection. An examination of the accident book found three had occurred but only two had been notified to the CSCI under Regulation 37. This related to a service user injuring his face following a seizure when he fell off a chair. The senior carer on duty acknowledged that this should have been notified to the CSCI. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 26 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 3 2 3 3 3 4 N/A 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 3 33 3 34 N/A 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 2 N/A LIFESTYLES Standard No Score 11 N/A 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 N/A 3 N/A 3 N/A 2 2 N/A Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA8 YA7 Regulation 12(2)(3) Requirement Timescale for action 08/10/06 2. YA9 13(4) The Registered Person must ensure service users meetings occur on a monthly basis. Outstanding Requirement. Timescale 4 February 2006 not met. The Registered Person must 08/10/06 ensure service users risk assessments include how risks should be minimized when escorting service users in the community. Outstanding Requirement. Timescale 4 February 2006 not met. 3. YA18 YA19 15(1) 4. YA19 12(1)(a)(b) (2) Service users care plans must include male service users’ gender care practices and how continence needs and foot care are to be managed. The Registered Person must ensure Individual Health Action Plans are completed 15/10/06 15/10/06 Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 28 5. YA34 YA41 6. YA41 17(2) Schedules 2 & 4 Part III Care Standards Act 31 & 32 17(2) Schedule 4 13(4) 37(1)(f) The Registered Person must ensure all staff recruitment records are available for inspection when this is requested by the CSCI. The Registered Person must ensure that alterations to care records must not be made with correcting fluid. The Registered Person must ensure any accident in the care home is reported to the CSCI without delay. 15/09/06 16/08/06 7. YA42 17/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations It is recommended that the Registered Provider give consideration in making the statement of purpose and service user guide available in a more accessible format including the use of photographs. Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 29 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 © 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 Liberty House Care Homes DS0000062432.V302667.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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