Inspection on 25/07/07 for Loretta House

This inspection was carried out on 25th 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Loretta House 07/09/06

Loretta House 04/01/06

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 Loretta House 4 Hunton Hill Erdington Birmingham West Midlands B23 7NA Lead Inspector Mr Jon Potts Unannounced Inspection 25th July 2007 09:05a Loretta House DS0000065681.V348730.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 Loretta House DS0000065681.V348730.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. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Loretta House Address 4 Hunton Hill Erdington Birmingham West Midlands B23 7NA 0121 384 5123 F/P 0121 384 5123 lhome@btinternet.com None Kidderminster Care Ltd 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) Vacant post Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users shall be 10 persons with a learning disability, being adults under 65 years of age with one exception for an agreed named individual. Not withstanding Standard 25.5 iii, the provider will be required to clearly demonstrate how a positive choice has been derived from persons agreeing to share, their advocates and any funding body. Service users will be ambulant. Accommodation is not agreed for persons who have mobility difficulty beyond the physical limitations of the home neither for persons who are physically disabled. Appropriate locks are to be provided for service users rooms within 6 months of date of registration and existing dead locks are to be immediately taken out of use. 7th September 2006 Date of last inspection Brief Description of the Service: Loretta House is a large, traditional style, detached and extended property, located at the junction of Hunton Hill and the Birmingham Road. The homes location, provides good access to bus and train services at the Gravely Hill train station, a few minutes walk away. Loretta House provides accommodation to ten service users, all who have a learning disability. The home briefly comprises of, two lounges located on the ground floor, a dining area. An open plan kitchen and laundry. Bathing and toilet facilities are located on all floors. The home does not have a lift, and the ground floor is on different levels. Service users must therefore be able to negotiate stairs. There are at present no assisted bathing facilities in the home, although provision of such is under consideration by the provider. There is a pleasant, well-maintained private garden at the back of the house and off road parking for several cars to the front. The home has 24hr staffing with multiskilled carers managed by seniors and an acting manager. The acting manager is responsible to the director of the company. The current scale of charges for accommodation and services ranges between £332.97 to £834.06 per week. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection focused primarily on the homes performance against key national minimum standards and was carried out over two days. Evidence was drawn from a variety of sources but involved tracking the care of a number of residents, which included discussion with residents wherever possible. All care records relating to these residents were examined as well as a number of other records including staff and management records. The inspector also had discussion with staff on duty, the manager and provider. There was also pre inspection information used that included an annual quality assurance assessment and a number of questionnaires completed by residents and relatives. The acting manager, staff and especially residents are to be thanked for their assistance with this inspection. What the service does well: What has improved since the last inspection? There has been noticeable progress in that the home has fully satisfied the majority of the requirements from the last inspection with improvements including development of residents care plans (which are now clearer, easier to follow and include residents goals and aspirations), risk assessments (both individual and environmental), communication techniques (including staff Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 6 training in sign language, pictorial menus etc), review of some key policies related to adult protection, as well as the homes statement of purpose. Staff training has continued and has included involvement in epilepsy awareness. 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. The summary of this inspection report can be made available in other formats on request. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 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 Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives who use the home have sufficient information presented to them to assist them with decision-making, and the homes procedures indicate that this would be the case for any prospective new admissions to the service. The home reviews the needs of residents although lack timely support from outside agencies to assist with this process. EVIDENCE: The current residents at the home have lived there for a number of years meaning that there have been no recent admissions to test out the homes policies and procedures in this area. Time was therefore spent reading the homes current procedures and discussing these with the acting manager of the home. This evidenced that the current procedures are generally satisfactory although would benefit from further work to clarify that prospective residents would need to have the opportunity to have access to the home pre admission, this for day and night visits, although this would (as stated by the acting manager) be dependent on the individuals needs and specific circumstances. The service has developed a Statement of Purpose, which sets out the aims and objectives of the home, and includes a service user guide, which provides Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 9 basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format at present although the acting manager discussed plans to produce a video based presentation, this to be produced with the involvement of the current resident group. The current statement of purpose was subject to some review since the last inspection to reflect the provision of a service to residents that are becoming older and in some cases more frail. It was positive to see that the majority of residents and relatives responding to CSCI questionnaires felt they received enough information about the home to enable them to make decisions and the majority of relatives felt they were kept up to date by the home. The procedures and the acting manager were clear that the home needs to consult the assessment information to see if they can meet the prospective individual’s needs before any they make the decision to accept the application for admission and offer a placement. Evidence available shows that there has been reassessment of the residents needs by staff in the home following on from reassessments carried out by Birmingham Social services, although these are mostly now over 12 months old. The acting manager was advised to raise the need for reassessment/update by the funding body with them. There was one reassessment carried out recently and this indicates that overall the home was meeting the needs of the individual although there are some environmental issues that the provider is addressing. Comments from relatives indicated that five out of the six responding to CSCI questionnaires felt the home meet residents needs. Existing residents were seen to have been provided with a statement of terms and conditions/Contract, although these would need review where there are changes, as with one the fees have increased (following an increase in the funding after social services reassessment). The contract gives basic information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy, although would benefit from presentation in more user friendly formats. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 10 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. Staff have residents best interests as a priority although there is scope for improving their involvement in care planning, with the home developing ways in which residents are involved in decisions about their lives, and playing an active role in planning the care and support they receive. EVIDENCE: There was evidence to show that the home has developed the care plans for individuals with documents titled ‘health action plans’, these building on the assessment and review information the home has to create a plan that is written in plain language, easy to understand and looks at all areas of the individual’s life with inclusion of goals for the individual. These documents were all in written format however and consideration needs to be given to looking at formats they may assist with residents involvement within these documents wherever this is possible, this possibly through person centred planning that uses more pictorial (possibly photographic) information. Whilst the staff and Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 11 acting manager clearly recognised the right of individuals to take control of their lives and to make their own decisions and choices, there was limited documented information available to show this happened in respect of care planning, with no signatures on care plans (where residents able), agreements with representatives, or minutes of multi disciplinary meetings where the plans could be agreed with the resident/representative. The care plans are however used as working documents and in the majority of instances the care detailed was seen to be carried through into practice. There was only one exception where communication strategies for one resident where not specific in the actual plan of care although guidelines were available separate to this, with staff understanding what they needed to do. Care plans are reviewed and updated by the residents key workers usually every month with residents views stated to be reflected within this through key workers observation of their preferences and choices over the prior month. The plan is supported by risk assessments that focus on keeping the residents safe when involved with independent living skills including such as cooking, housework, sharp objects etc. There was some evidence of staff recording limitations placed on residents (for reasons of safety) within these. Where there was issues in respect of resident’s behaviours these were also documented with risk assessments although recording of behaviours could be better. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 12 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. People who use services are supported to make choices about their life style, and supported to develop their life skills in accordance with individual capability. Social, educational, cultural, recreational activities meet individual’s expectations. EVIDENCE: The service has commitment to enabling people who use services to develop their skills, these supported through activities that including residents having a degree of meaningful occupation including such as housework and cooking. Many of the residents are involved with day placements at Adult training centres (ATCs). The home allows residents to participate in daytime activities that are of their own choice and according to their individual interests and capability, although Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 13 the acting manager did state that where residents have difficulty communicating their choices they are able to make clear if they do not wish to participate through such as behaviour. Where appropriate education and occupation opportunities are encouraged, these supported and promoted with access to such as the aforementioned ATCs and colleges. There are however some residents that due to age and frailty have a lesser involvement with activities limited by their ability and choice. Where residents are able they can usually access and enjoy the opportunities available in their local community, this sometimes dependent on staff availability. Resident’s involvement in activities was seen to be documented by staff and residents meetings (minutes available on resident’s notice board) were seen to include discussion in respect of preferred activities, as well as menus and involvement. All residents responding to CSCI questionnaires confirmed that they were able to do what they wished at any time of day, this confirmed by discussion with some of the residents at the time of the inspection. The home encourages residents to maintain important personal and family relationships, the majority of relatives responding to questionnaires confirming this was always or usually the case. The majority also stated they were kept up to date with important issues. The home is also proactive in seeking the views of relatives through annual quality assurance questionnaires. It is evident that the staff have worked with residents to develop their communication skills. This includes use of such as PECs where staff have worked with a speech therapist who in the last consultation with a resident made positive comment as to the staffs contribution. Discussion with staff evidenced they were well aware of the strategies detailed in documented guidelines in respect of PECs. Staff have also had training in basic signing. Residents are involved in the domestic routines of the home dependent on their individual capabilities, and residents where seen to be working with staff in cleaning their rooms. Residents have some involvement in meal preparation, and the home was seen to have a varied menu that includes alternatives for residents with specific dietary needs. The home has developed a pictorial book of all the meals available, these photographs of meals prepared at the home. This supplements a menu that is available in large print. Meals are balanced and nutritional and cater for varying choices and preferences, with individual care plans picking up on areas where there is specific dietary need. Staff were seen to be available to the residents at meals times in case assistance should be needed. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The staff at the home promote the principles of respect, dignity and privacy. The home recognises the right of the individual to control their medication where able and the homes policy/procedures and practice in respect of medication are with a few exceptions satisfactory. EVIDENCE: Discussion with some residents that were clearly able to express their views indicated that they were satisfied with the service and the way that care was provided by staff, this confirming comments from questionnaires where four out of the five relatives responding indicated that staff always gave the support expected to residents. All residents responding to the questionnaires stated that staff treated them well with comment from relatives stating that staff treated residents as ‘adults’ and that they had ‘the best interests’ of residents as a priority. The interaction observed between staff and residents at the time of the visit of the home was also seen to be appropriate. The aims and Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 15 objectives of the home were found to reinforce the importance of treating individuals with respect and dignity. Personal healthcare needs including specialist health and dietary requirements are recorded in each resident’s plan giving a clear overview of their health needs, and detail how the home intends to address these. Care plans were seen to document how the home will meet specific health needs such as diabetes with detail as to how this will be monitored, and the actions that staff will take when issues arise. The acting manager was however advised to consider use of tissue viability and nutritional assessments to highlight these areas for residents who were becoming frailer due to age. Resident’s access to healthcare and remedial services was seen to be clearly documented and it was stated that those residents who are fit and well enough are encouraged to be independent and have regular appointments at their local health care services. Where residents are not well enough the home will request visits from local health care services. Staff have access to training in health care matters and are supported to attend in house training given by appropriate health care specialists, an example of which was a session on epilepsy. The staff are involved in the use of blood monitoring machines to monitor the blood sugars of a diabetic resident. It was stated that guidance in the use of these had been provided by district nursing staff, although there was no documentary evidence of this, such as confirmation from the trainer stating staff are competent. Discussion with staff did indicate that they were aware of how to carry out this invasive practice with care however. The home has an appropriate medication policy supported by procedures and practice guidance, signed by staff. These underline the importance of allowing residents to self medicate where possible although there was no documentation to show that they consented to the home administering their medication as none fully self medicate. Two residents self medicate, although this is only when they take medication with them to day placements, this underlined by risk assessments. Medication records were seen to be fully completed, having required entries, with one exception where there was no corresponding signature from the G.P. when there was a change in medication due to one resident having a short course of antibiotics. It was also noted that there was no list of staff that administer medication in the MARs (medical administration records) with copies of their signatures, as they would appear on the MARs sheets, as should be the case so as to allow easy crossreferencing. Quarterly checks on the homes medication systems are carried out by the contracted pharmacist, issues identified at the last visit seen to have been addressed. The home does not currently hold controlled drugs although a controlled drugs book and policy is available should it be needed. Staff that administer medications have received the appropriate accredited training. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are generally well protected from abuse. EVIDENCE: The service was seen to have a complaints procedure that was available in written and alternative formats, this on display in a prominent place in the home and accessible to all the residents and visitors. Residents confirmed that they were aware of how to make a complaint although stressed that they did not have any. Residents also stated that staff listened and responded to what they said. Whilst only half of the relatives that responded to questionnaires stated they were aware of the homes complaints procedure the majority stated that the home listened and responded to comments that they made. In addition to the staff having a positive view of any comments that the home may receive there are annual quality assurance questionnaires sent out to relatives to glean comments as to their views of the service and any areas where they may see the potential for improvement. Whilst there was no record of the home having received any recent complaints the manager stated that records of complaints would be kept and that unless there were exceptional circumstances the service would respond within the agreed timescale. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 17 The policies and procedures for Safeguarding Adults were available on request and contained clear specific guidance that staff when asked understood, this evidencing that the regular training of staff in protection is effective. The procedures for the local social services department were readily available to staff for reference. Whilst there has not been any recent referrals in respect of adult protection the homes recently revised procedures set out or refer to local authority procedures in respect of how they would attend meetings or provide information to external agencies when requested. There would seem to be a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The homes policy on physical intervention and restraint has been reviewed since the last inspection and states that staff would not use restraint unless staff are trained. As no staff are trained this would indicate that the staff use no physical restraint, this confirmed by the acting manager and other evdience. The policy does not however fully explore more subtle issues of restraint due to such as potential use of medication, and other limitations that may arise (for example some residents would need staff to assist them to go out and this sometimes needs to be planned to fit in with the staff rota). There are potentially some issues around some residents behavioural patterns at present, and the home does not have a robust system for the recording of these, and comment from staff indicated some confusion as to whether a resident’s behaviour was becoming more challenging or not. The use of such as an ABC chart to evidence patterns of behaviour over set periods of time would assist the home chart potential triggers to such behaviour, and also possibly assist them when requesting support from health professionals as they would have ready evidence to hand. The acting manager was also advised to use such as body maps on a regular basis to document any marks on residents due to promoting independence, accidents, self-harm, pressure areas so that the potential for any unexplained injuries is reduced. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 18 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, 25, 26, 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and for the majority a safe environment. The environment to a degree compromises the needs of one resident, this recognised by a provider who is looking for a suitable solution that tackles this issue without compromising the independence of other residents. EVIDENCE: The home provides a physical environment that tries to meet the specific needs of the people who live there, although there are some difficulties due to one residents becoming frailer and having difficultly with such as getting in a standard bath. There was evidence that the provider is trying to establish suitable adaptations to meet these needs however. Overall the home is comfortable, and there is evidence that there has been on-going maintenance. The upstairs bathroom presented as needing replacement (as badly stained) though. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 19 People who use services are able to personalise their rooms, this evidenced by discussion with them and sight of their bedrooms. They stated that they were comfortable at the home and liked their rooms with some stating they choose the décor, especially for their own bedrooms. Where able residents were seen to have keys to their bedroom doors, although did not have lockable storage, although when asked they stated that this was something they did not want. En-suite facilities are not available, although none of the residents expressed any concerns in respect of this matter, and toilets are available of each floor of the house. People who use services are not always able to have the option of a single room although two residents that shared expressed satisfaction with this arrangement. The other residents that shared were unable to express a clear view as to their choice and there was no documented discussion with representatives as to this arrangement. The radiators around the home were all covered (to prevent access to hot surfaces) and the environment was found to be warm with hot water accessible at differing times during the course of the visit. Discussion with the resident in room 6 did indicate that the change of the light fitting, or movement of the same may assist in providing a better spread of light in the room, this as at present it is sited to one side of what is a spacious area. There are arrangements in place to prop open a resident’s bedroom door at night to aid her mobility and access to the toilet. Whilst the reasoning for this is understood the propping open of a fire door is not advisable and alternative methods for holding the door open that should be explored in discussion with the fire prevention officer. This arrangement also needs to be detailed in the homes fire risk assessment, Comment from residents, relatives and observation during the course of the visit evidenced that the home was clean and tidy, and there was no evidence of any unpleasant odours. The home was seen to have infection control procedures with reference to contact with the health protection agency as required. There have been no recent outbreaks of infection at the home. The manager or senior carry out a risk assessment of building room by room, this last completed in September 2006. The acting manager was advised to carry this out more frequently and to consider the implications of an ageing resident group. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 20 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. Staff at the home are trained, skilled and usually in sufficient numbers to support the people who use the service. Whilst the homes recruitment procedures support resident protection, the recruitment practices of the home have been seen to compromise these. EVIDENCE: The home has minimal staff turn over meaning the staff team is stable, with some staff having worked at the home, and with the residents for a number of years. Those staff spoken to were enthusiastic and knowledgeable as to the residents needs, this evidencing that they knew residents and their needs well. Interactions observed between staff and residents during the course of the visit were positive, with residents supported with sensitivity and respect. Daytime staffing varied between three staff at busier times and two staff when the majority of residents were at day placements. Staffing is sometimes provided on a planned basis to support residents to access the community, for instance shopping outings. At night there is one staff member who undertakes Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 21 a waking night shift. The home does not employ separate ancillary staff although there was evidence that the residents are involved with staff in the cooking and other domestic routines within the home, and as such these would be seen as a normal part of the carers role in promoting their independence. Based on the staffing hours the home needed from assessments carried out by Birmingham social services the previous year there would appear to be a minimal shortfall in the hours provided (there were 300 staff hours provided the week prior to inspection against assessments indicating the optimum would be 340 hours per week). The provider and acting manager in discussion were aware of this and have demonstrated that since the last inspection that they are pursuing reassessment for residents whose needs are increasing, and also increased funding to allow improved provision. Residents spoken to about staff were positive as to how they were treated although some relatives did comment that they had some doubts as to how well residents understood staff. This did not however present as an issue from observation during the inspection. The service clearly recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards. The acting manager is aware that there are some gaps in the training programme and in discussion highlighted these and how she planned to deal with them. Training of staff has continued since the last inspection including involvement in seizure awareness training and there was clear evidence of staff having training in other areas that were service specific (i.e. makaton, signing and diabetes). There is over 50 of the staff team with NVQ level two or higher. Induction training for staff was documented although the way in which this was recorded could be improved to better evidence how inductions are cross-referenced to national common standards, and learning disability award frameworks. Staff spoken to were clear regarding their role and what is expected of them, and all staff were seen to have signed key procedures indicating that they had read and understood them. The service has a recruitment procedure that meets the Regulations and the National Minimum Standards although there were issues identified when the files for recently recruited staff were sampled. The home was not in receipt of a disclosure for the one staff member (although a POVA check had been completed) and there was no risk assessment in place to detail how employing staff without a disclosure could be managed to reduce risks to residents. In addition there was only one reference available for the one member of staff. The homes procedure stated that staff would not be employed without the home receiving a disclosure prior to employment. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 22 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, 41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home considers the views of stakeholders within its developing quality assurance systems. There are some specific areas where record keeping could be better, this to protect residents rights and interests. EVIDENCE: The home still does not have a registered manager; this having been the position for some time and the current acting manager has yet to apply for registration. In discussion the acting manager did state that she is currently completing her nurse training and as such is accountable through the Nursing and Midwifery Councils code of conduct. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 23 The acting manager is supported by an experienced provider who in discussion was clearly aware of keys areas where the home performed well and where improvements could be made. Comments received indicated that the staff knew their jobs and carried these out well, with equality an integral part of the way the service was delivered. The acting manager expressed a clear commitment to run a service that is user focused, taking account of equality and diversity issues, and wanting to work in partnership with families of people who use the service. The home aims are clearly set out in its Statement of Purpose. There was evidence that the acting manager and staff are improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. The home was seen to have a checklist that covers how the home is to meet the expectations of the national minimum standards, senior staff currently working on this. The home does not have an annual development plan although the completion of its self-assessment prior to drawing this up would be necessary. The service has recently sent out questionnaires to relatives and the acting manager related the findings of these to areas where improvements were planned. It was pleasing to hear from staff and the manager that the provider is available and approachable and is keen to hear their ides and suggestions for the service. The home was seen to have a policies and procedures file that staff have signed, this found to be well organised with specific policies easy to find. Whilst these policies/procedures have been reviewed recently they were not signed or dated by the provider (to clearly show acknowledgement of the stated policy), this in the absence of a registered manager. Records in respect of resident’s monies in safekeeping were in one instance found to be inaccurate, this stated to be due to the fact that money withdrawn had not been entered in at the time withdrawn leading to the inspector finding a minor discrepancy in the monies kept. In addition the practice of having two persons sign the monies out was haphazard and there was no inventories of residents property seen in individual files. It is preferably that the one person is the appropriate resident but where this is not possible it must be a 2nd member of staff. Development of a more robust procedure in respect of record keeping in respect of resident’s monies would be advisable. The provider and acting manager are aware of the need to promote safeguarding and have developed a health and safety policy that generally meets health and safety requirements and legislation. Senior staff carry out an environmental audit, the last in September 2006, although more frequent reviews of this would be beneficial. In addition the review of the fire risk assessment so as to take account of bedroom doors been left open at night would be advisable. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 24 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 X 5 2 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 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X 2 3 X Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 25 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 12(1)(a) 15 Requirement The registered provider must ensure that there is clear evidence of residents involvement within the care planning process this through signature on plan, documentation of discussions with residents, documented minutes of multi disciplinary meetings agreeing care plans and such like. The registered provider must ensure that where there is a change to the medication regime for a resident there is clear documented proof that this has been authorised by the appropriate G.P. or similar. The registered provider should ensure that the staff better document instances of potentially challenging behaviour so as to assist with evidencing triggers and to support any request for professional health care assistance. The registered provider must locate and fit suitable bathing aids for one resident. The registered provider must DS0000065681.V348730.R01.S.doc Timescale for action 31/10/07 2. YA20 13(2) 30/09/07 3. YA23 13(1)b 14(2) 30/09/07 4. 5. YA29 YA34 13(1)(b) 23(2)(n) 19 31/10/07 30/09/07 Page 26 Loretta House Version 5.2 6. YA37 8(a)(b) 10(1) 7. YA41 17(2) ensure that all required recruitment checks (as detailed within the care Home regulations 2001) for new staff are carried out prior to employment so as to fully protect residents. The provider must ensure that the Central Registration Team receive an application to register a manager, this to formalise on site management arrangements for the home. The registered provider must ensure that any monies taken out of a resident’s safe keeping account are documented at the time this occurs and that the transaction is verified by a minimum of two persons consistently. In addition inventories of all residents property must be documented and reviewed at a suitable frequency. This practice will protect the interest of service users. 31/10/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA3 Good Practice Recommendations The registered provider should contact the social services office responsible for funding arrangements and pursue the need for residents to have at least annual multidisciplinary reviews of residents care. The registered provider should review resident’s contracts when there has been a change in the level of funding. The registered provider should list the names of staff responsible for the administration of medication against their signatures and initials, as they would appear on MARs sheets. DS0000065681.V348730.R01.S.doc Version 5.2 Page 27 2. 3. YA17 YA20 Loretta House 4. 5. YA20 YA19 6. YA23 7. 8. 9. YA27 YA26 YA35 10. YA42 The registered provider must ensure that the home has evidence that residents consent to medication. The registered provider should obtain evidence of staff competence (from the district nurse providing guidance or similar) in taking blood samples to monitor diabetic’s blood sugars. The registered provider should introduce the use of body maps to document any injuries or marks to residents due to such as promoting independence, accidents, self harm or tissue breakdown so as to better avoid the potential for unexplained injuries. The registered provider should change the stained upstairs (1st floor) bath to provide a more attractive bathing facility for residents. The registered provider should revise the lighting in Bedroom 6 to provide a better spread of light in keeping with the occupant’s wishes. The registered provider should improve on the documentation of the induction of new staff to fully evidence involvement in all common induction standards and the learning disability award framework. The provider should instigate more frequent reviews of the homes environmental review/assessment, this to include any relevant changes that impact of fire precautions. Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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. Extracts may not be used or reproduced without the express permission of CSCI Loretta House DS0000065681.V348730.R01.S.doc Version 5.2 Page 29 - 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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