CARE HOME ADULTS 18-65
Mrs Linda Nicholls 573 Chester Road Castle Bromwich Birmingham West Midlands B36 0JU Lead Inspector
Justine Poulton Unannounced Inspection 20th October 2005 10:15 Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 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 Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 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. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mrs Linda Nicholls Address 573 Chester Road Castle Bromwich Birmingham West Midlands B36 0JU 0121 240 7786 0121 240 7786 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) Mrs Linda Nicholls Mrs Linda Nicholls Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th February 2005 Brief Description of the Service: 573 Chester Road is registered as a Care Home for Younger Adults, providing care and support for no more than five people with Learning Disabilities. Mrs Nicholls is the owner of the service and is also registered as the Manager. The home is a detached 5 bedroom family house on a main road on the border of the Castle Bromwich and Smiths Wood areas of Birmingham and Solihull. The residents benefit from single bedroom accommodation and receive care and support within a domestic living environment. Local shops and amenities are a short distance away, and a local day centre is within walking distance. The main shopping area of Chelmsley Wood is a short drive away. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday and was carried out from 10:15am until 17:30pm. The residents, manager and deputy manager co-operated fully with the inspection. A total of 18 standards were inspected on this occasion of which 6 had shortfalls. Of the 22 requirements made at the previous inspection 19 have been met, 2 have been carried forward to this report as they were not met and one was not inspected on this occasion. Three of the residents were at home for all of the inspection and were spoken with informally. The manager and deputy manager were available during the inspection. In addition to this, records, files and policies and procedures were also inspected. The inspector would like to thank the residents, manager and deputy manager for their co-operation and hospitality during the inspection. What the service does well: What has improved since the last inspection?
The manager has worked hard since the last inspection to meet all of the requirements made. Out of 22 requirements 19 have been met with only 2 outstanding. Comprehensive documentation is now available for prospective residents informing them about the home, all residents now have their own bank accounts, an exploration into the possibility of a medical condition for one resident has been undertaken, all foods are now stored safely in line with food hygiene guidelines, the manager has ensured that she has been involved in all care planning and reviewing for one particular resident undertaken by Solihull Social Services and most health and safety issues identified have been addressed. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 6 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. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 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 Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Information about the services and facilities in this home are available for prospective residents when making a decision about whether the service will be able to meet their needs. EVIDENCE: The home has a Statement of Purpose in place, which provides information, which would give prospective residents a good insight into what the home provides. A service user guide has also been compiled. Both of these documents use pictures and symbols as well as text, ensuring that they are accessible to a wide range of people. No new residents have been admitted to the home since that last inspection therefore standards 2, 3 and 4 are deemed to be not applicable on this occasion. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Development in the care planning system provides adequate information for carers to satisfactorily meet residents needs. The inclusion of dates and signatures will confirm that information is current and accurate. Carers have an understanding of the individual risks to residents. EVIDENCE: The registered manager and deputy manager have undertaken work to produce residents support plans in a new format. Two of these were looked at alongside the current plans in use. Information available was comprehensive and informative, however in the new plans there were no signatures, dates or review dates. Risk assessments have been compiled within the new plan format alongside each area of care identified. These include areas such as personal care support, medication, daily routines and communication. Although the information within these assessments is brief, it advises of the risks and any action that is to be taken to alleviate them. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 10 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 and 14 People living in this home have opportunity to live ordinary and meaningful lives appropriate to their needs. They are supported and enabled to be part of the local community in which they live. EVIDENCE: Evidence was available within the files looked at and through discussion with the registered manager, deputy manager and residents to confirm that the residents are offered age, peer and culturally appropriate activities. Although the residents that were at home had limited verbal communication, all three answered positively when asked if they got to do things that they enjoyed. Two residents are afro caribbean, and the registered manager has arranged for an afro caribbean cook to come into the home twice a week to do specialist cooking with them. An evangelical type church service has also been found, that the manager said they appeared to enjoy going to, and are always ready when the church volunteer arrives to collect them on a Sunday morning. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 11 Three of the residents go to a local college for part of each week, where they participate in courses such as internet and e mail, small animal care, gardening to attract wildlife; and textiles, collage and clay. In addition to this two of the residents attend a local day centre for the remainder of the week. Two residents attend a local day centre for all of the week and one resident spends two days at home when he is not at college. Hobbies and interests detailed within the support plans looked at include listening to reggae, dancing, computers, eating out, going to zoo’s, visiting country parks and watching football. All five residents also attend three evening clubs during the week. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 12 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 and 20 Personal support in this home is offered in such a way as to promote residents privacy, dignity and independence. The current system for medication management does not completely ensure residents safety. EVIDENCE: Information on the support required to meet personal care needs was available for all of the residents. This is wide ranging, with one resident being totally self caring through to quite high levels of support for another. Two residents have en suite facilities appropriate to their needs, whilst the other three share a ‘family’ bathroom. The manager stated that personal support is provided as necessary in private. None of the residents currently administer their own medication. Medication is supplied to the home by a local pharmacy in dosset boxes, which are checked by the deputy manager. The home has produced its own medication administration records. On the day of the inspection it was noted that one resident was taking a medication that was not on the record sheet. This was discussed with the manager and was rectified following a call to the residents GP to confirm that the medication was still prescribed. All staff are currently undertaking a Safe Handling of Medications course through Solihull College. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 13 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): 23 The policies and procedures in place for the protection of vulnerable adults provide a safe environment for the people living in this home. EVIDENCE: The home has a policy in place for the protection of adults from abuse. This has been reviewed by the manager since the last inspection and is now a comprehensive, informative document. Both the manager and the deputy manager said that there have been no allegations of abuse made to the home. Staff have undertaken abuse training via their NVQ qualifications. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 14 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, 25, 27, 28 and 29 The appearance of, and facilities within this home creates a comfortable and homely environment for the residents. EVIDENCE: The home is a five bedroomed detached family house. Up until recently it was the family home of the registered manager. The accommodation is domestic in style, decorated nicely and has good quality furniture and soft furnishings. Three residents bedrooms were looked at during the inspection. These were also found to be nicely decorated, and contained plenty of evidence of personalisation in the form of pictures, ornaments and photographs, along with collections such as cars and vehicles. Two residents bedrooms have ensuite shower rooms. The home also has a family style bathroom upstairs and a separate toilet downstairs for use by the residents. A large lounge, conservatory and kitchen are available for shared use by the residents. Throughout the inspection residents were able to make use of these spaces freely to engage in any activity of their choosing. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 15 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): 34, 35 and 36 Residents are being supported by a small, committed staff team who understand their needs and wishes. The recruitment policy and procedure must be more robust to ensure that residents are protected from harm by the people caring for them. The lack of staff supervision leaves residents vulnerable to potential risk to their health and well-being. EVIDENCE: The home employs a small staff team of four, including the registered manager and deputy manager. The registered manager said that she has taken on three additional staff but they have not commenced work as yet as they have not had a Criminal Records Bureau (CRB) check. Inspection of the staff files evidenced that the manager has not sought a Criminal Records Bureau check for any member of staff employed by the home, and has relied on disclosure certificates obtained by previous employers where they were available. It was advised that this was because the manager did not know where to go to get the applications countersigned. This was discussed with the manager. Photocopies of identification documentation was available for three staff members, as were two written references. A completed application form was also available for two staff. Not all of the files contained copies of terms and conditions of employment. Two members of staff have completed their NVQ II awards. The registered manager and deputy manager have also completed their NVQ III and Registered Managers awards.
Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 16 All staff are registered with Solihull College for training in Food Hygiene, medication administration and infection control. The registered manager stated that the new staff will be registered on the Learning Disability Awards Framework when they commence employment. A requirement from the previous inspection was for all staff to receive supervision six times a year. There was no evidence available to confirm that this requirement has been met. The registered manager stated that as yet she is not carrying out supervision with staff in line with national minimum standards. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 17 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): The lack of testing of fire detection equipment and routine fire drills leaves residents and staff vulnerable to potential risk to their health and well-being. EVIDENCE: A requirement of the previous inspection was for fire drills to be carried out in the home every 6 months. The registered manager stated that this has not been undertaken as yet. There was also little evidence to confirm that the fire alarm points are tested on a weekly basis. No other standards were inspected on this occasion. Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x 2 3 1 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Mrs Linda Nicholls Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x DS0000004553.V261977.R01.S.doc Version 5.0 Page 19 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 YA6 Regulation 15(2) Requirement The new care plan documentation requires signing and dating. Review dates require including. The manager must ensure that the Medication records are accurate, and include all medication prescribed to residents. Maintain the temperature of the water in the bathroom and toilets at 43oc. (Not inspected on this occasion) Criminal Records Bureau checks must be obtained for all staff employed by the home. All staff files must contain the information specified in Schedule 2 and Schedule 4(6) of the Care Homes Regulations 2001. Staff must be provided with formal, recorded supervision at least 6 times per year. (14/03/05, not met) Timescale for action 31/01/06 2 YA20 13(2) 20/10/05 3 YA24 13(4) 31/01/06 3 4 YA34 YA34 19 sch 2(7) 19(1)(b) 31/12/05 31/12/05 5 YA36 18(2) 31/12/05 Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 20 6 YA42 23(4)(c)(iv) Fire drills must be carried out (e) every 6 months. (14/03/05, not met) Fire alarm points must be tested on a weekly basis. Records must be kept. 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Birmingham Office Ladywood House 45-56 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 Mrs Linda Nicholls DS0000004553.V261977.R01.S.doc Version 5.0 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
