Inspection on 17/01/07 for Natalie House

This inspection was carried out on 17th January 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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Natalie House 03/11/08

Natalie House 05/12/07

Natalie House 17/11/05

Natalie House 23/06/05

Natalie House 18/03/05

Natalie House 25/05/04

Natalie House 27/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

r CARE HOME ADULTS 18-65 Natalie House 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG Lead Inspector Amanda Lyndon Key Unannounced Inspection 17 January 2007 09:50 Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Natalie House Address 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG 0121 457 9592 0121 457 9592 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) Not known Alphonsus Homes Ms Novelet Stewart Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 17th November 2005 Brief Description of the Service: Natalie House is registered to provide accommodation, personal care and support for five adults with learning and physical disabilities. It is situated in a quiet residential area on the edge of the Lickey Hills in Rednal, Birmingham. It is close to public bus routes and the shopping centre at Rubery is nearby. The property is a purpose built bungalow, first opened in 1991 and is furnished and decorated to a good standard. It is specifically designed to meet the needs of people with learning disabilities, who may also be physically disabled with the exception of the existing spa bath which is not suitable for people with physical disabilities. Staff are available to provide assistance with bathing as required. Each single bedroom has en-suite facilities, including level entry shower and hand wash basin. Bedrooms are decorated in homely and appropriate styles. There is a comfortable lounge and a separate dining room. There is a well equipped kitchen, laundry and office. The garden is enclosed and private, including lawn and patio areas and is suitable for wheelchair users. There is limited off-road parking at the front of the building. Smoking is not permitted for residents or staff within the Home. There is a comprehensive and interesting in-house and external activities programme. A copy of the most recent CSCI inspection report is available in the Home. The weekly fee to live at Natalie House is between £1000 and £1400. Items not covered by the fee include outings, personal toiletries and clothing and other leisure pursuits. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of a one day unannounced field work visit undertaken by one Inspector when there were five residents living at the Home. On the day of the visit all of the residents left the Home mid morning to pursue their leisure activities. The Inspector met all of the residents however the communication support needs and level of learning disability of all of the people living there made it difficult to seek their views directly. All residents had lived at the Home since it opened in 1991, with the exception of one resident who had come to live there in 2003. There were no visitors at the Home on the day of the visit. It was evident that there was a family atmosphere at the Home and the living environment on the day of the visit was found to be calm and relaxed. Information was gathered by speaking with the Registered Manager, three staff members, the visiting Physiotherapist, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. Prior to the field work visit the Registered Manager had completed a pre inspection questionnaire, giving some information about the Home, residents and staff which was taken into consideration. No service satisfaction questionnaires had been completed therefore the Registered Manager was arranging for these to be distributed to relatives after the visit. No immediate requirements were made on the day of the visit. Following the visit CSCI received a letter from the parents of one resident living at Natalie House and this contained much positive feedback about the care and support provide to residents by the staff team, the comfortable living environment and services provided at the Home. What the service does well: Prospective residents are encouraged to spend time at the Home in order to sample what life would be like to live there. Health care is good and residents are cared for in a respectful manner by staff working at the Home. Residents are encouraged and supported by the staff team to maintain their independence based on their individual abilities and interests. Residents can choose to do the things that they enjoy each day. There was a family atmosphere at the Home and a good rapport had been built up between residents, staff and their visitors. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 6 Residents are supported to continue to practice their chosen religions whilst living at Natalie House and this ensures that their beliefs and individuality are respected. Residents are involved in food shopping trips so that they participate in the weekly menu planning. Residents families are provided with opportunities to put forward any suggestions for improvements to the service provided at Natalie House. Residents are provided with a clean and comfortable living environment and are encouraged to personalise their bedrooms so that they feel comfortable in their surroundings. Staff turnover is low and this ensures continuity of care for residents. Staff have a good understanding of the residents’ complex communication needs in order for their needs and wishes to be expressed. The management team are approachable and friendly. Staff are well supported by the senior staff and management team and this ensures that they have the confidence and support to work in a competent manner. There are regular maintenance checks and servicing of most of the equipment used at the Home and this ensures that they are safe to use. What has improved since the last inspection? Care plans identified the specific support required by staff in order to meet residents’ individual care needs based on their abilities and preferences in respect of their daily lives. Residents’ care needs are reviewed regularly with the involvement of residents’ families. Risk assessments are undertaken so that residents are supported to lead safe and fulfilling lives based on their individual abilities. Individual activity plans had been written and included detail of residents’ individual interests. Picture aids had been introduced to assist residents in conveying to staff their needs and preferences in respect of their daily lives. The majority of residents’ bedrooms and the lounge and dining room had been redecorated and residents and their families were involved in this so that they felt comfortable in their surroundings. The Home is regularly monitored for quality. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 7 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. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 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 Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 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): 2&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process is thorough and prospective residents and their families have enough information to make informed decisions about whether Natalie House would be an appropriate choice for them. EVIDENCE: There had not been any new admissions to the Home since 2003. The Registered Manager stated that the admission process was thorough and included a number of visits in order to meet prospective residents in their own surroundings and trial visits at Natalie House. The last person who had come to live at Natalie House was encouraged to visit the Home on three occasions prior to admission in order to sample what life would be like to live there. Pre admission assessments of prospective residents’ individual care needs were undertaken to ensure that these could be met whilst living at the Home. The Registered Manager stated that much consideration is given to the suitability of any new residents coming to live at the Home with regard to how well they would fit in to life as part of the small resident group there. Residents come to stay at the Home on a “settling in” period and on completion of this a social care review is undertaken involving the resident, their relatives, Home’s staff and the Social Worker. This provides all involved Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 10 with the opportunity to discuss whether the resident’s care needs were being met at the Home and whether they wished to remain there. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 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 in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to maintain their preferred routines in respect of their daily lives and are supported to lead safe and fulfilling lives. The current system for the monitoring/auditing of residents’ monies and the lack of information included in fee/transport invoices may not safeguard residents or staff. EVIDENCE: On admission to the Home comprehensive assessments of residents’ individual care needs were undertaken and care plans were derived from this information. These are written plans that outline the care and support required by staff in order to meet the residents’ needs whilst living at the Home. Care plans included good detail of residents’ preferred routines in respect of their daily lives so that these could be maintained whilst living at the Home and identified ways to promote residents’ independence. Care plans identified the support required by staff in order to ensure that residents’ maintained links with those people important to them. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 12 These were reviewed every six months with the involvement of residents’ families as appropriate, however these must be signed by all involved in the review as evidence of this involvement. Due to the complex care needs of the residents living there, none of the residents were able to bathe independently or go outside of the Home on their own as their personal risk assessments had identified that this would not be appropriate or safe. Other personal risk assessments undertaken included the risk of residents choking, developing sore skin, falling out of bed, the use of bed safety rails, travelling in the minibus and any social/leisure activities that were arranged. This was in order to minimise any risks identified whilst encouraging residents to lead fulfilling and safe lives. Although comprehensive risk assessments had been undertaken the staff team had not had training in this area and it is recommended that this be arranged. Staff met during the visit had a good knowledge of residents’ individual care needs including any trigger factors that may result in agitation and the specific support required by staff in order to reduce this. Due to the complex communication needs of residents and level of support required in this area, care reviews involving the key worker, management team and residents’ relative or representative were undertaken regularly so that individual resident’s care was evaluated and any suggestions for improvements regarding this were put forward. The minutes of care reviews undertaken identified that residents’ relatives were satisfied with the standard of care provided. Residents were encouraged by the staff team to make decisions regarding their daily lives based on their individual abilities, for example when choosing what to wear or eat. Picture aids had been produced in order for residents to express their preferences in respect of the food that they would like to eat, activities that they would like to participate in and how they were feeling that day. None of the residents living at the Home had the ability to manage their own finances however they were encouraged by their key workers to choose and purchase appropriate items out of their personal monies as needed in order to promote their independence and individuality. The Registered Manager stated that she was the appointed agent for four residents living at the Home and this had been a longstanding arrangement. A secure facility for the safekeeping of small amounts of residents’ money was provided at the Home. A sample check of two residents’ financial records was undertaken. Money held balanced with the account, and receipts and items were available to verify expenditure. Individual inventories of residents’ personal belongings and valuables were kept however not all of these were up to date. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 13 The Registered Manager was unable to state the actual fees charged to residents in respect of their accommodation and transport costs as their monthly invoices for these charges did not identify the actual breakdown of costs and this may prevent any errors in charges from being detected and does not safeguard residents. Whilst it is not considered to be ideal that the Registered Manager is appointed agent for the four residents, if no independent agent is available, regular auditing/monitoring of residents’ finances must be undertaken by an independent source in order to safeguard both the Home’s management team and residents. Care records were stored securely in order to maintain residents’ confidentiality. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 14 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 in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities provided meet the needs and expectations of all residents living at the Home. Residents are provided with a choice of healthy meals that meet any special dietary requirements. EVIDENCE: Residents participate in a range of activities based on their interests and abilities including aromatherapy, hydrotherapy, shopping trips, a light sensory room and discos and are encouraged to participate in house hold tasks and cooking with the full support of staff. Staff record and monitor the success of activities provided and ensure that residents don’t participate in an activity that they don’t enjoy. For example three residents began horse riding and staff observed that it was evident that one resident was not benefiting from this so an alternative activity was introduced for this person. It was pleasing that a separate individual activity programme had been devised for each resident based on their individual interests and abilities. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 15 Staff are provided to support residents on an annual holiday and although this was not possible last year due to staff shortages, the Registered Manager stated that a holiday may be arranged this year for residents who are interested. Interesting photographs of activities enjoyed by residents were available in photograph albums in the Home. Natalie House has a minibus and designated drivers to ensure that residents have the opportunity to participate in activities outside of the Home. Residents visit the hairdressers regularly and all residents appeared to be well supported in respect of grooming on the day of the visit. Opportunities for worship for residents of all faiths could be arranged however none of the residents currently living at the Home had expressed an interest in this. None of the residents attend college or work placements and the Registered Manager stated that this may be something of interest for one resident living at the Home and would be pursued further. Residents are supported by the staff team to maintain links with their families and it was apparent that a good rapport had built up between the family of one resident and the staff team in particular. Staff support one resident to visit her mother as she has not been well recently and could not visit Natalie House. There were no rigid rules or routines at Natalie House and it was evident that the staff encouraged the residents to choose how they spent their day, within the limitations of their disabilities and this ensures that their individuality is maintained. The kitchen was well equipped, clean and had been refurbished a couple of years ago. There were ample stocks of fresh and frozen food at the Home on the day of the visit and these were stored appropriately with the exception of bread that had been opened and was not stored in an air-tight container or bread bin. A carton of custard had been opened three days prior and had been stored in the fridge without being covered. Menus identified a variety of healthy meals including home made dishes, traditional English meals and foreign dishes. A light meal is served for lunch and the main meal is served at tea time as this fits in with residents’ leisure activities and other commitments during the day. Residents were offered a choice of main meal each day and a “take away” meal was purchased on a Friday evening. A cooked breakfast was available on a Saturday morning and a roast dinner was prepared on a Sunday. Snacks were available at all times so that residents were not hungry. Special diets could be arranged for reasons of health, taste and religious/cultural preferences. Meals were liquidised for one resident living at the Home who has swallowing difficulties. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 16 Following recent training about healthy eating the menus were due to be revised with the involvement of residents. Residents accompany staff on food shopping trips so that they are involved in the menu planning for the coming week. It was noted that the dining table had been raised in order to accommodate a resident’s wheelchair however this may have resulted in the table being positioned too high for other residents to use comfortably, thus enjoy their meal and a review of this should be undertaken. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are good. Residents are cared for in a respectful manner and this ensures that their self esteem and dignity are maintained. The management of medication may not safeguard residents. EVIDENCE: Personal support care plans included good detail of the specific support required by staff in order to meet the residents’ individual care needs based on their abilities and preferences, for example during bathing and at meal times and it was evident that the timings of the personal care provided was flexible on a daily basis. All five residents were seen during the course of the day. It was evident that residents were well supported by the staff team to meet their personal hygiene needs and to choose clothing appropriate to their age, gender, culture and the time of year. Residents and staff appeared to be relaxed and comfortable in each other’s company and staff were supporting residents in a respectful manner. Health plans were written for any health concerns that individual residents may have and these included good information about the nature of the health concern and the support required from staff in order to manage and monitor Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 18 the particular condition. One resident was registered blind and his health plan identified that he would get agitated if the staff approached him without explaining what was happening. Staff training in this area had been provided and the agitation had now ceased as he was approached in an appropriate and sensitive manner, suitable for his needs. The Home’s staff had arranged for an occupational therapy assessment to be undertaken for this person to determine whether any aids would be beneficial to improve his daily life due to his poor eyesight. No residents living at the Home exhibited challenging behaviour. One resident had epilepsy and a detailed health plan was available for staff regarding the management and emergency treatment of this so that all staff knew what action to take in the event of an emergency. A written protocol was available in respect of the treatment prescribed in the event of a seizure and this had been signed by the resident’s Doctor. A health plan had been written in respect of a resident that has a longstanding problem of constipation. This gave good detail of the support required by staff to prevent constipation from arising and the treatment regime to be started if she became constipated, however did not state at what point the resident’s Doctor or District Nurse must be informed. There was evidence that the staff were monitoring this resident’s physical health so that any abnormalities could be detected. Residents were weighed regularly and there was evidence that the staff sought medical advice about any concerns that they had regarding this in order to ensure that residents were healthy. One resident appeared to have a very pale skin colour and the Registered Manager stated that she would seek medical advice about this in order to ensure that he did not have an underlying medical condition. Residents had access to a range of social and health care professionals including speech and language therapy, occupational therapy, general practitioners (GP), district nurses and dentists. There was a separate system for the recording of multi disciplinary input and the reasons and outcomes of GP visits was recorded. Daily reports gave good detail about visits form health and social care professionals however health care plans were not written for all short term health problems, for example when antibiotics were prescribed. Each resident had a “key worker”. This is a staff member who has the responsibility for overseeing their individual care needs. Staff had a good knowledge about the non-verbal communication methods used by individual residents in order to convey their needs for example by body language used or Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 19 verbal noises made. One resident was able to direct the staff using the limited speech that he had and the staff were able to understand this. One staff member said “ We act as advocates for the residents to ensure that they have whatever they need” The Home employs a Physiotherapist who works an hour each week with one resident living at the Home and it was evident that a good rapport had built up between him, the residents and staff. A record of his weekly visits was kept however this did not include detail of the actual input/care provided, any progress made and the reasons for the visits. Following assessment none of the residents living at the Home had the ability to self administer their own medication in a safe manner. All staff responsible for the administration of medication had undertaken training about the safe management of this in order to safeguard residents. Medication records were well maintained and there were generally robust procedures for the management of this. There was however some improvements required in respect of the management of medication. Medication is dispensed in a “cassette” style format and as a result of this it was not always possible for the Home’s staff to confirm that they were administering the correct medication, especially if the size and colour of tablets change. One medication that had been discontinued remained on the medication administration chart (although it hadn’t been administered) and this may result in it being administered in error. Liquid medication had not been dated on opening and the lunch time medication of a resident that was going to be out of the Home at that time had been left unattended in the care office. This must be stored securely to prevent it from being accidentally swallowed by another resident. Drug audits were not undertaken regularly and it is recommended that these be undertaken before and after medication rounds in order to assess staff competence in this area. Following Doctor’s advice, staff had purchased and administered non prescription medication for two residents and a written record of the administration of these was maintained. However, a policy had not been written in respect of the procedure to follow about this in order to safeguard residents. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 20 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 in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible to residents and their visitors. Systems are in place to protect residents from harm. EVIDENCE: Since the last visit CSCI had not received any complaints about the service provided at Natalie House and no complaints had been made to the Home directly. The complex communication needs of residents living at the Home meant that it was hard to assess fully if they considered that their views were listened to. However, staff try very hard to ensure that residents are as involved as much as possible, or as each person’s individual capabilities allow. All residents living at the Home had limited verbal communication skills and it was evident that staff provided the appropriate support to residents so that their care needs and wishes were listened to and acted upon. Residents’ families were provided with opportunities to raise any concerns that they may have about the services provided at the Home on the residents’ behalf. A comprehensive adult protection policy had been written and local contact details of relevant agencies to be notified in the event of alleged or actual abuse was available for staff to refer to. Staff had undertaken recent training about the protection of vulnerable adults. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With the exception of the bathing facilities, aids and adaptations are provided that meet the needs of residents living at the Home. Residents are provided with a clean and comfortable living environment in which they are safe and secure EVIDENCE: Natalie House provides a homely and well-maintained living environment for residents. It was well decorated and furnished throughout in a homely style. Photographs of residents were on display throughout the Home, promoting a family atmosphere. Most of the residents’ bedrooms had recently been redecorated in an appropriate style to reflect the gender, age, culture and interests of individual residents and some residents and their families had been involved in the choices made regarding this. Bedrooms contained residents’ personal possessions, ornaments and televisions and DVD players so that they felt comfortable in their surroundings. This provided them with a private area in which to spend some time instead of the main lounge if they chose. The lounge and dining room had been redecorated recently in a light and homely style. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 22 All bedrooms were for single occupancy and had an en suite toilet and hand basin facility. There was one communal bath and this included a spa facility, however this did not meet the needs of two residents living at the Home as their physical health had declined and they were not able to get in and out of the bath. Due to a physical disability, there was no facility for one resident to get undressed and dressed in the bathroom therefore was transported to and from the bathroom and bedroom wrapped in towels and this does not uphold her dignity. Staff do all that they can to ensure that this is carried out sensitively. On resident has a medical condition concerning the spine and would not be able to use a normal bath seat therefore specialist advice is required. The bath had also been identified as a health and safety risk to staff as the bath is positioned at a low fixed height so staff had to bend down to support the residents using the facility. This had been brought to the attention of the Home Owner during previous visits to Natalie House as a matter of serious concern. Natalie House is registered to provide care for people with physical disabilities however it is clear that the bathing facility provided does not meet the physical needs of all residents living there.. The Registered Manager stated that following the last CSCI visit, advice had been sought by the Physiotherapist employed by the Organisation about this and he had advised that the transfer hoist be used by staff to assist the two residents in and out of the bath and the staff team had been carrying out these instructions so that the identified residents were able to have a bath. Further independent specialist advice must be sought without delay as the hoisting equipment being used may not be fit for purpose and the risk of staff injuring themselves as a result of bending too low to support residents whilst they are in the bath and the lack of dignity for residents are still present. On the day of the visit the Registered Manager telephoned the Occupational Therapy team to arrange for an assessment to be undertaken. There was one transfer hoist being used regularly for a resident who was not able to stand and different sized slings were available for use with other residents should the need arise. One resident had a wheelchair and this had been measured and designed for this person’s specific use. Bed safety rails and protectors were used as deemed necessary following assessment and pressure relieving equipment was provided as required so that residents did not develop sore skin. One resident was provided with an adjustable height bed so that the health and safety of staff was protected when providing care for this person. An occupational therapy assessment had been undertaken in respect of obtaining a suitable chair for a resident who had experienced numerous falls out of her original arm chair. Since obtaining the new chair there had been no further incidences of falls for this person. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 23 The Home was clean, tidy and fresh throughout and there was a hygienic system for the laundry of residents’ personal clothing and bed linen in place. The garden was well maintained, secure and was suitable for wheelchair users. The Registered Manager stated that most of the residents enjoyed being in the garden in warmer weather and were able to access this as they chose. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 24 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, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The proposed weekend staffing levels will meet the needs of residents living at the Home. Residents are generally supported by an adequate number of appropriately trained and vetted staff. EVIDENCE: The Registered Manager stated that there were three care staff on duty during peak times of the day, for example first thing in the morning and during meal times, however the staffing rotas identified that this was not always the case at weekends. Remedial action had been taken about this and additional staff were due to commence employment at the Home so that the staffing levels were increased during weekends. Staff met during the visit stated that all of the residents living at the Home were at risk of choking on their food however they felt that the staffing levels were adequate to provide the appropriate support to residents at meal times. The management team work in addition to the care staff on duty and provide support and advice as required including an “on call” system. Two staff members are on duty overnight and staff confirmed that this was satisfactory in order to meet the needs of the residents living at the home. The staffing rota format did not identify the actual hours worked by each staff member therefore it was difficult to establish the number of staff on duty at any one time during day time hours. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 25 Staff turnover was low and agency staff are rarely used and this is important to ensure continuity of care for residents. It was apparent that a good rapport and trusting relationship had been built up between the residents and staff team. Care staff have a multi task role including providing personal care, preparing meals and supporting residents whilst participating in activities. Staff files examined included most of the information required by regulations and the Organisation had deemed that all staff working at the Home were safe to work with vulnerable adults. A reference had not been requested from the last employer of one staff member who had recently commenced employment at the Home, however two references had been obtained for this person. New staff undertake comprehensive induction training so that that they provide a good standard of care for residents. Staff had undertaken recent training relevant to their job roles including autism awareness, healthy eating and menu planning, epilepsy and equal opportunities. 15 of staff had achieved NVQ Level 2 care qualification, well below the recommended number of staff. Four staff were however, working towards this and three staff were working towards NVQ Level 3 Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 26 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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the residents living there. Staff are well supported to ensure that they have the appropriate knowledge to work in a safe and competent manner however the lack of training provided regarding moving and handling does not safe guard residents. EVIDENCE: The Registered Manager had been in post for the last five years and had an excellent knowledge of the individual care needs of the residents living at the Home and had built up a good rapport with residents, their families, visiting professionals and the staff team. She has an approachable and friendly management style which contributes to the homely atmosphere at Natalie House and is currently working towards the Registered Managers’ Award. Group meetings involving residents had been arranged in the past however the success of these were limited due to the complex communication needs of the residents living at the Home, therefore other ways of monitoring the service provided at the Home had been introduced. Service satisfaction questionnaires Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 27 had been distributed to residents’ relatives in order for them to put their views across about the Home. A new system for formal quality assurance was to be implemented in the near future, however the current system in place included Managers employed at other services provided by the Organisation visiting Natalie House to undertake in-house audits of the services provided there. A report of the findings of these had not been produced. Staff meetings were held regularly so that staff are informed about any new procedures or services provided for residents living at the Home. The minutes of the last meeting were not available at the home on the day of the visit. Quality monitoring visits are undertaken by Senior External Managers on a regular basis and there was evidence that the staff addressed any requirements made or suggestions put forward during these in order to improve the care provided. With the exception of medication that had been left unattended, any items deemed to be a risk to the health and safety of residents had been stored securely. Staff had undertaken recent training about health and safety issues including fire safety and food hygiene in order to safeguard residents in these areas. Accident records identified that two accidents had occurred involving the use of the hoist and it was noted that all of the staff required refresher training in this area. This was brought to the attention of the Registered Manager who stated that this was planned for the near future. A number of staff had undertaken training about first aid, infection control and health and safety and it was evident that plans were in place to ensure that all remaining staff attended future planned training in these areas. It was evident that individual support was provided for staff in respect of their individual training needs so that they had the appropriate knowledge to work in a safe and competent manner. It is recommended that an individual training needs matrix be completed so that each staff members’ individual training needs could be easily identified. Maintenance checks of equipment used at the Home are undertaken so that they are safe to use. An exception to this was that the transfer hoist was due to be serviced. Remedial action had been taken following the most recent Fire Officer and Environmental Health visits to the Home. Residents have access to the main kitchen in order to participate in daily living activities however the hot water temperature to the hand wash basin in this Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 28 area exceeded safe limits and must be reduced so that scalding accidents do not occur. Accident reports were written for all accidents involving residents however these did not identify any action taken or outcomes following the accident. These must be audited so that any trends in accidents are identified and so that measures to minimise the risk of further accidents of the same could be implemented. There was evidence that the appropriate professional advice was sought in respect of one resident who was experiencing frequent falls and measures had been introduced to reduce these. Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 29 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 Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 30 CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 1 28 x 29 2 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 2 x x 2 x Natalie House DS0000016731.V289084.R01.S.doc Version 5.1 Page 31 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 2 Standard YA6 YA23YA7 Regulation 15 13(6) 20(3) Requirement Timescale for action 01/04/07 3 4 YA17 YA20 16(2)(j) 13(2)(4) Care plans must be signed by all people involved in the agreeing and reviewing of these The system for the management 15/03/07 of residents’ personal monies must be further developed to include: • residents’ monthly invoices for accommodation and transport fees must clearly identify the breakdown of costs • regular auditing/monitoring of residents’ finances must be undertaken by an independent source • individual inventories of residents’ personal belongings must be kept up to date All opened foods must be stored 15/02/07 appropriately The management of medication 15/02/07 must be further developed to include: • All medication must be stored securely at all times • Medication no longer DS0000016731.V289084.R01.S.doc Version 5.1 Natalie House Page 32 5 YA19 6 7 YA19 YA29YA27 required must be clearly identified on the medication administration charts as discontinued • Liquid medication must be dated on opening • Drug audits must be undertaken regularly • A policy must be written about the administration of non prescription medicines 12(1) Health plans must identify the 15 point at which further medical advice must be sought if there is no improvement in the treatment of a medical condition 15 Health plans must be written for any short term health concerns 12(4)(a) The bathing support needs of 13(5) each person in the Home should be reviewed, and a report 23(2)(j)(n) submitted to CSCI (previous time scales of 02/06/05 and 31/01/06 not met) An assisted bathing facility must be available that meets the needs of residents living at the Home. This must be fit for purpose and uphold the dignity of residents. An action plan must be submitted to CSCI by: 50 of care staff must have achieved a minimum of NVQ level 2 in care Adequate staffing levels must be maintained during weekends References must be sought from the last or most recent employer for all prospective staff members prior to commencing employment at the Home The Organisation must make the DS0000016731.V289084.R01.S.doc 28/02/07 15/02/07 15/04/07 8 9 10 YA32 YA32 YA34 18(1) 18(1) 19(1) 30/06/07 15/02/07 15/02/07 11 YA39 24(2) 01/07/07 Page 33 Natalie House Version 5.1 report of the findings of any monitoring activity (quality assurance) available to interested parties 12 13 YA42 YA42 18(1) 18(1) (timescale of 28/02/06 not met) All staff must undertake refresher training about moving and handling All remaining staff that have not already done so must undertake refresher training about first aid, infection control and health and safety The transfer hoist must be serviced and checked for safety The temperature of the hot water to the hand wash basin in the kitchen must be reduced to be within safe limits Accident records must be audited and must include detail of any action taken or outcomes following accidents involving residents. 15/03/07 15/03/07 14 15 YA42 YA42 23(2)(c ) 13(4) 15/02/07 15/02/07 16 YA42 12(1) 13(4) 28/02/07 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 2 3 4 5 Refer to Standard YA9 YA17 YA19 YA20 YA32 Good Practice Recommendations Staff should undertake training about risk assessment processes A review should be undertaken about the raised height of the dining table to ensure that all residents can use it comfortably The written record of weekly Physiotherapy input for a resident should include detail of the care given, any progress made and the reason for the visit A review of the use of the current “cassette” style medication system should be undertaken The staffing rota format should be amended to identify the actual hours worked by each staff member DS0000016731.V289084.R01.S.doc Version 5.1 Page 34 Natalie House 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. 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