Inspection on 05/12/07 for Natalie House

This inspection was carried out on 5th December 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 6 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 17/01/07

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.

CARE HOME ADULTS 18-65 Natalie House 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG Lead Inspector Kerry Coulter Key Unannounced Inspection 5 & 6th December 2007 10:00 th Natalie House DS0000016731.V352581.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 Natalie House DS0000016731.V352581.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. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 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.V352581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 17th January 2007 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 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 within the Home. A copy of the most recent CSCI inspection report is available in the Home on request. The service users guide did not include the fees charged to people who live there. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over one and a half days; the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home have communication difficulties and were unable to give their opinions on the care and support they receive. Four surveys were received from staff and three were received from relatives, their views are included in this report. What the service does well: Staff treat each person as an individual and talk to people in a way that shows they respect them. Staff support people to make decisions about their day-to-day lives by spending time observing their gestures, facial expressions and their non-verbal communication. The food is nice and people have a healthy diet with lots of fruit and vegetables. People are involved in food shopping trips so that they participate in the weekly menu planning. People are encouraged and supported to maintain relationships with their families. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 6 The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. Each person living there has their own bedroom. These include their personal things. The home is clean and well decorated so it is a nice place to live. Staff turnover is low and this ensures continuity of care for people. Staff have a good understanding of people’s needs. 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? The home has started to complete new health action plans for people. This will help to ensure people receive the health care they need to stay healthy. An up to date list of people’s belongings is now maintained so that staff can track if anything has gone missing and people’s property is looked after. Some rooms had been redecorated or had new carpets so that the home is more comfortable and homely for the people who live there. The height of the dining table has been reviewed to make sure it is comfortable for people at the home. An Occupational Therapist has completed an assessment of the bathing needs of people at the home. Staff have received more training so they know how to meet the needs of people at the home. The transfer hoist has been serviced and checked for safety to make sure it is safe to use. Water temperatures are at safe levels so they are not too hot or cold and people are not at risk of being scalded. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 8 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. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 9 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.V352581.R01.S.doc Version 5.2 Page 10 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 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users generally have the information they need to make a choice as to whether or not they want to live at the home. Before people move in their needs are assessed so they know that their needs can be met there and they can visit the home so they know what it is like to live there. EVIDENCE: People who live at the home have their own copy of the Statement of Purpose and Service User Guide. These documents generally include all the relevant and required information with the exception of the range of fees that are charged for people to live at the home, to include transport charges. The information is in a standard written format. The AQAA completed by the Manager says that it is intended to update the Service User Guide to include pictures. This will make the guide easier to understand so that people who are considering moving to the home will have all the information they need to make a decision about moving there. There had not been any new admissions to the Home since 2003. The Statement of Purpose details a satisfactory assessment and admissions procedure. At the last key inspection in January 2007 the process was looked at for the last person who moved into the home. It was found that they were Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 11 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 individual care needs were undertaken to ensure that these could be met whilst living at the Home. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans generally detail the support that people need but improvement is needed to how plans are reviewed to ensure that staff give support in the way people prefer and need. People are given choices in their day-to day lives and are supported to make decisions. Risk assessments need minor development to ensure that risks to people are managed in a safe and responsible manner and that staff have enough information to manage these risks. EVIDENCE: Two records of the people who live there were looked at. These included an individual care plan that detailed how staff are to support the individual to meet their needs and achieve their goals. They included how staff are to support the person with their daily living skills, during the night, their activities, personal care, communication, and health needs. All plans were generally up to date but for some areas of care there was more than one plan in the file and some information was contradictory. It was also difficult to locate the most up to date plan as old information had not been removed from Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 13 the file and archived. Plans were signed as regularly reviewed but there was no record of the evaluation process that had been used to decide if the plans needed to be updated or stay the same. During the course of the visit, it was possible to observe members of staff supporting people to make choices about what they wanted to do. Sometimes this was limited because of people’s communication support needs and learning disabilities. Staff were observed assisting people to make a choice wherever possible, for example people chose what meal they wanted by being shown several foods and pointing at the one they wanted. Picture aids had also been produced in order for people to express their preferences in respect of the food that they would like to eat and activities that they would like to participate in. Records sampled included individual risk assessments. These stated how staff are to support the person to minimize risks from things such as falling out of bed, having bed rails, hot water, having hydrotherapy, using the mini bus, hot radiators and being transferred from their wheelchair. The majority of assessments sampled were up to date and satisfactory in content. It was good that where incidents had occurred a new risk assessment had been completed, for example it was suspected that one person may have been hurt by tripping over a rocking chair in their bedroom so a new risk assessment had been completed. Improvements were needed to some risk assessments. Some assessments had been reviewed in the last six months but the information within them was not current. For example one person had a risk assessment about the possibility of them hurting their knees on the dining table. The assessment had not been updated to reflect that this individual now had their own table. One person had an assessment about the risk of having pressure sores. Whilst the assessment was up to date the information within it was inaccurate and the person may be at a higher risk of pressure sores than the outcome of the assessment suggests. As with care plans, the risk assessments were signed as regularly reviewed but there was no record of the evaluation process that had been used to decide if they needed to be updated or stay the same. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. People are offered a varied and healthy diet so ensuring their health and well being. EVIDENCE: People who live at the home participate in a range of activities based on their interests and abilities including aromatherapy, hydrotherapy, horse riding, shopping trips, meals out, a light sensory room and discos. People are also encouraged to participate in house hold tasks and cooking with the full support of staff. It is good that a separate individual activity programme is devised for each person based on their individual interests and abilities. The home have day care workers, whose main role is to provide activities for people, discussion with the Manager indicates she hopes to increase the number of day care workers as some days can be very busy such as the day some people go horse riding. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 15 Natalie House has a minibus and designated drivers to ensure that people have the opportunity to participate in activities outside of the Home. Discussion with staff and the Manager indicates that one of the drivers is due to leave the home soon. This will leave the home short of drivers. Arrangements will need to be made to ensure there are enough drivers on duty as people at the home pay a monthly fee towards the use of the minibus. During the summer months people went out on trips such as the safari park, garden centre and the countryside. Recently people had been supported by staff to go and see the Christmas lights. At the last inspection it was identified that people had not had the opportunity to go on holiday due to staff shortages. The Manager had hoped that a holiday would be arranged this year for those that wanted to go. Unfortunately people have not had the opportunity to go. The Manager said this was because there were no staff who had volunteered to go with them, due to their own family commitments. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and benefit from different experiences. Records showed and staff said that people are supported to keep in contact with their family and friends where appropriate. This is through visits and telephone calls. Records show that everyone who is important to people is welcome to visit, this includes the dog of one person’s family. Staff also support people to buy presents and cards for their relatives at special times such as birthdays. One person has parents who do not visit often due their health. It is good that in conjunction with the Occupational Therapist the home is considering how contact can be maintained, consideration is currently being given to using the internet and a web cam to maintain contact. One relative commented that they are always made very welcome when they visit. There were no rigid rules or routines observed at Natalie House and it was evident that the staff encouraged people to choose how they spent their day, within the limitations of their disabilities and this ensures that their individuality is maintained. Menus sampled showed that people living there are offered a variety of food that includes fresh fruit and vegetables to ensure their diet is healthy. People are offered a choice of main meal each day and a “take away” meal is purchased on a Friday evening. Lunchtime practice was observed on the first day of the inspection. People went into the kitchen with staff to choose what food they wanted. Meals were liquidised for one person living at the Home who has swallowing difficulties. The people living there go with staff to shop for their food and are involved in preparing meals. As recommended from the last inspection a review has been undertaken about the height of the dining table to ensure that all people can use it comfortably. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally people’s health care needs are recognised and responded to ensuring that their health is promoted. The management of the medication needs to improve to ensure that people get the medication they need so ensuring their health needs are met. EVIDENCE: Personal support care plans included good detail of the specific support required by people to meet their individual care needs. The people living there had individual styles of hair and dress. This was appropriate to their age, gender, the weather and the activities they were doing. Records show that people are involved in shopping for their own toiletries and are supported to go to the hairdressers. Females who live at the home often have their nails painted by staff and staff have arranged for a beautician to visit the home regularly. Staff were observed supporting people in a respectful manner. Health plans were written for any health concerns that individuals may have and these included some good information about the nature of the health concern and the support required from staff in order to manage and monitor the particular condition. Unfortunately, as with the care plans in general there Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 17 was often more than one plan and old information had not been archived. This made it difficult to establish if the most up to date information was being looked at. One person 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. This person had a seizure on the second day of the inspection and staff responded appropriately by spending time with the person until they were fully recovered. People had access to a range of social and health care professionals including speech and language therapy, occupational therapy, general practitioners (GP), district nurses, optician and dentists. The Home employs a Physiotherapist who usually works an hour each week with one person living at the Home. Some improvement was needed to the frequency of weight monitoring for individuals to ensure their health and well being. One person had been discharged from the weight clinic in August as the clinic were happy for staff at the home to monitor the persons weight. However there was no record of this being done since the person was discharged. Another person is supposed to attend the clinic as they are above their ideal weight, their records show they last went to the clinic in August. It was unclear from their health plans how often they are supposed to be weighed. The Manager acknowledged that the system for planning and recording people’s healthcare needed to improve. The Manager said that a new health action plan format had been obtained from the community nurse. The Home was seen to have recently started to complete this document for one person. Medication is stored in a locked cabinet. All staff responsible for the administration of medication had undertaken training about the safe management of this in order to safeguard people. The home retains copies of prescriptions so that staff can check the correct medication has been received from the chemist. Records show that the medication people need is regularly reviewed with their GP. The home has its own systems in place for checking that medication is being given safely, a weekly audit is done that covers medication stock, administration records, expiry dates of medication and cleanliness of the cabinet. The audits did not identify any issues but some issues were seen to need improvement at this inspection. For one person their care plan regarding constipation directed staff to give ‘as required’ medication if the person had not had their bowels opened for two days whilst another plan directed staff to give ‘as required’ medication after three days. Records showed that the person had in fact gone six days before Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 18 ‘as required’ medication was given. Protocols for ‘as required’ medication were generally in place, however there was not one for one person who was prescribed medication for constipation. The Manager said she would ensure this was done. It is recommended that the agreement of the GP is obtained for the protocols. One member of staff was observed to dispense lunchtime medication, they did not refer to the medication administration chart when dispensing, and only looked at the chart when they came back to sign the chart after having administered the medication. This is an unsafe practice, the chart needs to be checked before medication is given to make sure the person is getting the right medication. It was identified at the last inspection that medication that had been discontinued remained on the medication administration chart (although it hadn’t been administered). It was observed at this visit that some discontinued medication remained on the chart. The Manager said that there had been delays in the pharmacist removing it from the chart and this had now been done for the most recent chart. The Manager was advised that where discontinued medication remained on the chart it needed to be recorded clearly on the chart the medication is discontinued. This will help to make sure people are not given medication that is no longer prescribed. Some medication administration records had gaps where medication had not been signed for, sometimes a ‘code’ had been recorded where the medication had not been given. Unfortunately on one chart it was not recorded for a two weeks period what the code actually meant. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 19 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate complaints procedures are in place so that people feel listened to. General practice promotes the protection of people from abuse, but one incident was not managed in line with adult protection procedures. 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 home has a complaints procedure, this was observed to be on display in the office. It was brought to the attention of the Manager that visitors to the home may not have easy access to the procedure in the office. The Manager took action and the procedure was moved to the main hallway. Surveys received from relatives indicate they are aware of the home’s complaint procedure. The people living at Natalie House have communication support needs, and a formal complaints procedure has little relevance for them. They are reliant on the vigilance of relatives or staff members who know them well to interpret changes in demeanour, behaviour or body language, to alert them to the fact that something is amiss. However, it is good that the Manager is intending to review the current format of the complaints procedure to try and make it more accessible to people. Staff have completed training in the protection of vulnerable adults and policies and procedures to include whistle blowing are readily available to them. Two Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 20 staff questioned on what they considered to be abuse and what they would do if they suspected abuse were able to give satisfactory answers. A few days before the inspection a bruise was noticed below the eye of one person living at the home. The Manager said that the cause of the bruise was unknown but there was a possibility the person had tripped over a rocking chair in their bedroom. As required under the Care Home Regulations the Manager sent a notification to the Commission as soon as possible after the bruise was observed. The homes accident book was also completed. As the cause of the bruise was not known the Manager also arranged for the person to go to the GP. Discussion with the Manager shows that the person’s social worker or duty social worker were not informed. This should have been done so they could make a decision about if the incident needed looking at under adult protection procedures. The Manager accepted this should have been done and the incident was notified to a social worker during the inspection. The Manager was aware of the new Mental Capacity Act but has yet to complete training on this subject. This Act provides a statutory framework to empower and protect vulnerable people who may not be able to make their own decisions. An up to date inventory of people’s belongings is now maintained, as required at the last inspection, so that staff can track if anything has gone missing and people’s property is looked after. The Manager is the appointed agent for four people living at the Home and this had been a longstanding arrangement. As required at the last inspection the safeguards for this has been increased and another member of staff completes an audit of the records. People’s finances are sometimes checked by the Service Manager as part of their monthly visits to the home. Safeguards would be further increased if a full and detailed audit of monies was undertaken by the Service Manager or a person external to the home. A secure facility for the safekeeping of small amounts of individual’s money was provided at the Home. A sample check of two people’s financial records was undertaken. Receipts and items were available to verify expenditure. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 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 people living at the Home. People 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 people living there. It was warm, clean, free from unpleasant odours, well decorated and furnished throughout in a homely style. People’s bedrooms were in good decorative order in an appropriate style to reflect the gender, age, culture and interests of the individual. Some people’s families had been involved in the choices made regarding this. Bedrooms contained personal possessions, ornaments, televisions and DVD players so that they felt comfortable. All bedrooms were for single occupancy and had an en suite toilet and hand basin facility. Although for one person, the shower in their en-suite bathroom is not accessible to them. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 22 The home has a lounge and separate dining room, both were decorated to a good standard. The Manager said that it was planned to fit a new carpet in the dining room as the current one was a little worn. New seating is also to be purchased for the lounge. A new carpet was recently fitted in the hallway. Unfortunately this has already been damaged by what appears to be cleaning products. The Manager said that arrangements were being made for the damaged section of carpet to be replaced. 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 people living there. This has been identified in previous inspection reports. There is one communal bath. The bath has previously been identified as a health and safety risk to staff as the bath is positioned at a low fixed height so staff have to bend down to support people 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. The last inspection report identified that due to a physical disability, there was no facility for one person to get undressed and dressed in the bathroom and therefore they were transported to and from the bathroom and bedroom wrapped in towels. This does not uphold their dignity but staff do all that they can to ensure that this is carried out sensitively. One person has a medical condition concerning the spine and would not be able to use a normal bath seat therefore specialist advice was required. The Physiotherapist employed by the Organisation advised that the transfer hoist be used by staff to assist the two people in and out of the bath and the staff team had been carrying out these instructions so that the identified individuals were able to have a bath. The inspector required that 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 people whilst they are in the bath and the lack of dignity for people are still present. Discussion with the Manager indicates that an assessment of the bathing facilities by an Occupational Therapist has now been completed, however the Manager was unable to locate the assessment during the visit. The Manager agreed to send a copy of the assessment to the Commission. The Manager provided evidence that quotes to install a new bath and ceiling hoist tracking system had been obtained. These were dated April, but a date for the work to begin has yet to be confirmed. The AQAA completed by the Manager said the bath would be replaced within the next twelve months. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are generally competent and have access to a good range of training opportunities to help them meet the needs of people at the home. People are not always supported and protected by the organisations recruitment processes. EVIDENCE: Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. One relative commented that they ‘have nothing but praise and admiration for the people who care for my son’, another relative said ‘‘care and concern shown by all staff is exemplary’. It is good that since the last inspection five staff have completed the Learning Disability Awards Framework (LDAF). To ensure people are supported by a fully qualified staff team at least 50 of staff need to achieve an NVQ in care, currently only three of the sixteen staff have completed an NVQ. Discussion with the Manager indicates that they are the only NVQ assessor in the home for seven staff who are undertaking this. This means that if no other Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 24 arrangements are made for assessing staff then progress towards 50 of staff having an NVQ will be slow as the Manager does not have the capacity to assess everyone. The management team work in addition to the care staff on duty and provide support and advice as required including an “on call” system. The home does not use agency staff and instead uses bank staff or staff work extra hours to cover any gaps. Two staff members are on duty overnight and this appears satisfactory to meet the needs of people living at the home. Discussion with staff and observation of rota’s shows that there are usually three staff on duty at peak times in the mornings, daytime and up until 7-30pm, Monday to Friday. Three staff are usually needed on duty to support people safely and to enable community activities to take place. At the last inspection a requirement was made to maintain staffing levels at weekends. Discussion with staff and observation of the rota indicates that staffing levels at weekends has improved and there is usually a third member of staff on duty 50 of the time. Some staff felt that staffing levels still needed to improve at weekends. The recruitment records for three members of staff were looked at. For two members of staff robust procedures had been followed to include obtaining written references and a criminal record bureau (CRB) check. The home had a new member of staff who had worked at the home for a few days. A senior member of staff stated that the full CRB check had yet to be received but that a Pova First check had been done. (This is a check to make sure people are not on the list that bars them from working with vulnerable people). The senior said that until the CRB check had been received the staff would not be working unsupervised with people at the home. The rota highlighted that this was the case and a risk assessment had been completed. The recruitment records for the new member of staff included an application form and written references. The Pova First check was not evident. The Manager said she had been told by the Service Manager that this check had been received at headquarters and had been posted to the home. This arrived during the inspection. On examination it was revealed that a Pova had been unable to be done as a full CRB application had not been received. The Manager confirmed with head quarters that no POVA First check had been received then sent the new staff home. The Manager said the member of staff would not return to work until the check had been received. Whilst it appears the Manager genuinely believed a Pova check had been done the procedures followed did not safeguard people at the home from the risk of unsuitable people working with them. The Manager should have had sight of the checks completed before the new staff commenced work in the home. The organisation has a good record of providing training opportunities for staff via a rolling programme and the home has an annual training plan. Staff who returned surveys said they were happy with the training provided. Training records show that most of the staff have had training in adult protection, food Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 25 hygiene, health and safety, first aid, epilepsy and manual handling. Several staff have recently attended a healthy eating course. One person who lives at the home is currently undergoing tests to see if they have dementia. It is good that training for staff in dementia has been arranged for December. Checking of files and discussion with the Manager indicates that she has fallen behind with doing staff supervisions. Staff need to have regular supervision so that they receive the support they need to carry out the job. Staff meetings are held but they are not always regular. They should happen at least every two months so that staff know about the changing needs of the people who live there and are kept up-to-date with best practice. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. General practice promotes people’s health safety and welfare, but some issues need attention to ensure this. EVIDENCE: The Manager completed the annual assessment (AQAA) for the home prior to the inspection taking place. The content did not always reflect what was actually happening in home, for example it said supervisions were regular and people are weighed regularly when this was not the case. Whilst the Manager was professional throughout the visit and observed to have a very caring attitude towards people at the home an issue of poor practice had occurred regarding the recruitment of a new member of staff who had not had the appropriate checks. It is the Manager’s responsibility to make sure robust recruitment procedures are followed. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 27 The Manager had been in post for over five years and had an excellent knowledge of the individual care needs of the people living at the Home. Discussion with the Manager indicates she is undertaking the Registered Manager’s Award. The Manager presents as an approachable individual and appears to have a good working relationship with the staff team. One staff commented ‘approachable and caring manager who is dedicated to the service users’. Surveys received from relatives indicated they were happy with the management of the home, one commented ‘managers are always ready to listen’. Quality assurance systems are in place. The Service Manager visits the home and writes a report of their visit as required under Regulation 26 to ensure the home is being well managed. Reports provided showed these visits are generally done monthly, however some reports for earlier in the year were not available. Service satisfaction questionnaires have previously been distributed to peoples’ relatives in order for them to put their views across about the Home. Recent reports from the Service Manager indicate this has not yet been done for this year despite it being an action needed on several reports. Audits are completed every year, performed by one of the other home managers. In addition to providing a separate assessment of the quality of the service, this provides managers with a good learning opportunity by directly observing practice elsewhere. Where issues that need improving had been identified a plan was seen to be in place to address the issues however some issues still needed to be addressed to include staff supervisions and holidays for people at the home. Quality assurance would be further improved if the information from the audits was used to develop an annual development plan for the home. This is something that the home intends to do, as indicated on their AQAA form. The home has some other audits in place that look at the medication system and the premises. A number of checks are undertaken regularly by the home to make sure that the health and safety of people living there is maintained. A number of these were sampled. The temperature of the water is monitored weekly to ensure it will not pose a risk of scalding to people. Systems are in place to monitor the temperature of the fridge, but these records showed that food is not always stored at safe temperatures to reduce the risk of food poisoning. Certificates were available to show the regular servicing of the hoist and gas installations. Staff regularly test the fire equipment to make sure it is working and fire drills are conducted regularly. An engineer regularly services the fire equipment to ensure it is well maintained. Records show that staff have had fire training so they know what to do in the event of a fire occurring. One staff questioned knew what to do in the event of someone at the home refusing to evacuate if the fire alarms sounded. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 28 As stated earlier in this report there have been previous concerns raised about possible risks to staff when assisting people to use the home’s bath due to its low height and the support needed to assist people to bathe. Discussion with the Manager indicates that a risk assessment has not been completed regarding this. Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 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 CHOICE OF HOME Standard No Score 1 2 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 X 26 3 27 1 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 2 X X 2 X Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 30 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 YA20 Regulation 13(2)(4) Requirement The management of medication must be further developed so that people receive the medication they need safely, to include: Medication no longer required must be clearly identified on the medication administration charts as discontinued. (Previous requirement not met from 15/02/07). Staff must refer to the medication chart before administering medication. Written protocols must be in place so that staff know when to administer PRN ‘as required’ medication. Ensure staff sign the medication administration record after medication has been administered or indicate using the appropriate code why medication has not been given. Ensure the Social Services are notified of any potential adult DS0000016731.V352581.R01.S.doc Timescale for action 30/01/08 2 YA23 13(6) 05/01/08 Natalie House Version 5.2 Page 31 3 YA27 23(2)(j)(n) 4 YA27 23(2)(j)(n) 5 YA32 18(1) 6 YA34 19(1) protection incidents to ensure people are being protected from the risk of abuse. Copy of the Occupational Therapist’s report regarding the bath is to be forwarded to the Commission. An assisted bathing facility must be available that meets the needs of people living at the Home. This must be fit for purpose and uphold people’s dignity. Staffing levels must be maintained during weekends to ensure the needs of people living at the home are met. (Previous requirement not met from 15/02/07). Operate a thorough recruitment procedure to include obtaining a POVA check for all staff before they commence work in the home. 30/01/08 30/06/08 30/01/08 05/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The service users guide should include the fees charged so that people have all the information they need about the home. Proceed with plans to update the Service User Guide to include pictures. This will make the guide easier to understand so that people who are considering moving to the home will have all the information they need to make a decision about moving there. Review the care planning system to ensure there is clear evidence of how plans are evaluated, old plans are DS0000016731.V352581.R01.S.doc Version 5.2 Page 32 2 YA1 3 YA6 Natalie House archived and information in plans is not contradictory. This will ensure staff have easy access to the most up to date information and know what support each person needs. 4 YA9 Complete an audit of risk assessments to ensure information within them is up to date and accurate, this will help staff know what they need to do to help keep people safe. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and benefit from different experiences. Staff need to ensure that people’s weight is regularly monitored. This is to ensure that individual’s health needs are identified and can be met. Written protocols for the administration of PRN ‘as required’ medication should be countersigned by the GP to ensure people receive the medication they need safely. Safeguards would be further increased if a full and detailed audit of people’s monies was undertaken by the Service Manager or a person external to the home. Make arrangements to meet target of 50 of staff team achieving qualification at NVQ level 2 or above. There should be at least six staff meetings each year to ensure that staff are kept updated with changing needs of the people who live there and ‘best practice’. Ensure staff receive supervision at least six times per year to ensure that they are supported to meet the needs of the people living in the home. Produce an up to date annual development plan for the home as part of an effective quality assurance system Ensure the fridge is maintained at a safe temperature so that people are not put at risk of food poisoning. A full risk assessment needs to be completed regarding the risks to staff when assisting people at the home to use the low bath. 5 YA14 6 YA19 7 YA20 8 YA23 9 10 YA32 YA36 11 YA36 12 13 14 YA39 YA42 YA42 Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Natalie House DS0000016731.V352581.R01.S.doc Version 5.2 Page 34 - 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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